ErinoakKids - Botox

Botulinum Toxin Type A (Botox®) is a purified form of Botulinum Toxin which can be safely used in health care. Health Canada has deemed Botox® to be safe for the treatment of upper and lower focal spasticity in children with Cerebral Palsy.

Botox® works by temporarily blocking the chemical responsible for sending messages from the nerves to the muscles that makes them contract and move. This causes temporary muscle weakness and at the same time allows the stiff muscle to relax.

Some of the symptoms of Cerebral Palsy and other neuromotor disorders are due to spasticity. Spastic muscles have difficulty relaxing.
When a ‘normal’ muscle is active or working, it contracts and shortens or lengthens; when it is resting or inactive, it relaxes to its original length. Muscles that are ‘spastic’ do not relax to their full length at rest. Prolonged spasticity leads to permanent muscle shortening often called contractures.
Over time spasticity may lead to bone and joint deformities. These, in turn, make it harder for children to use their limbs functionally. Part of the recommended treatment for Cerebral Palsy is directed at minimizing the effects of spasticity on muscle function and growth.

Botox® can be used to reduce spasticity with goals of:

Promoting more normal muscle growth
Avoiding or postponing the need for surgery
Improving range of motion which can allow for improved comfort when wearing braces or during serial casting
Improving children’s functional abilities
Reducing discomfort and pain associated with spasticity

Physiotherapy, orthotics (braces), serial casting and for some, orthopaedic surgery, are interventions used to manage spasticity and may be paired with Botox® injections.
Evidence shows that the benefits of Botox® are greatest for children 2-7 years old. Older children and teens may still report benefits.

Botulinum Toxin is injected into muscles in the arms or legs. The dose of Botox® is calculated on the basis of body weight and the number of muscles that will be injected. Botox® can also be injected to the muscles in the jaw to reduce teeth grinding and to treat excessive drooling.

Improvement in spasticity is expected within 7 days.

Each child’s response varies. The effects tend to last for 3-6 months but for some it can last up to 12 months. Botox injections most often are recommended every 6 months.

Medicinal ingredient: Onabotulinumtoxin A for injection, a sterile, form of purified botulinum neurotoxin type A complex. Non-medicinal ingredients: Albumin (human) and sodium chloride.
Note: Botox®, the form of Botulinum Toxin used in Canada, contains a small amount of albumin, a derivative of human blood. Therefore, there is a theoretical risk of transmission of viral diseases with this drug. However, no cases of viral transmission have ever been identified.

Some individuals experience side effects after their Botox® injections.

The most common side effects are:

Temporary local weakness
Nausea
Mild fever within 1-2 days after the injection
Localized pain, bleeding or bruising at the injection site
Respiratory infections
Skin rash or itching

Rare, but potentially serious, systemic side effects may occur as early as day one of the injections and as late as several weeks after treatment. These side effects may include:

Allergic reaction or anaphylaxis
Generalized muscle weakness and fatigue
Difficulties in swallowing
Slurred speech
Breathing difficulties
New onset or recurrent seizures (ABBVIE)

Your child should seek immediate medical attention if he/she experiences any of the above mentioned systemic side effects.

You are allergic or sensitive to any of the ingredients
You have an infection where Botox® is injected.

Speak to your physician prior to Botox® injections if your child is taking or is likely to take antibiotics, especially aminoglycoside antibiotics.

Pediatrician, Registered Nurse, Physiotherapist and Therapy Assistant

The Botox Clinic is offered at the Brampton, Mississauga and Oakville sites. Please confirm the location of your appointment prior to the appointment day.

Your child’s Health Card. The Ministry of Health and Long Term Care requires us to validate your health card at every clinic visit.
In order for the team to complete a full assessment, bring your child’s orthotics, wheelchair and walking aids. Older clients may be more comfortable in shorts during the assessment.
Your child’s favorite toy for comfort.
List of current medications and allergies.
Any notes or questions that you may have.
Any other forms related to your child’s care, such as reports from previous assessments, letters, and x-rays.
A list of goals that you and your child would like Botox to address this may include ease with dressing and toileting or wearing orthotics comfortably.

Your child may be asked to complete a series of physical tasks in order to assess their mobility and general level of functioning. Your child’s range of motion will be assessed while lying down on the assessment bed. Your child’s gait will be assessed and a video recording will be obtained for comparison as required.

To determine the injection plan, a physical assessment will need to be completed. Please bring a pair of shorts for your child to ease their comfort during the assessment. If your child wears braces/orthotics on their arms or legs, please bring them for the team to assess. Younger children may want to bring a comfort toy or blanket. Please bring your child’s health card and ensure it is up to date.

The team use a variety of strategies to reduce the discomfort as much as possible during the injection procedure. Topical analgesia is used by either applying freezing spray and/or placing ice packs on the injections sites. Parents/caregivers can assist by providing reassurance and supporting opportunities for distraction during the procedure. The clinic has many toys and treats to help with distraction that clients can choose from. Comfort items from home are always welcome. Clients can also choose to be part of our BEad Brave program, where they receive various beads for their bravery and hard work after Botox.

Botox, injections under oral and IV sedation are offered in partnership with Brampton Civic Hospital (William Osler Health System) and Credit Valley Hospital (Trillium Health Partners). Please speak with your ErinoakKids Botox® team to determine if this is an appropriate option for your child.

The cost of Botox® is covered by OHIP+ in full for families who are qualified for the Assistance for Children with Severe Disabilities (ACSD) program and families who do not have private insurance. If you have private insurance, please contact your provider and request approval forms prior to your child’s injection appointment, these will need to be completed by the physician and sent to your insurance for pre-authorization which can take up to 1 month. For families whose private insurance does not cover Botox®, please speak to the Pediatric Nurse in clinic, they may be able to assist you with alternate methods of funding.

If you have questions about scheduling your child’s appointment, call 905-855-2690 ext. 3. If you have questions about Botox® injections for your child call 905-855-2690 and dial 0 for reception, ask to speak with the nurse at the site where your child receives care.

After your child receives their injections, the team will make post- botox recommendations based on the agreed upon goals. Post-botox recommendations are made to optimize the effects of the botox and are unique to each individual based on needs. These may include:

encouragement to wear orthotics for longer periods
recommendation for serial casting or use of knee immobilizers or hip abduction wedges for sustained stretching
on-going use of mobility equipment i.e. stander, walker, as applicable
completion of a home exercise program
attendance at Physiotherapy program(s) in-centre

Services

What is Botulinum Toxin?

How does Botulinum Toxin work?

How does Botulinum Toxin help children with cerebral palsy?

How is Botox® given?

How soon can you see the effect of Botox®?

How long will the effects of Botox® last?

What are the ingredients in Botox®?

Side Effects

Who should not use Botox®?

Who is part of the team?

Locations

What to bring to the appointment

How can I prepare my child prior to the visit?

What should I bring to the appointment?

Will this be uncomfortable for my child?

Are there options to put my child to sleep during their injections?

Is there funding for this treatment?

Who to contact?

What happens after Botox®?