PRIMARY OBJECTIVE: To describe clinical experience using botulinum toxin type A (BTX-A) in children with acquired brain injury. RESEARCH DESIGN: Single centre, open label, pilot study. METHODS AND PROCEDURES: Twenty-one patients were randomized to three groups according to impairment severity and treatment objectives. EXPERIMENTAL INTERVENTIONS: Group 1: Spastic quadriparesis patients with impaired consciousness treated with the primary goal of improving comfort and well-being; Group 2: Patients with upper limb spasticity treated with the primary goal of improving arm functioning; Group 3: Lower limb spasticity patients treated with the primary goal of improving leg function. OUTCOMES AND RESULTS: Baseline, 1, 3 and 5-month post-treatment assessments were carried out using joint goniometry, Modified Ashworth Scale and video-observations. All groups demonstrated initial improvements, with patients in Group 2 showing a positive effect at least 5 months post-treatment. CONCLUSIONS: With a good outlining of treatment goals, BTX-A is an effective therapy for brain injury patients.