U.S. National Library of Medicine - Infant botulism is a potentially life-threatening disease in which a bacteria called Clostridium botulinum grows inside a baby's gastrointestinal tract.

Clostridium botulinum is a spore-forming organism that is common in nature. The spores may be found in soil and certain foods (such as honey and some corn syrups).

Infant botulism occurs mostly in young infants between 6 weeks and 6 months of age. It has been reported to occur as early as 6 days and as late as 1 year.

Risk factors include swallowing honey as a baby, being around contaminated soil, and having less than one stool per day for a period greater than 2 months.

According to the Centers for Disease Control and Prevention, in 2010 there were a total of 85 laboratory-confirmed cases of infantbotulism. In 2009, there were 84 cases. No deaths were reported.

Symptoms

  • Breathing stops or slows
  • Constipation
  • Eyelids sag or partially close
  • Infant appears "floppy"
  • Infant doesn't gag
  • Loss of head control
  • Paralysis that spreads downward
  • Poor feeding and weak suckling
  • Respiratory failure
  • Tired all the time (lethargy)
  • Weak cry

Treatment

Botulism immune globulin is the main treatment for this condition. Infants that receive this treatment have shorter hospital stays and less severe illness.

Any infant with botulism must receive supportive care during their recovery. This includes:

  • Ensuring proper nutrition
  • Keeping the airway clear
  • Watching for breathing problems

If breathing problems develop, breathing support, including the use of a breathing machine, may be needed.

Antibiotics do not appear to help the baby improve any faster, and are not needed unless another bacterial infection such as pneumonia develops.

The use of human-derived botulinum antitoxin may also be helpful.

Prevention

Theoretically, the disease might be avoided by preventing exposure to spores. Since honey and corn syrup are sources of Clostridium spores, they should not be fed to infants less than 1 year old.

Q&A from the infant botulism treatment and prevention program www.infantbotulism.org

A: Yes, it is ok for a breastfeeding mother to eat honey. Botulism is not transmitted by breast milk. The Infant Botulism Treatment and Prevention Program recommends continuing breast feeding or the feeding of expressed breast milk during the illness and recovery from infant botulism.

As always, thorough hand washing practices should be strictly adhered to, especially in households where honey is regularly consumed by family members and other caregivers. Doing so will help prevent having honey on surfaces that may come into contact with the infant’s mouth.

Although the bacterial spores that cause infant botulism are known to occasionally be present in honey, even if a mother was to eatbotulism spores in honey, the spores are far too large to pass through her body and into breast milk. Also, botulinum toxin does not pass into breast milk. For this and other reasons, breast milk is not a source of the bacterial spores or the toxin that cause infant botulism.

As stated in the patient management section of our website, breast milk constitutes optimal nutrition for infants, and mothers should be encouraged and supported in their efforts to continue breastfeeding through their infant’s illness and recovery.

A: In the absence of serious hospital-acquired complications, no. The prognosis for infant botulism patients is excellent with anticipated full and complete recovery. Recovery results from regrowth of the nerve endings that then are able to signal the muscles to contract. Botulinum toxin does not penetrate into the brain, and so infant botulism patients retain all the intelligence, athletic ability, musical ability, sense of humor and orneriness with which they were born.

A: No. Infants treated with BabyBIG® will have a protective level of toxin-neutralizing antibody for at least six months following administration of the medicine. This feature allows sufficient time for elimination of C. botulinum, which has temporarily colonized the infant’s intestine causing disease.

Since the disease of infant botulism was first recognized more than 35 years ago, there have been no instances of an infant acquiring the disease more than once. During this time more than 3700 cases of infant botulism are known to have occurred worldwide.

However, a few reports of "relapsing" infant botulism have been published during this time. Careful review of these case reports by our program's physicians indicates that these were cases in which the infant was discharged prematurely, before they had adequate recovery of strength needed to sustain feeding and breathing. For a further discussion of this topic please see the patient management section of our website under the For Physicians tab.