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Botulinum toxin for spasticity

What is botulinum toxin?

Botulinum toxin is a purified form of the same toxin that may be in improperly canned foods. It is prepared for several uses and is used safely in children. Botox® is the brand name for botulinum toxin type A.

One use of botulinum toxin is injections (shots) for treatment of localized spasticity. Botulinum toxin works by blocking the chemical messages between the nerve and the muscle. The doctor will decide which muscle groups to treat and the number of injections your child will need.

Botulinum toxin will not work right after the injection. It takes several days to work, with the greatest effect seen in 3 to 4 weeks. The effects of botulinum toxin last an average of 3 months.

How is botulinum toxin given?

Botulinum toxin injections are given into the affected muscle. If the muscle is large, several shots will be given into the same muscle to allow the medicine to be evenly distributed.

The injection is somewhat painful for a while because it is given into the muscle. To make the needle pokes less painful, the doctor will apply an anesthetic cream to the skin areas ½ hr before the injections. (See the education sheet "Anesthetic cream.") Your child will still feel some discomfort, such as pressure or a stinging feeling during the injections.

A sedative medicine is usually given to children to help them relax for the procedure. The medicine causes children to become drowsy and will help them to forget the discomfort. The doctor will discuss the use of sedation medicine with you before the procedure. (See the education sheets, "Sedation for a procedure," and/or "Nitrous oxide for sedation."

What are the side effects?

Botulinum toxin causes few side effects. Less than 5 percent of children who receive it may have a fever between 101° F and
103° F. Fever is not an indication of whether or not botulinum toxin will work.

Some children may have less energy for a few days after the procedure. Some children may have a short-term decrease in function if they were using their spasticity to support themselves.

Rarely, a child could have gagging, choking, or trouble swallowing. If this happens, call the doctor right away.

What happens after the injections are done?

If sedation was used, your child will need to be observed for a short time after the procedure. The nurse will give you instructions for caring for your child.

Your child should not do any strong stretching of the muscle for 72 hours after receiving the injections. The doctor will give you instructions for activity restrictions.

For a few days, your child may feel discomfort in the affected muscles. If so, check with your doctor about giving a pain-relieving medicine to increase comfort.

When should I call for help?

Call your doctor if:

  • trouble swallowing
  • choking or gagging
  • trouble breathing – call 911


This sheet is not specific to your child, but provides general information. If you have any questions, please call the doctor or: _______________________________________.


Children's Hospitals and Clinics of Minnesota
Patient/Family Education
2525 Chicago Avenue South
Minneapolis, MN 55404
Last reviewed 8/2015 ©Copyright

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Minnesota Family Resource Center library, or visit

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