Children with health conditions, like cerebral palsy, head trauma or dystonia, often experience muscle stiffness, rigidity and spasms. These symptoms can be painful and disrupt your child’s daily life. Intrathecal baclofen (ITB) pump therapy helps relieve this discomfort by relaxing your child’s muscles so they can function better.
Our team is highly trained in implanting, removing, maintaining and filing intrathecal baclofen (ITB) pumps to treat severe muscle stiffness that can interfere with your child's movement, feeding and bathing. Many of the children we treat with an ITB pump are able to walk, sit and move more comfortably.
Overview
What is pediatric intrathecal baclofen pump therapy?
ITB therapy is a treatment program that your child’s rehabilitative medicine doctors will prescribe. It involves:
The surgical placement of a medical device
A physical therapy and occupational therapy routine customized for your child’s needs
ITB pumps safely deliver medication directly to your child's spine. This medicine helps relieve severe muscle spasms and stiffness caused by disorders present at birth, serious injuries or developmental disabilities. The ITB pump can help when oral medications don't give your child the relief they need.
ITB pumps do not cure muscle problems. They are most helpful as part of an ITB therapy plan that includes physical therapy to help improve your child’s mobility and ease their pain. The medication from the pump helps your child’s muscles relax. With more relaxed muscles, your child will be more comfortable during physical and occupational therapy, which will help them make more progress.
Children often need ITB pump therapy for a long period of time.
Benefits
What are the benefits of pediatric intrathecal baclofen therapy?
Intrathecal baclofen therapy provides:
Muscle tension relief
Reduced pain and discomfort
Improved range of motion and mobility
A constant flow of medication to your child’s muscles for around-the-clock relief
Fewer side effects than oral medications
Automatic delivery that you don’t have to think about or remember to give to your child
Adjustable dosing to fit your child’s specific needs
Side Effects
What are the side effects of pediatric intrathecal baclofen therapy?
Physical therapy has no side effects. However, an ITB pump may cause some side effects if your child’s dose is wrong.
If their dose is too high, they may:
Become extra sleepy
Struggle to wake up
Have seizures
If they aren’t getting enough medication, they may experience:
Itching
Crankiness and irritability
A high fever
Muscles tightening up and breaking down, which can lead to kidney failure in severe cases
Risks
What are the risks of pediatric intrathecal baclofen therapy?
Physical therapy has few risks, though some children may feel tired or have sore muscles. The risks of the ITB pump may include:
Risks associated with going under anesthesia to have the pump placed
The pump not working properly
Your child getting too much or too little medication
Our team of neurosurgeons and physical therapists are specially trained to use, replace, refill and maintain these devices throughout your child’s ITB therapy. We work to avoid unnecessary surgeries for your child during this treatment. For example, the pumps we use last for seven years and we are able to adjust your child’s dosage without surgery. We will also train you on symptoms to watch for to avoid issues or catch them early.
What to Expect
What to expect with pediatric intrathecal baclofen therapy
If you are considering ITB therapy for your child, we will provide you with information on:
How to manage the pump once it is in place
What your child’s life and care plan will look like with the pump
How to prepare your child emotionally before the procedure
How to prepare your child to go under anesthesia
How to position and transfer your child once the pump is implanted
What to expect before Pediatric Intrathecal Baclofen Therapy
Before we start ITB therapy with your child, our neurosurgery team will put a small amount of the ITB medication into your child’s back to see how your child will respond to the medication. If your child responds well, we will talk to you about ITB therapy as a treatment option for your child.
Before your child can start ITB therapy, they will need to have the pump placed, which requires surgery. Before the procedure, our neurosurgery team will give your child a physical examination. We will also help them relax through a combination of Child Life services and medications. You can be present for your child’s anesthesiology preparation before the procedure.
The surgery to place the pump will be done in an operating room and will take about 90 minutes. Your child will stay in the hospital for about two days after the pump has been placed. Then, we will discharge your child to go home. You will not need any additional equipment for the pump.
Learn more about your child’s surgery day.
What to expect during Pediatric Intrathecal Baclofen Therapy
After surgery, your child will probably feel some tenderness and discomfort at the incision sites for a while. They may need to wear a binder on their lower back for several weeks to keep the pump in place while they heal from surgery. Your child’s care team will guide you on keeping the wounds clean and bathing your child.
Your child will have to refrain from twisting, bending, turning and stretching their torso for the first six to eight weeks after their procedure. After that period, your child can resume most daily activities. However, your child should not participate in contact sports because those can displace the pump and cause complications.
What to expect after Pediatric Intrathecal Baclofen Therapy
ITB pumps help decrease the tightness in your child’s muscles, which also helps your child progress in occupational and physical therapy. They should begin to make progress in their mobility and overall function very quickly.
The pump will need to be refilled several times each year. Although your child doesn’t need surgery to refill the pump, you will need to bring your child to Children’s Health so we can refill it for them.
How to Prepare
How do I prepare my child for pediatric intrathecal baclofen therapy?
What is my child allowed to eat and drink before having their Intrathecal Baclofen pump placed?
Your child will need to stop eating and drinking certain foods and liquids before they go under anesthesia. Your child’s care team will provide you with detailed instructions on:
When they should begin fasting
What medications they should start or stop taking and when
When they should stop drinking water and other clear liquids
What are the prep instructions for Pediatric Intrathecal Baclofen Therapy?
Your child’s care team will offer you tips on preparing your child and yourself for what will happen at the hospital to help make your child’s surgery day as comfortable as possible. The pump placement will make caregiving for your child easier, as they will be more comfortable and mobile. Your child’s care team will help you and your child anticipate what living with an ITB pump is like and train you on how to care for them.
What are the Child Life services for Pediatric Intrathecal Baclofen Therapy?
Child Life services will work with you and your child before and after the ITB pump is placed and whenever your child’s pump needs to be refilled or reprogrammed. They will:
Provide your child with age-appropriate information to help them cope with a hospital stay
Work with your family to ensure that everyone feels prepared for and informed about your child’s care
Keep children calm and entertained to help them relax
Help your child recover comfortably, emotionally and physically, after any ITB pump-related procedure
What questions should I ask my provider about pediatric intrathecal baclofen therapy?
As you consider ITB therapy for your child, you might want to ask your child’s care team:
How many intrathecal baclofen pump surgeries have you performed?
How can I help make sure my child’s catheter/pump does not get damaged?
What activities should my child avoid?
Are there other treatment options for muscle spasticity that my child could receive instead?
What medications should my child stop taking before having their ITB pump installed?
How will their other medications be affected by the therapy on an ongoing basis?