Botox and Cerebral Palsy

Cerebral Palsy Treatments

syringe and vials of botox with little boy receiving physical therapy in background

Using Botox for cerebral palsy offers a way to treat certain aspects of CP without invasive procedures like surgery. Children with CP who receive Botox injections may experience improved movement and decreased spasticity.

What Is Botox Used to Treat?

Botox injections for cerebral palsy offer the possibility of relief from some of the symptoms of spasticity. Botox may be used to treat spasticity in a child’s lower body. Uses could also include injecting Botox into certain muscles at any place in the body if a child is experiencing spasms there.

Botox has been approved to treat several aspects of muscle function. In adults, Botox is approved for treating muscle spasticity and dystonia of the neck (abnormal and repetitive muscle movement that may be debilitating and/or painful).

Though the FDA has not yet approved Botox for treatment of children with lower limb spasticity, your doctor may suggest using Botox for your child. Healthcare providers have the professional discretion to decide if the benefits of a medical invention outweigh potential risks.

Children who receive Botox injections may experience benefits such as:

  • Better range of motion
  • Decreased pain in stiff muscles
  • Greater ease in stretching
  • Improvement in the independent use of upper extremities
  • Improvement in the positioning of joints and limbs
  • Significant improvement in walking gait
  • Reduced spasticity/fewer spastic movements

Botox may also allow your child to tolerate braces better. Treatment may additionally make it possible to delay surgery to correct joint and/or muscle problems until your child is older, potentially reducing the risks associated with surgery.

How Does Botox Work?

Botox is an injectable drug produced using the bacteria botulinum toxin A, which creates a highly toxic substance. If it is ingested, the neurotoxin may be extremely toxic and even deadly. However, botulinum toxin A may be injected locally and in smaller doses for medical and cosmetic purposes.

When used for medical purposes such as treatments for migraines, overactive bladder and other conditions involving the muscles, Botox weakens or completely paralyzes the specific muscles into which it has been injected. Botox may also prevent the firing of certain nerves. The weakening or paralysis effect produced by Botox is not permanent. Botox used in this way may relax muscles and decrease pain.

Your doctor will inject Botox into your child’s affected muscle group. They may suggest certain strategies to cut down on discomfort or anxiety your child could experience, including:

  • Bringing comforting items from home, like a special toy or blanket, or playing music
  • Encouraging parents or other care providers to remain with the child during the injection procedure
  • Using ethyl chloride, a “freezing spray” on the area of the injection
  • Using oral Versed (midazolam), a drug that creates amnesia for the procedure and decreases anxiety

If you request oral Versed, your doctor will take your child’s vital signs before and after the injection and may require additional monitoring. Your child must stay under an adult’s care the full day after they’ve received Versed, and they cannot go to school. You must make sure to bring the G-tube connector if your child has a G-tube, as that will be used for Versed administration.

When it’s time for your doctor to administer the Botox, they will clean the area of the identified muscle groups with alcohol before applying the ethyl chloride. Then, the doctor will administer the Botox using a small needle. The injection takes just a few minutes. The number of injections your child needs to receive may depend on the size of the muscle as well as the total number of muscles identified for injection.

Potential Side Effects

It is not known whether Botox is useful or safe for treating muscle stiffness in lower limbs. There have not been any clinical trials for this use of Botox, and the FDA has not approved Botox for spasticity in children.

It is also possible for the toxin to spread beyond the site of injection and cause botulism symptoms. This may lead to death.

Although Botox is not likely to cause botulism when it is given as a local injection, it does have some other risks. Potential side effects generally go away after a short time. Common side effects that may occur from a Botox injection include:

  • Falling, if the injection is given in the legs (possibility a result of local weakness or a change to ankle position or gait pattern)
  • Localized infection at the injection site
  • Localized pain at the injection site
  • Temporary general weakness
  • Temporary weakness in the extremity where the injection was given

Pain should resolve in a few days. While experiencing localized pain, your child may take a pain reliever such as Tylenol or Motrin and/or use an ice pack at the injection site.


Your child should not receive a Botox injection in certain situations. Botox cannot be administered if your child has:

  • A fever
  • A cough
  • A cold
  • Flu-like symptoms

Botox also cannot be administered if your child received immunizations in the last week, or if they are scheduled to receive immunizations within seven days after the date the Botox is administered. Someone who is pregnant or breastfeeding also should not receive a Botox injection.

Botox may provide therapeutic effects for children living with cerebral palsy. Consult with your doctor to discuss this treatment possibility if your child deals with spasticity.

While Botox may be of therapeutic help to your child, it’s important to also know the source of your child’s CP in the first place. If you suspect that medical negligence contributed to your child’s CP, contact us now at Janet, Janet & Suggs. Our team of dedicated cerebral palsy lawyers can help you determine if you have a case



Claire Surles, RN
Reviewed by:
Claire Surles, RN
Registered Nurse

Claire comes to JJS after a 10-year career as a labor and delivery nurse. She dedicated her hospital efforts to advocating for families, providing the safest birthing environment possible as Newborn Admission Nurse at UMMC St. Joseph Medical Center in Towson, Maryland. Her passion for helping those who experienced losses at any stage of gestation led to her appointment as Coordinator of the hospital’s ROOTS perinatal loss program. READ FULL BIO

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