Botulinum Toxin (Botox) Injections
Information and Guidance
Botulinum toxin (commonly known as Botox) is sometimes used as part of the overall management of Erb’s palsy to help address muscle imbalance. It works by temporarily relaxing overactive muscles, which may allow improved balance between muscle groups and support more effective use of the arm.
The aim of Botox treatment is not to repair nerve damage, but rather to create a window of opportunity during which movement, posture, and function may improve. For some children, this period of muscle relaxation can support progress in how the arm is used in everyday activities.
Botox is typically considered as part of a wider care plan and is often used alongside physiotherapy and, where appropriate, occupational therapy. Any decision to proceed with Botox is made carefully, based on individual assessment and clinical judgement, and following discussion with the medical team.
Physiotherapy and rehabilitation
Physiotherapy plays an important role following Botox injections. When muscles are temporarily relaxed, therapy may focus on:
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Supporting improved movement patterns
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Encouraging more balanced use of the arm
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Maintaining joint flexibility and function
An individual post‑injection plan is usually provided by the clinical specialist physiotherapist and/or occupational therapist, tailored to the child’s specific needs.
After the procedure
Most children can:
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Go home on the same day
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Resume normal daily activities shortly afterwards
Follow‑up with the medical and therapy team is commonly arranged several weeks later to review progress and functional change.
Possible effects and side effects
Botox is widely used in paediatric care and is generally considered safe when administered by experienced clinicians.
Some children may experience short‑term effects such as:
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Mild discomfort at the injection site
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Temporary soreness or bruising
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Short‑lived weakness in the injected muscle
More general side effects are uncommon, and serious side effects are rare. Families are advised to contact their medical team if they notice symptoms that are unexpected or concerning.
FREQUENTLY ASKED QUESTIONS
Does Botox cure Erb’s palsy?
No. Botox does not repair nerve injury and is not a cure for Erb's palsy. It is used to help with muscle balance and movement, with the aim of improving functional use of the arm during a temporary period of muscle relaxation.
How long do the effects last?
The effects of Botox usually begin within a few days, with maximum effect seen after a couple of weeks. The benefit typically lasts several months, after which muscle activity gradually returns to its previous level.
Will more than one injection be needed?
Some children benefit from a single treatment, while others may be offered further injections if the clinical team believes there is potential for additional benefit. This is assessed on an individual basis.
Is Botox painful?
The injection itself may cause brief discomfort. Some children experience temporary soreness or minor bruising afterwards. The medical team will discuss comfort measures and, where appropriate, anaesthetic options in advance.
What should prompt medical advice after Botox?
You should contact your medical team if you notice:
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Unexpected or significant weakness
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Difficulty swallowing or breathing
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Severe pain, swelling, or any symptoms that cause concern
Who can I speak to if I have questions?
If you have questions about Botox treatment or what to expect afterwards, you can speak with:
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The brachial plexus clinical specialist physiotherapist
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The occupational therapist or medical team involved in care
They can provide guidance specific to your situation and address individual concerns.
