Botox injections for your child? While there may be some benefits, there are also a number of risks you need to consider

The more I know, the less I know.

Botox injections become extremely popular in cosmetic and medical use. But what has me worried these days is its increased use in children with hyper tone cerebral palsy. In fact, almost every day in my practice, I hear about another child whose doctor has recommended Botox injections. And I ask myself: Why – what for?

But, let’s just step aside for a moment to analyze the Botox injection itself and its supposed “local effect.” Botox is derived from the botulinum toxin, a neurotoxin that interferes with nerve impulses and causes muscle paralysis – including breathing disorders leading to death – muscle weakness, speech disorders and swallowing problems. Depending on the introduction of the botulinum to the human body, 90 to 270 nanograms of this toxin is enough to kill a person weighing 200 pounds or 90 kilograms.

Botox itself contains a very small dosage of botulinum toxin. Interestingly enough, the American Food and Drug Administration cautioned about the use of Botox in children – a warning it reissued in April 2009. Moreover, the FDA did not approve Botox injections as a treatment for spasticity in children. In a document called Early Communication about an Ongoing Safety Review of Botox and Botox Cosmetic (Botulinum toxin Type A) and Myobloc (Botulinum toxin Type B), the FDA states that it is “aware of the body of literature describing the use of botulinum toxins to treat limb spasticity in children and adults. The safety, efficacy and dosage of botulinum toxins have not been established for the treatment of limb spasticity of cerebral palsy or for use in any condition in children less than 12 years of age.”

The FDA goes on to say that “the pediatric botulism cases occurred in patients less than 16 years old, with reported symptoms ranging from dysphagia to respiratory insufficiency requiring gastric feeding tubes and ventilatory support. Serious outcomes included hospitalization and death. The most commonly reported use of botulinum toxin among these cases was treatment of limb muscle spasticity associated with cerebral palsy.” You can read the FDA’s comments in full at

Yet in Canada, Botox injections have been approved as a treatment for children with hyper tone cerebral palsy and other neurological disorders. As a practitioner, I have read accounts about “the whole world of abilities” which Botox injections have given to one child or another. Personally I have seen quite a few children after they’ve received Botox injections and have not seen any improvements. In some cases, I saw even deterioration.

The spasticity and / or hyper tone come from the central nervous system or the brain. Each child is born with hyper tone, but this tone becomes balanced and normal coordination of movement is built up when the child starts to move his or her head, roll from side to side and develop. The child who does not experience this “normal development” is developing abnormal “hyper or hypo tone.” In other words, this child is in the “evil circle” of inability to move functionally, which in turn leads to hyper or hypo (low) tone.

In my professional and personal opinion, the most important thing is to teach the child all functions all the time. This constant learning will normalize the child’s tone. If there is spasticity, followed by deformation of the joints, then there may be a place for Botox in your child’s treatment program. But keep in mind that there is no such thing as “local injection.” Any agent injected into the body will be absorbed and distributed by the blood throughout the whole body.

So given all this, before you to decide to allow your health practitioner to use Botox on your child, please consider your child’s age and condition and what gains your child stands to make as a result of the injection. And don’t forget that the effects of Botox wear out over time and that your child would need repeat injections at regular intervals.

Most important of all, keep in mind that Botox injection is not a simple, harmless shot. It does pose health risks for your child. The decision is yours, so make it wisely.


About the author

Natan Gendelman has written 274 articles for Enabled Kids.

Natan Gendelman is licensed as a physical therapist in Russia and Israel. After moving to Canada, he was certified as a kinesiologist and osteopathy manual practitioner. Natan has more than 20 years of experience providing rehabilitation and treatment for conditions such as cerebral palsy, autism, Down syndrome, pediatric stroke and acquired brain injury. He is the founder and director of Health in Motion Rehabilitation, a Toronto-based clinic whose main objective is to teach their patients the independence necessary for success in their daily lives.

17 thoughts on “Botox injections for your child? While there may be some benefits, there are also a number of risks you need to consider

  1. I feel it necessary to write a review of this website which I have been a regular visitor of your website for many years. I would gladly recommend this website to someone looking for these kinds of stuff. Thank You!!

  2. Our daughter was diagnosed with CP at 6 months of age. We did Botox treatments at the recommendation of her doctors. She cried and screamed every time – it was horrible. She got 3 shots in each of her calf muscles each time. The doctors made it sound like it was our only option. Her left hip is subluxated and they said the botox would prevent her high tone from pulling her hip fully out of it socket. Neither me nor my husband ever felt good about the Botox. Eventually we stopped doing it. And guess what? Our daughter’s hip is still intact. She is doing just fine without the botox. We are so thankful we stopped poisoning our daughter’s body. Instead we see a chiropractor who has worked wonders! We also pray every day for her health. These two things combined have worked far better than the injecting our daughter with Botox.

    • Thank you so much for your comment! I’m so glad to hear that she’s doing fine :) It’s important to be aware of the risks of Botox treatment and make a good informed decision before putting your child through it!

  3. My 6 year old Grandson has to get Botox Shots, due to having a stroke pre-birth. He is getting older and really fighting everyone when he needs the shots. Do you have any recommendations on how to keep him calm and help prepare him for the shots.

