Many parents of young babies know not to give their baby honey because of the risk of the baby coming down with botulism. Honey seems like such a wholesome and natural product that it hardly seems possible that it can be dangerous for babies under 12 months old.
But honey is not the only way infants can come down with botulism. In fact, honey isn’t even the most common source for an infection with Clostridia botulinum, the bacteria that causes botulism. In addition to occasionally being found in honey, C. botulinum can often be found in soil and dust and may be in carpets or other surfaces in even the cleanest homes.
There are a couple of closely related bacteria that can also cause botulism, but C. botulinum is the most common one. This bacteria forms spores, which are versions of the bacteria that have a shell that can withstand extreme conditions like dryness or an acid environment. Most people over age 1 year can swallow C. botulinum spores, and nothing happens to them.
However, in infants, sometimes when spores of the C. botulinum bacteria are swallowed, they start to grow in the intestine and form an infection. The bacteria then form a toxin that is one of the deadliest known to humanity. It is not the infection that is the problem, it is the toxin the C. botulinum bacteria produce.
Botulinum toxin is a potent neurotoxin, which means that it attacks nerves and causes paralysis. The infant with botulism may be unable to move well and, if the muscles of the chest are paralyzed, may have difficulty breathing. As more toxin is made by the bacteria and the toxin spreads, the baby may suffocate because he or she cannot breathe.
Only about 15% of cases of botulism in infants is known to have been caused by honey, according to the American Academy of Family Physicians. This is why it is recommended that babies under age 12 months never be given honey or any foods containing honey. This includes pacifiers that have been dipped in honey.
But this means that the source of the infection is not known in more than 80% of cases of botulism in babies. In these cases, the cause is most probably spores swallowed by the baby that were in soil or dust.
Unlike with honey, the spores in the home or the outdoors can’t really be avoided because they are everywhere. Infants probably swallow botulinum spores all the time, but it is not known why the spores become active and start to grow in the intestine only in some infants. Despite the spores being all around, infant botulism is very rare. Only about 70 to 80 cases of infant botulism occur in the United States each year, according to the Centers for Disease Control and Prevention.
Infant botulism is rare, but it can happen, and parents should be aware of the symptoms and warning signs. These include:
- Constipation, which can be the first symptom
- The baby having muscle weakness, where the baby is unable to control or lift his or her head and is having floppy movements
- A different sounding or weaker cry
- Drooping of the eyelids
- Difficulty sucking or feeding
- Difficulty breathing
If your baby is starting to show these symptoms, call your healthcare provider. If you can’t reach your healthcare provider, take your baby to the emergency room. Botulism can get worse and as it worsens, the muscles that control breathing may become weaker leading to suffocation.
Botulism in babies can be treated. The first treatment is to give the baby oxygen and other breathing assistance. Other supportive case will include making sure the baby gets enough food and fluids without choking. One important treatment is the use of a drug called BabyBIG, which is an antitoxin to the botulinum toxin.
Most babies with botulism will recover completely. An infant with botulism may need to be hospitalized for a long time while the toxin wears off and the nerves that control muscles start to recover and regrow.
The diapers of a baby with botulism must be handled very carefully. Botulinum bacteria and toxin can be found in the baby’s feces for several weeks or months after the start of the infection. Parents and other caregivers must wash their hands very well after handling a dirty diaper. The dirty diaper should be disposed of in such a way that no one else comes into contact with it. If a parent or caregiver has an open cut on their hands, they should wear gloves while changing diapers to ensure that no bacteria or toxin enters the cut.
Botulism can occur in adults, usually as a food-borne disease. Food-borne botulism is caused by eating foods that have been contaminated with C. botulinum or by the botulinum toxin. This usually happens if person eats foods that were poorly canned, preserved, or fermented at home. About 25% of cases of botulism are caused by food.