In response to the COVID-19 pandemic, ErinoakKids has made changes to our operations. Please click here for the latest information.
arrow_back close

Botox Clinic

Referral Criteria: Botox clinic evaluates children for the treatment of spasticity caused by cerebral palsy and similar disorders such as acquired brain or spinal injuries. Through the use of Botulinum A (Botox®) the goal of Botox® injections is to reduce spasticity and involuntary movements in certain muscle groups to:

  • Promote more normal muscle growth to delay or avoid the need for surgery
  • Improve range of motion to allow comfortable brace wear
  • Improve the client’s functional abilities: walking, standing, sitting and use of upper extremities
  • Improve caregiving activities such as bathing, diapering and dressing
  • Reduce discomfort associated with increased tone 

Clients with late fixed contractures are not appropriate for the Botox clinic; a referral to the Orthopedic Surgeon is advised.

Who Can Refer: Pediatric Physician/Neurologist or Nurse Practitioner (Please include OHIP billing information and all relevant supporting documents)

Who is part of the team: Paediatrician, Registered Nurse, Physiotherapist and Therapy Assistant

What to expect during the visit: To minimize the discomfort a freezing spray will be used to numb the skin prior to injections. You can help distract your child during the procedure.

What to Bring to the Appointment:

  • 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. 

How can I prepare my child prior to the visit:

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.

Sedation Option
At ErinoakKids, we do not offer sedation services. Sedation clinics are offered at Credit Valley Hospital for clients who receive multiple injections. You can speak with the ErinoakKids Physician if you are interested in this option.  

If you are using Assistance for Children with Severe Disabilities (ACSD), OHIP+ or Exceptional Access for your payment, the nurse will send your child’s health card number to the selected pharmacy for payment processing.  

If you are using private insurance, you will be asked to call the pharmacy and provide your insurance information and method of payment as needed. Most private insurance companies require pre-authorization for coverage for Botox. Please contact your insurance provider well in advance to obtain the coverage request forms. 

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

Contacting the Botox Clinic
If you have questions about Botox Clinic, please speak to your Physiotherapist or call your home site and ask to speak to the Pediatric Nurse.

About Botulinum Toxin

Are There Any Side Effects?

Botulinum Toxin was approved by Health Canada in 1999 and has been used safely in treating many children with Cerebral Palsy over the years. However, some patients do experience adverse side 
effects like: 

  • Temporary local weakness 
  • Mild fever within 1-2 days after the injection 
  • Localized pain, bleeding or bruising at the injection site 
  • Temporary incontinence 

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 
Please remember
Your child should seek immediate medical attention if he/she experiences any of the above mentioned systemic side effects.
At What Age Should Children Be Assessed for Treatment with Botulinum Toxin?
Botulinum Toxin is mainly used to treat muscles which relax slowly or incompletely.  Children with “fixed” or permanent muscle shortening usually require a different type of treatment.   However, children with early fixed muscle contractures may benefit from a combination of Botulinum Toxin and bracing or serial casting. 
There is evidence that younger children (2 – 7 years) may benefit more from Botulinum Toxin than other children.  However, older children may also receive some benefit.
Does Botulinum Toxin Always Work?

Most, but not all who are injected with Botulinum Toxin are helped.  However, a small number of children may not benefit from this treatment.  There are a number of possible explanations for a poor response.  Botulinum Toxin may not work because of technical problems with the injections.  This problem is minimized by using ultrasound to locate the right muscles. 
Among adults treated with Botulinum Toxin there have been some who have appear to develop resistance to the toxin.  Some people develop antibodies to the toxin which prevent it from working.  This could also occur in children.  Finally, there are children who fail to respond to Botulinum Toxin for reasons that are not yet understood. 
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.

How does Botulinum Toxin Help Children with Cerebral Palsy?

Some of the symptoms of Cerebral Palsy are due to spasticity, a condition in which certain muscles are continuously contracted. Spastic muscles have difficulty relaxing. 
In order to understand how Botulinum Toxin may help children with Cerebral Palsy, it helps to understand how normal muscles function. When a muscle is active or working, it contracts or shortens; 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 (contractures). 
Over time this may lead to bone and joint deformities. These, in turn, make it harder for children to use their limbs. Part of the treatment for Cerebral Palsy is directed at minimizing the effects of spasticity on muscle function and growth. Physiotherapy, orthotics (braces), serial casting and eventually orthopaedic surgery are all methods used to manage spasticity. When Botulinum Toxin is used to reduce spasticity, 
it is to: 

  • Promote more normal muscle growth 

  • Avoid or postpone the need for surgery 

  • Make it easier for children to wear orthotics or undergo serial casting 

  • Improve children’s functional abilities 

How Does Botulinum Toxin Work?
Botulinum Toxin works by blocking the chemical responsible for sending messages from the nerves to the muscles that makes them move. This causes temporary muscle weakness and at the same time allows the stiff muscle to relax.
How is Botulinum Toxin Given?
Botulinum Toxin is injected into muscles in the arms or legs. Before the injection, a freezing cream* called 
EMLA or Maxilene is applied to the skin over the muscle and left there for about 30 minutes. 
The dose of Botulinum Toxin is calculated on the basis of body weight. 
Note: There may be a small charge for the freezing cream
How Long Does the Effect Last?
The effect of Botulinum Toxin injections generally last for 3 to 4 months.  It may be necessary to repeat injections, however, not within a 3 to 4 month period. Too frequent injections may lead to a decreased effect over the years.   It is important to understand that many children who receive Botulinum Toxin injections may still require orthopaedic surgery at a later date. 
Is There Funding for This Treatment?
The cost of Botulinum Toxin 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. For families whose private insurance does not cover Botox, please speak to the Pediatric Nurse or your Service Navigator as they may be able to assist you with alternate methods of funding. 
What is Botulinum Toxin?
Botulinum Toxin is one of a number of toxins produced by the bacterium Clostridium Botulinum. Small amounts of the purified toxin have been said to be beneficial in the treatment of some medical 
Botulinum Toxin has been approved by Health Canada to treat conditions such as strabismus (squint), blepharospasm (involuntary spasm of the eyelid), spasmodic torticollis (wry neck), excessive sweating and focal spasticity in children with Cerebral Palsy or in adults after a stroke. 
When are the Effects of Botulinum Toxin Injection Seen?
The effects of the injection should be seen within 1 to 2 weeks.  You should notice that it is easier for the injected muscle to relax (e.g. if your child’s calf muscle has been injected it should be easier to carry out heel cord stretching exercises.)