    Thank you

  4. Hi

    I have 3 year old identical twin sons. One has recently been diagnosed with CP. His neuro surgeon has recommended botox as the only solution to assist him to walk flat footed. He currently walks on his toes – even with AFOo’s.

    Is 3 years old too young to consider botox?

  5. I searched on the FDA website and here is the link to a doc
    and here is what it says:
    It is not known whether BOTOX is safe or effective in people younger than:

    x 18 years of age for treatment of urinary incontinence
    x 18 years of age for treatment of chronic migraine
    x 18 years of age for treatment of spasticity
    x 16 years of age for treatment of cervical dystonia
    x 18 years of age for treatment of hyperhidrosis
    x 12 years of age for treatment of strabismus or blepharospasm

    My son, who has mild hemiplegic CP, was sick for 2 weeks when he got botox when he was 3 years old. Now the doctor has prescribed it again though he can walk and run and climb stairs, and I do not know what should I do, I just stumbled upon this page looking for info.

  6. Hi Natan,

    I have a daughter who is now 7 and has walked on her toes from the beginning. She still walks on her toes 99% of the time unless you remind her. We’ve done shoe inserts, AFO’s and also physical therapy to try and help with her hypertonicity. I believe all of it has helped keep her muscles to not become as tight as they could be. She has been labeled on the autism spectrum through the education system but not medically. We, as her parents, believe that the toe-walking may have started off as a sensory issue and has become a terrible habit or… there could be some slight neurological damage that would cause her to do this. That all being said, we have been offered Botox treatments along with casting to help stretch her leg muscles and to help re-train her brain to walk correctly. She’s at an age that we think would be great to straighten things out and that she’d hopefully have normal function of her legs after this treatment. I’ve done research on botox and I’m still getting mixed feelings on it. I want to give my daughter her legs back but I obviously don’t want to harm her in the meantime. Do you think that casting and bracing could work fine without the botox treatments? Our Dr. gave us the option to do the protocol the way we feel most comfortable. I’m trying to get as many educated opinions as possible. If you have any thoughts for us, we would greatly appreciate it. Thank you for your time. :)

    • Hi Julie,

      Thank you for your message. Unfortunately, I don’t know your child’s specific condition and abilities such as what she can and can’t do and where the toe walking came from, so I am unable to provide you with the best possible option. In my opinion, botox should be your last option, if at all. I’m sorry I couldn’t be of more help. Good luck with your decision and let me know if you have any other questions.

      All the best,

      Natan Gendelman

  7. Minha filha tem 3 anos e é portadora de uma PC leve onde ficou com sequela motora mais do lado direito, andou aos 2 anos e pisa com a ponta do pé e vira o pé para dentro… faz fisioterapia desde os 6 meses e agora a Neurologista e o Ortopedista indicou o uso de botox junto com uma ortese para tratamento, acreditando ser um tratamento mais indicado, portanto tenho ouvido varias opiniões sobre o Botox, estou sem saber o que fazer… gostaria de orientação…

    • Hi Silvana,

      Thanks for your question. Your daughter’s leg follows the position of her trunk, meaning that her foot is turning inwards because the hip itself is turned inward.

      To address her condition, my personal opinion is that the health risks and side effects associated with using Botox outweigh the benefits your child may experience. However, every child and condition are different, so be sure to do your research before making your choice final.

      Thanks and good luck,

      Natan Gendelman

  8. Angel, I am a Mom of a child who has recieved Botox – I am also a freelance writer and working on an article about kids & Botox treatments. I liked your comments- would you be willing to be interviewed through email for my article? Please respond here if you are willing and I will send you my email address. Thanks so much.

  9. We waited until our child was 5 before her first Botox experience. Mild CP secondary to strokes in utero and Epilepsy (based in the area of her stroke damage). We also allowed the professionals a local children’s hospital to perform the injections. We read through all quite a bit of the information prior to consenting; basing our decision on our child’s unique situation, and weighing the positive and negative. Hard to make informed decisions when many of the things you read on the internet focus on the negative and not so much on the positive. In life, there are so many “What if’s”…. We decided that this was a treatment we were willing to try for our child. Best to each family along this journey… ultimately, you know what is best for your child!

    • You’re right, it’s important to do your research and weigh the pros and cons before deciding on any treatment. Thanks for sharing Angel!

  10. As a special education teacher I am truly disgusted that nobody did anything about that! I hope that teacher was fired! The child I take care of recieves botox injections and it really helps! Good Luck :)

  11. Thank you for this blogg. My 11 year old son doesn’t have CP but Botox has been suggested for him. We recently found out although written in his IEP he has not been recieveing PT in school and I was unaware of it. Now his his legs have begun to tighten and he complains of pain. My son has NF1 and uses a wheel chair but there is no known medical reason as to why he does not walk. After a visist with a Neuromuscular rehab doctor it is believed that they can get him walking with the use of the botox injections as well as some casting and rigid therapy and they believe that he will only need a 1 time injection. This is something to think about. Thank you.

  12. Hello,I love reading through your blog, I wanted to leave a little comment to support you and wish you a good continuation. Wishing you the best of luck for all your blogging efforts.

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