Kids Health Info

Intrathecal baclofen 3 the ITB pump

  • Intrathecal baclofen is a treatment used for children with spasticity and dystonia. Baclofen is a medicine that tells the muscles to relax. Intrathecal baclofen is baclofen that is given into the space around the spinal cord. This is done through a permanent, surgically implanted pump that is placed in the abdomen (tummy) with a catheter (tube) that goes to the spinal cord.

    ITB-1 RCH KHI

    See picture 1.

    How does it work?

    A neurosurgeon implants the pump (about the size of a computer mouse) into your child's abdomen on one side near the hip bone.  Joined to the pump is a long tube which is inserted into the space surrounding your child's spinal cord. We use a programmer (a very small computer) to tell the pump how much medicine to release. The programmer uses telemetry (similar to radio waves) to tell the pump what to do. 

    ITB-2 RCH KHI

     

    ITB-4 RCH KHI

    See pictures 2 and 4.

    How does the baclofen get in the pump?

    On the face of the middle of the pump there is a silicon port, or opening. A long, thin needle is used to inject the baclofen into this port. See picture 3.  The baclofen will last from one month to six months depending on the dose your child is receiving. When your child needs their pump refilled, an appointment will be made with Developmental Medicine to see the clinical nurse consultant (CNC) and your child's baclofen doctor.  Your child will have local anaesthetic cream put on the skin over the pump.  This will numb the area where the needle goes in. When the cream is used, most children do not feel pain from the needle, although some react to the pressure of the needle going through the skin. The procedure takes about half an hour.

    ITB-3 RCH KHI

    How will baclofen work for my child?

    Your doctors cannot predict exactly how baclofen will work for your child as every child is different. Every child has different goals for their therapy and every child responds differently. If your child has had a successful baclofen trial we do know baclofen will reduce some tightness in your child's muscles, but we cannot predict exactly how it will work. Most parents of children who already have the baclofen pump report very positive results and are happy that their child had the pump implanted.

    Important considerations

    • If your child ever needs an MRI (Magnetic Resonance Imaging) scan you must tell the medical imaging staff and baclofen team as soon as your MRI appointment has been booked (call your baclofen nurse). The MRI machine can stop the baclofen pump from working and the baclofen team must be there during the scan to check the pump.
    • The pump will 'beep' when the battery is about to go flat or if the pump is close to running out of baclofen. If you hear beeping you must contact the baclofen team as soon as possible (see Kids Health Info fact sheet: ITB 4 - Complications). 
    • The battery in the pump has a life of five to seven years. This means that if you decide to continue with the treatment, your child will need another operation in about five to seven years to replace the pump. 
    • If your child needs to have surgery after the pump is implanted, it is important to tell the surgeon that 'monopolar cautery can interfere with the pump program'. Ask the surgeon to contact the baclofen team for more information.

    Key points to remember

    • Baclofen works differently for every child. The doctors cannot predict exactly how it will work for your child.
    • Once implanted, your child will need a repeat appointment at the RCH about every one to six months so the pump can be refilled with baclofen.
    • There are important factors to be aware of if your child is going to get a pump. You need to be aware of these so you know when you need to call a doctor about the pump. (see Kids Health Info fact sheet: ITB 5 - FAQ)

    For more information

    Contact

    The Royal Children's Hospital
    T: (03) 9345 5522
    A Baclofen doctor is on call 24 hours a day, seven days a week. Call the main hospital number and ask for the on-call developmental medicine consultant OR the on-call rehabilitation consultant, depending on which is your child's primary baclofen team.

     

    Developed by the Royal Children's Hospital Department of Developmental Medicine in consultation with the Departments of Neurosurgery, Paediatric Rehabilitation, Orthopaedics and Physiotherapy. Many thanks to the parents who were involved in the development and review of this fact sheet. First published in August 2007. Updated November 2010.


Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.