Use of bitulinum toxin in children

Botulinum toxin (BOTOX) is used in the treatment of spasticity in children.Doses of up to 29 units per kilogram has been used in some studies.Body weight,muscle size,location of muscle and degree of spasticity has to be considered in selecting the dosages.However there are no studies to indicate how much dose should be used to saturate neuromuscular junction is unknown.botox when injected will diffuse into the muscle and block the nearby neuromuscular junction.This causes defective acetylcholine release.increasing the amount of saline used for dilution increase the diffusion.Local anaesthetic may be required before injecting botox in children.