The role of Botulinum Toxin | Hull University Teaching Hospitals NHS Trust

This leaflet has been produced to give you information about your child’s treatment and will hopefully answer some of your questions. It is not intended to replace the discussion between you and your child’s therapist but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please do not hesitate to contact the hospital physiotherapist on telephone number tel: 01482 674532 or your child’s own physiotherapist.

What is Botox®?

Botox® is the trade name for Botulinum Toxin, a protein produced from the bacteria Clostridia. This toxin works by preventing nerve impulses from reaching the muscle, resulting in the relaxation of overactive muscle, such as may be seen in cerebral palsy and other conditions. The effects can be felt 24 to 48 hours after the injections. The peak effect occurs at 2 weeks, and this lasts between 3 to 6 months, although the benefits may last longer.

Once the overactive muscles that are causing the posture and movement difficulties have been identified and injected, your child will require a period of rehabilitation. This will help you / your child to learn how to adopt a better posture or move more appropriately. Botox® is also useful for helping to maintain muscle length during growth spurts.

How is it given?

If you consent to your child having Botox® injection(s), your child will then be placed on a waiting list. Whilst on that list it would be helpful if you could inform the hospital if you book any holidays. You will be contacted once a date becomes available, and your child’s physiotherapist will be informed if you accept that date. Your child will then be offered an appointment to attend the hospital before your child’s injection date in order to meet the nursing staff and / or play therapist who will explain the procedure and learn about your child. The hospital physiotherapist will also contact you before your child comes into hospital and offer your child an appointment to assess your child’s movement and learn about your child’s current physiotherapy programme.

On the day of the injection(s) you and your child will be asked to come to the children’s ward, or day surgery unit, where you will meet the anaesthetist and the surgeon who will be performing the injections. The injections are done in theatre under a light general anaesthetic to ensure you remain still. The surgeon uses a device called a nerve stimulator to check the needle is in the right place and then the injections are given. A sticking plaster will be placed over the injection sites.

On returning from theatre your child will go back to the ward. Your child will be allowed to go home the same day as the injections are given once your child has rested and eaten.

What to expect after the Botox Injection®?

There may be a slight local tenderness or bruise at the site of the injections, but this will not last long. Due to the anaesthetic it is advisable to avoid school and any sporting activity for the rest of the day. Following this, normal activities may be resumed. Studies have shown that moving the injected muscle helps to spread the Botox® within the muscle thereby maximising the effects. We therefore suggest moving about as normal once home after the injections and avoid wearing splints if possible, for the rest of the day.

Adverse events or side effects are rare and may include:

Generalised weakness
Flu like syndrome

Even if the above occur they are temporary and will not last long.

How to get the best results from the injection)s)

Please read the information leaflet. Share the information it contains with your family and friends (if you wish), so that they can provide help and support. There may be information they need to know, especially if they are taking care of your child following this examination.

The hospital physiotherapist will liaise with you and your child’s regular physiotherapist to develop a treatment plan to help you get the best results from the injections.

This may require:

a change to your child’s splints which should be arranged by your community physiotherapist.
the provision of some temporary splints
recommendation of a piece of equipment
attendance to physiotherapy once or twice weekly at the hospital Physiotherapy Department for up to 6 weeks following the injections

It is important that you tell the physiotherapist if you do not think your child will be able to follow the treatment plan. We will also liaise with school / nursery staff if children require changes to existent school management programmes.

School / Nursery

It is advisable that you inform the school / nursery, once your child is put on the waiting list for injections, that time off will be required for the injections and follow up appointments. We do our best to offer appointments at convenient times and will try to avoid particularly difficult times such as exams, provided that you have informed us of these.