{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T13:27:32Z","timestamp":1791638852340,"version":"4.3.4"},"reference-count":143,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T00:00:00Z","timestamp":1720051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Since its first approval by the Food and Drug Administration in 1989 for strabismus, botulinum toxin indications of use have been widely expanded. Due to its anticholinergic properties, this toxin is currently approved in adult patients for the treatment of a wide range of neuromuscular, otolaryngologic, orthopedic, gastrointestinal, and urologic disorders. Approved pediatric indications of use include the treatment of blepharospasm associated with dystonia, strabismus, lower-limb spasticity, focal spasticity in patients with cerebral palsy, and neurogenic detrusor overactivity. Alongside these approved indications, botulinum toxin is extensively used off-label. Although several clinical studies have shown that botulinum toxin is effective and well-tolerated in children, uncertainties persist regarding its long-term effects on growth and appropriate dosing in this population. As such, further research is needed to better define the botulinum toxin risk\u2013benefit profile and expand approved uses in pediatrics. This narrative review aimed to provide a broad overview of the evidence concerning the clinical effectiveness and safety of BoNT with respect to its principal authorized and non-authorized pediatric therapeutic indications, as well as to describe perspectives on its future use in children.<\/jats:p>","DOI":"10.3390\/toxins16070306","type":"journal-article","created":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T09:50:32Z","timestamp":1720086632000},"page":"306","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Understanding Clinical Effectiveness and Safety Implications of Botulinum Toxin in Children: A Narrative Review of the Literature"],"prefix":"10.3390","volume":"16","author":[{"given":"Salvatore","family":"Crisafulli","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Verona, 37124 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ciccimarra","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Public Health, University of Verona, 37124 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1365-548X","authenticated-orcid":false,"given":"Zakir","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Riphah Institute of Pharmaceutical Sciences, Riphah International University, Gulberg Green Campus, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Maccarrone","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Public Health, University of Verona, 37124 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1147-7296","authenticated-orcid":false,"given":"Gianluca","family":"Trifir\u00f2","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Public Health, University of Verona, 37124 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1136\/bmj.320.7228.161","article-title":"Uses of botulinum toxin injection in medicine today","volume":"320","author":"Bhatia","year":"2000","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s00702-007-0728-2","article-title":"From poison to remedy: The chequered history of botulinum toxin","volume":"115","author":"Erbguth","year":"2008","journal-title":"J. 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