Children with CP with greater motor involvement, as indexed by GMFCS level, may be at risk for increased pain (intensity, frequency and duration) that interfers with activities of daily living. The clinical index of suspicion should be raised accordingly when evaluating children with developmental disability who cannot self-report reliably.

Although there is considerable evidence that Btx/A is efficacious for the treatment of spasticity associated with CP, there is little direct evidence specific to associated analgesic effects after Btx/A treatment. These preliminary findings indicate that Btx/A treatment for spasticity resulted in significant pain reduction for this patient sample. This was the first study to directly ask parents about their child's pain pre-Btx/A and post-Btx/A treatment. These findings have implications for the management of pain associated with spasticity and CP and suggest further research is warranted.

This randomized, double-blind, placebo-controlled study compared the efficacy of inhaled nitrous oxide (N 2 O) with enteral midazolam for sedation of children with cerebral palsy (CP) undergoing botulinum toxin A (BoNT-A) injections. Fifty children (29 males, 21 females; mean age 8y 2mo [SD 4y 5mo]; range 1-16y) were randomized to sedation with N 2 O (n=25) or midazolam (n=25). Groups were similar in type of

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