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Botulinum Toxin-A: considerations after injection fact sheet

Botulinum Toxin-A: considerations after injection

There are a number of things to consider, watch and do in the days and weeks after your child receives Botulinum Toxin (BoNT-A) injection/s.

Common side-effects

In the week following your child’s treatment you may notice:

  • a gradual decrease in the ‘stiffness’ of your child’s arms and/or legs
  • mild pain or subtle bruising around the site of injections in the first day or two—this often settles with paracetamol and is very short-lived.

Other adverse effects are uncommon and temporary. Your doctor will have discussed these with you when your child was booked your child for their injections.

Take note of all changes you notice (positive and negative) after the injections and when they occur. It may be useful to keep a diary.

Report any mild adverse effects to your doctor or therapist at your follow-up appointment.

Urgent concerns

Return to your GP or the hospital immediately if you notice any of the following:

  • difficulty breathing, vocalising or swallowing
  • widespread rash
  • generalised weakness
  • floppiness

Please notify us during work hours so we can record it in your child’s medical record.

Things you can do at home

Once discharged from hospital, your child can engage in their normal, everyday activities.

If your child has a regular home exercise program of stretching (including wearing leg wraps or arm splints), continue this as per your usual regime.

If your child wears any orthoses or splints they should continue using these according to their normal regime. If your child is a bit unsteady on their feet following their injections, they may benefit from wearing their ankle-foot orthoses more frequently.

Post-injection casting and orthoses

  • Your child may need a cast series after their BoNT-A to improve the length of muscles and their ability to function. This will be decided by the doctor and therapist on injecting day.
  • Serial casting is usually started one to three weeks after BoNT-A injections. This is to allow the BoNT-A to become chemically effective within the muscle so that stretching is better tolerated and to promote the improvement of overall muscle length.
  • Splinting the upper limb and wearing orthoses in the lower limb help to maintain adequate joint position and muscle length.
  • For children who are able to walk, orthoses can help to improve their walking pattern. It is important that these are fitting well around the time of BoNT-A. If your child is outgrowing their orthoses, a new one may be recommended.

After BoNT-A therapy

Your child may benefit from a therapy program after their injections. It will involve a stretching and strengthening program and will be targeted around the goals you made before the treatment. Your child’s therapy program will be developed and coordinated by our therapists.

If you live in Brisbane, you will be offered a block of therapy sessions at the Queensland Children’s Hospital.

If you live in a regional or rural area, therapy programs may be coordinated to occur with local therapists in these areas. If your child does not have a therapist, we will help to arrange one for you.

To make the most of the BoNT-A injections, ensure your child follows a regular post-BoNT-A home program during and after their therapy block.

When to begin post-BoNT-A therapy

  • For children requiring casting, begin the post-BoNT-A therapy after the cast series is completed.
  • For children who do not require casting, begin the post-BoNT-A therapy one to two weeks after the injections (this allows time for the BoNT-A to become chemically effective within the muscles).


The duration of your child’s post-BoNT-A therapy will depend on the goals you have set with your doctor and therapists. Some children manage well with home programs only while some children will require additional therapy sessions with their primary therapist. Generally children will receive between three and six weeks of therapy after their BoNT-A injections. This should include a home program to help achieve your goals.

Follow-up appointments

Follow-up appointments are scheduled to occur two to three months after your child’s BoNT-A injections. They may take place at the hospital or over the phone. Your regular therapists are welcome to attend any of your child’s appointments.

At these appointments we will assess your child to evaluate their response to BoNT-A. This may include a review with the doctor and therapists where repeat review of your goals, measurements of spasticity, muscle length and strength, motor control and task analysis will be performed.

Children who can walk may have another video taken of their walking. This will be used to evaluate any effects the BoNT-A and therapy has had on your child’s walking pattern.

After this assessment your child’s doctor and therapists will talk to you about ongoing treatment options.

What to bring:

For any of your follow-up appointments (including therapy sessions):

  • Bring your Medicare card
  • Dress your child in loose clothing that can be pushed up or removed if required (shorts are a good idea).
  • Brings your child’s usual everyday footwear
  • Bring any orthoses, splints or gait walkers your child uses—assessing their function with an orthosis or splint is helpful for making decisions on ongoing treatment.
  • Bring any additional equipment that is easily transportable (e.g. leg wraps, SWASH braces).
  • Ensure you bring along any equipment provided by us that your child is outgrowing or you have problems with so it can be reviewed.

Contact us

Queensland Paediatric Rehabilitation Service
Queensland Children’s Hospital
Level 6, 501 Stanley Street, South Brisbane 4101
t: 07 3068 2950
t: 07 3068 1111 (general enquiries)
f: 07 3068 3909

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

Resource No: FS195. Developed by the Queensland Paediatric Rehabilitation Service, Children’s Health Queensland. Updated: August 2015. All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.