Article Text

G131(P) How acceptable is Botox without sedation? A second service evaluation of parental/ carer views of using play, distraction, local anaesthesia and Entonox during intramuscular injections of Botulinum Toxin (Botox), without sedation, in children with neurodisability
  1. S Amobi,
  2. V Campbell
  1. Chailey Heritage Clinical Services, Sussex Community Trust, North Chailey, UK


Aim We considered the change in the way Intramuscular injections of Botox are given in our community-based outpatient clinic. Our practice changed from using sedation (midazolam) when a colleague reported older children preferring not to have sedation; use of midazolam ceased after a review of sedation outside of a hospital setting.1,2,3

In a service evaluation in 2011 97% of responders felt the injections were similar or easier than a blood test and 83% did not want to consider using sedation, no parents requesting its use.

This second service evaluation was to see if views had changed, if Entonox was tolerated, if local anaesthetic cream would be better and to consider if a hospital setting enabling sedation was needed.

Method An anonymised postal questionnaire to parents/carers of children who had received Botox over a 12 month period.

Result Twenty-one of seventy-two questionnaires were returned (29%).

19/21 (90%) would not wish to have their child sedated; 2/21 (10%) were not sure.

Comparing the procedure to an immunisation or blood test, carers perception was that Botox injections were ‘easier’ 3/21, ‘the same or similar’ 13/21 or 'worse' 5/21.

7/21 children were able to use Entonox.

13/21 parents felt their child would give the same response, 8/21 were not sure.

Conclusion The number of respondents was small compared to 2011 where a 65% response was achieved. Despite the chance of bias, these results are broadly in line with routinely collected post-injection reviews. Botox injections are perceived by carers to be similar to having blood tests or immunisations. The parents in this sample did not want their children sedated for this procedure.

Children’s views are going to be sought by ‘talking mats’ and compared with caregivers perceptions.


  1. C Fairhurst, J Bridgeman, D Browning. To sedate or not to sedate that is the question – which analgesia is necessary for botulinum toxin injections? BPNA Abstracts 2007

  2. Scottish Intercollegiate Guidelines Network (SIGN). Safe Sedation of Children Undergoing Diagnostic and Therapeutic Procedures. A national guideline. Revised 2004 (now withdrawn)

  3. National Institute of Clinical Evidence (NICE). Sedation in children and young people (GC112). 2010

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.