Baclofen is one of the medicines that doctors use most often to treat two types of abnormal muscle tone: spasticity and dystonia.
These conditions are common in people who have cerebral palsy, multiple sclerosis and other brain and spinal cord injuries and diseases.
People can take baclofen by mouth or by using a baclofen pump. If your child has been taking anti-spasticity medicine by mouth and it is not effective, or is causing unwanted side effects, the care team may recommend a baclofen pump. The pump is a device that a pediatric neurosurgeon places into the abdomen. It connects to a thin tube called a catheter that goes into the intrathecal space (this is the space that contains the spinal fluid in the spinal column).
Unlike anti-spasticity medicine pills taken by mouth, the pump delivers the medicine directly to the spinal fluid around the spinal cord and nerves. This can relax muscles without many of the side effects of taking anti-spasticity medicine by mouth, such as excessive drowsiness and constipation. Most patients with a baclofen pump don’t need to take the medicine by mouth anymore.
If the care team agrees that a baclofen pump is a good option for your child, they may recommend a “trial dose” first. During this trial, your child will be given a light anesthetic. The pediatric rehabilitation medicine doctor will inject a single dose of baclofen into the space around the spinal cord.
Next, a physical therapist (PT) will watch to see how your child responds to the medicine. The PT will look at muscle spasticity, stretch reflexes, and how often spasms or cramping are happening. You will be asked to feel and move your child’s arms and legs during this time to tell if the medicine is helping.
The trial dose typically wears off within six to eight hours. Your child will be able to go home the same day. If your child responds well to the intrathecal baclofen trial, you may choose to have a pediatric neurosurgeon do surgery to implant a pump. The surgery can happen immediately after this trial or later, depending on what works best for your family.
Surgery to place a baclofen pump lasts two to three hours. Your child will be put to sleep with general anesthesia. They will have two incisions (cuts). One incision will be on the abdomen, where the neurosurgeon will place the pump. The other will be on the lower back, where the neurosurgeon will put the infusion catheter into the intrathecal space (spinal column).
During surgery, the neurosurgeon will implant the pump under the skin of the abdomen. The catheter will extend under the skin from the pump into the intrathecal space. The neurosurgeon will fill the pump with baclofen and program it to deliver a continuous, low dose.
After the surgery, your child will stay in the hospital for two to five days. For the first 24 hours, your child needs to stay flat in bed to help prevent a headache. Baseline X-rays will be done once your child is able to sit up and before going home.
The care team will use an abdominal binder (wrap) after surgery to reduce swelling and help your child be more comfortable during the healing process. Your child will be given medicine to help control pain. A pediatric rehabilitation medicine doctor will examine your child every day during the hospital stay to watch for symptoms of baclofen overdose or withdrawal. The doctor will recommend possible dose adjustment to the pump and / or begin to decrease anti-spasticity medicine by mouth.
A physical therapist may see your child during the hospital stay to help with mobility, transfers or equipment needs.
Your child will go home when they:
Before you leave the hospital with your child, the care team will:
For the first two weeks after returning home, you will need to wash your child’s incisions every day with baby shampoo and warm water. For the next four to six weeks, you will need to limit some of your child’s activities such as bending, twisting or turning at the waist. This will help the healing process.
About two weeks after going home, your child will have a follow-up visit in the neurosurgery clinic for wound check and suture removal. They will check the incisions and see how well your child is responding to the baclofen.
Your child should not submerge in water until the stitches have been removed and the incisions are well healed without scabbing. Your child may take a shower, if able. Showers in a shower chair are safe for the healing wound. Your child will continue with the abdominal binder until the two-weeks-after-surgery visit.
Expect to have follow-up visits every one to two weeks for the first two or three months after surgery. The goal is to find the best baclofen dose to reduce your child’s symptoms of dystonia or spasticity while minimizing side effects. To adjust the dose, the doctor uses an electronic tablet with a programmer “wand.”
Your child’s care team may refer them to outpatient physical therapy to work on strengthening and mobility skills.
Your child’s pump must be refilled with baclofen every two to six months (depending on the dose).
To refill the pump, the pediatric rehabilitation medicine doctor or nurse will put a sterile needle through the skin into a refill port on the pump. The provider will remove any remaining baclofen from the pump and put the new medicine into the pump. During this appointment, the provider may change the pump dose.
The care team will make sure you schedule a refill appointment one to two weeks before the pump runs out of baclofen. The pump is programmed to sound an emergency alarm if your child’s pump volume is low.
If the pump runs empty or has an unexpected malfunction, your child can have baclofen withdrawal symptoms. These can be severe and life-threatening and include:
It is rare, but a child can receive too much baclofen through the pump. This is called baclofen overdose. Contact the Pediatric Rehabilitation Medicine Clinic or the pump doctor on call if your child’s muscles seem too loose or if your child seems too drowsy. Call 911 if your child has trouble breathing or will not wake up with vigorous stimulation.
Contact the Pediatric Rehabilitation Medicine Clinic or the pump doctor on call if your child develops muscle tightness or spasms along with:
These symptoms can mean that your child is having baclofen withdrawal. This can happen if your child is used to getting the medicine and then suddenly isn’t getting enough.
The pump has an emergency alarm system. If you hear a faint noise like an ambulance siren coming from the pump, act quickly. It could mean that the pump is not working correctly, and the medicine is no longer flowing into the intrathecal space. Contact the Pediatric Rehabilitation Medicine Clinic or the pump doctor on call for instructions on giving anti-spasticity medicine by mouth. The provider may tell you to go to the emergency department.
Baclofen pump therapy can be very effective for children with spasticity or dystonia despite potential complication risks. It can reduce pain and discomfort, improve function and mobility, and make positioning and caregiving easier. It can be used along with other therapies, such as oral medication, Botox injections (for children with CP and dystonia), and deep brain stimulation (for children with dystonia). If the therapy isn’t helping, the pump can be removed safely at any time.
The battery in the baclofen pump can last up to seven years. Before the battery runs out, your child will need another surgery to replace the pump. Your pediatric rehabilitation medicine doctor will notify you when there is about one year remaining on the pump’s battery life. This allows for plenty of time to schedule neurosurgery follow-up and pump replacement surgery.
Last Updated 06/2026
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