Botox May Save Babies' Lives

Medical first in Montreal. Infants with life-threatening syndrome, stigmatized older kids can live normal life

SHARON KIRKEY, Canwest News Service

Canadian doctors are using Botox to get newborns off breathing machines and to treat the social humiliation of excessive drooling in older children and teens.

In what is being described as the first case anywhere of Botox being used on a newborn, a Montreal doctor injected minute doses of the botulinum toxin into the salivary glands of a 21/2-month-old infant suffering from CHARGE syndrome, a rare but life-threatening congenital problem that can cause multiple birth defects, including difficulty swallowing. Saliva ends up pooling in babies' throats and filling their lungs.

The Montreal baby was choking on his secretions "from the minute he was born" in 2005, said Sam Daniel, associate director of research of the otorhinolaryngology division at the Children's Hospital. The baby developed multiple pneumonia and had to be connected to a ventilator when he was five days old. Doctors tried four times to get him off. Normally, the only option is to perform a tracheostomy, where a tube is inserted through a hole in the neck into the trachea, or windpipe. Babies "breathe through their neck and get suctioned through this tube that's hanging out of their neck," Daniel said.

But the tube has to be suctioned regularly to remove thick mucus and secretions. And because there's an open passage into the lungs, children can easily catch infections. There's also a five-per-cent risk of death.

"It's very dramatic and commits the family to basically providing 24 hours a day of care," Daniel said. "I've seen families break because of the burden of care."

Two weeks after Daniel used Botox to paralyze the nerves in the baby's saliva glands to keep them from secreting saliva, the baby was taken off the ventilator. Repeat injections were given every four to six months until his glands shrunk and stopped overproducing saliva.

Three years later, the Montreal toddler is leading a normal life. The case appears this week in the journal Archives of Otolaryngology. Researchers at Toronto's Hospital for Sick Children also have reported using Botox to treat drooling in older children with neurological conditions.

Daniel has now performed more than 1,000 Botox injections in children, including 12 newborns, with "hyper-salivation." Many have cerebral palsy. But, "others are normal kids who for whatever reason have more saliva than others," he said.

"You can't believe when these families come. You have the child who can't attend daycare because no one wants to play with him, he's wetting all the toys and kids reject him.

"I've had a teenager who was refused cooking classes because everyone thought she was disgusting." He once treated a waiter who was fired for spitting when he talked.

"At a social level, it affects these kids. Often, they're isolated at school, they're bullied, they're teased. They smudge their drawings with saliva, or their homework is dirty. It has a much higher social impact than a lot of other conditions and it's very stigmatizing," Daniel said.

Medications can cause side effects such as severe constipation or blurry vision, and surgery to remove the saliva glands can be an even worse trade off, Daniel said. Mouths can end up "dry as wood" or not enough saliva is produced to lubricate food.

"The advantage of Botox is that its fully reversible and you can tailor how many glands you're going to inject."