OBJECTIVES: Chronic aspiration of salivary secretions can cause major pulmonary morbidity in neurologically impaired patients. Many treatments are proposed to address these problems, some with significant side effects. Botulinum toxin type A injection into the salivary glands is known to reduce salivary flow without major complications. Few reports exist regarding the use of this treatment in the prevention of recurrent aspiration pneumonia. We studied the effects of this treatment for patients with recurrent aspiration pneumonia. METHODS: We performed a chart review of 12 patients, ranging in age from 7 months to 37 years, treated with botulinum toxin injections at a single tertiary care institution. A caregiver telephone questionnaire was also administered. The numbers of pulmonary infections and hospitalizations before and after the initiation of treatment were compared. RESULTS: Nine of 12 patients reported improvement in the numbers of hospitalizations and pulmonary infections following botulinum toxin injections. Reduction in the use of anticholinergic medication and reduced pulmonary toilet requirements were also noted. There were no complications of treatment. CONCLUSIONS: Botulinum toxin injection into the salivary glands can be effective in reducing pulmonary morbidity in many neurologically impaired patients. This relatively simple technique offers an alternative to the use of anticholinergic medication and may obviate the need for more invasive surgical treatment in certain patients.