Botulinum toxin was proved to be safe over many years in the pediatric population for many indications. Wide experience and more than a decade of research have provided the basic framework for using botulinum toxins in preventing joint deformities and enhancing motor function. In children, a great opportunity exists with botulinum toxin that allows improved motor control and elongation of shortened muscles. Although 3 to 4 months in an adult life is short, for a child it is a relatively greater proportion of their life experience and may be long enough for skill development. The improvement noted in function after botulinum toxin use is facilitated by comprehensive rehabilitation. For children with focal hypertonia, botulinum toxins offer a dramatic change that affects rehabilitation. Research rapidly has captured the positive effect of the toxins on impairment and functional limitations. Not to be overlooked are outcomes related to quality of life. The long-term use of botulinum toxins and the role the toxins play throughout the life span of the person with a childhood hypertonic disorder are yet to be determined.