Botulinium toxin is produced naturally by the bacterium clostridium botulinum.  When purified, it can be used in tiny, controlled doses to relax excessive muscle contraction.

It has been used as a medicine for over 15 years in the UK.  It is used in the treatment of several conditions in children, including cerebral palsy and other neurological causes of muscle stiffness and pain.

How does it work?

When injected into muscles, Botulinium toxin has a local and controlled effect.  It blocks the messages between the nerve endings and muscle fibres around the injection site, causing weakness of the nearby muscle.

Injections usually take effect within a few days, with peak relaxation four to six weeks later, although this can vary from child to child. These chemical effects last for approximately three months.  However, the functional benefits may last for longer, in some cases, up to one year after the injection.

Are there any side effects?

Since Botulinium toxin injections have been routinely used in children, serious adverse events have rarely been reported.  As with all prescription medicines there may be some associated side effects – the team caring for your child will minimise the chance of any of these happening by carefully calculating the correct dose and injection sites for your child.

The most common side effects reported are:

  • Soreness at the injection site
  • The injections cause weakness in the injected muscles and sometimes nearby muscles.  This weakness is temporary but in the short-term may make balance more difficult.
  • Some children complain of mild flu-like symptoms in the days after injections, which may be treated with paracetamol if necessary.

Injection day

You will have been given instruction about the latest time that your child can have eaten, or drunk fluids before the procedure. You and your child will need to come onto Ward 10 to be admitted and seen by the doctor who will be giving the injection, and anaesthetists.  This is the time to ask any questions you may have.

The injections are carried out in the day surgery unit (DaycaseUK) whilst your child is asleep under general anaesthetic; this takes a few minutes only.  Sometimes a plaster cast is applied while the child is under anaesthetic, this will have been discussed with you beforehand.

Parents and carers are welcome to stay with their child whilst the anaesthetic is being given. You can then wait in the waiting room in day surgery and wait for the recovery nurse to call you when your child is awake.

Following the injections, once your child has had something to eat and drink, you will be able to take them home, usually within a couple of hours.

The arrangements for follow up will be discussed with you before your child is discharged.

When you get home

Your child may be sleepier than usual over the next 24 hours.  This is due to the sedation or anaesthetic and your child should soon recover.

Your child may experience pain or discomfort around the injection site.  This should only last for a couple of days and paracetamol is usually enough to make your child feel more comfortable.

Your child may have mood changes, which can make them irritable.  This is temporary and is a result of the anaesthetic or sedation given.

If your child takes any medication regularly, give this as usual.

If your child is unduly sleepy or difficult to rouse, make sure that they are in a safe position on their side and seek further medical support.

If you have any questions or require further information or advice, please contact:

Day surgery unit – 01935 384339

Children’s Ward – 01935 384360

After 7 pm, the Senior Sister on Duty

(Clinical Site Manager) – 01935 384525

Any Medical concerns: –  01935 384540

Ref: 10/21/139

Review: 10/23