Spasticity and muscle-relaxant treatments (paediatric)
From oral medicines and botulinum toxin to baclofen pumps and surgery — how high muscle tone is managed in children, especially in cerebral palsy.
Spasticity and dystonia (high or fluctuating muscle tone) are common in cerebral palsy and other neurological conditions, and can cause discomfort, difficulty with movement and care, and — over time — joint and bone problems. A range of treatments is available, from oral medicines to targeted injections, an implanted pump and surgery. The right choice depends on whether the tone is widespread or focal, how severe it is, and the child's goals.
At a glance
- Targets
- Spasticity and dystonia (high/fluctuating muscle tone)
- Focal tone
- Botulinum toxin injections to specific muscles
- Widespread tone
- Oral medicines (e.g. baclofen) or an intrathecal baclofen pump
- Selected children
- Selective dorsal rhizotomy (a neurosurgical option)
- Always with
- Physiotherapy, orthotics and goal-setting
Oral medicines
Oral muscle relaxants — most commonly baclofen, and sometimes diazepam, tizanidine or dantrolene — reduce widespread high tone. They can help comfort and care, but because they act on the whole body they may cause drowsiness or weakness, so the dose is balanced carefully. For dystonia, other medicines (such as trihexyphenidyl or, in specific situations, levodopa) may be used.
Botulinum toxin (focal treatment)
When tightness is concentrated in particular muscles, botulinum toxin injections relax those muscles for several months, often to support a specific goal — improving gait, easing care, preventing contractures or relieving pain — alongside physiotherapy and sometimes casting or orthotics.
Intrathecal baclofen and surgery
For severe, widespread tone, an intrathecal baclofen pump delivers medicine directly to the spinal fluid, giving strong tone reduction at much lower doses than tablets, with fewer whole-body side effects. Selective dorsal rhizotomy (SDR) is a neurosurgical procedure that permanently reduces spasticity in carefully selected children — usually those with spastic diplegia who can walk — and is followed by intensive rehabilitation. Orthopaedic surgery addresses established contractures or bony problems.
Tone management is most effective as part of a plan with clear goals (comfort, function, preventing deformity) and always alongside physiotherapy — not as an isolated 'fix'.
How an educational review can help
An educational review can explain the options for your child's pattern of tone, how they fit together, and the trade-offs involved, helping you prepare questions for your treating team. It is educational and does not replace your clinician's care.
Selected sources
- Guidelines on the management of spasticity in children and young people with cerebral palsy.
- Evidence reviews for botulinum toxin, intrathecal baclofen and selective dorsal rhizotomy in paediatric spasticity.
Last reviewed: 2026-05-22
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