Infant botulism is an illness that can occur when an infant ingests bacteria that produce a toxin inside the body.

The condition can be frightening because it can cause muscle weakness and breathing problems. But it is very rare: Fewer than 100 cases of infant botulism occur each year in the United States, and most babies who do get botulism recover fully.

Infant botulism is treatable, but because of its severity, it's important to learn the symptoms so you can recognize it early. Also know that honey is a known source of the bacteria spores that cause botulism. For this reason, honey shouldn't be given to babies under 12 months of age.

About Infant Botulism

Infant botulism can occur when a child ingests spores of Clostridium botulinum bacteria, which are found in dirt and dust and can contaminate honey. This illness typically affects babies who are between 3 weeks and 6 months old, but they're susceptible to it until their first birthdays.

These bacteria are typically harmless to older kids and adults because their mature digestive systems can move the spores through the body before they cause any harm.

But very young babies haven't developed the ability to handle the spores yet. So once an infant ingests them, the bacteria germinate, multiply, and produce a toxin. That toxin interferes with the normal interaction between the muscles and nerves and can hamper an infant's ability to move, eat, and breathe.

Two other types of botulism tend to affect older kids and adults: wound botulism occurs when the bacteria infect a wound and produce the toxin inside of it; foodborne botulism is usually caused by eating home-canned foods that contain the toxin.

Signs and Symptoms

Symptoms of botulism appear between 3 to 30 days after an infant consumes the spores. Constipation is often the first sign of botulism that parents notice (although many other illnesses also can cause constipation). Call your doctor if your baby hasn't had a bowel movement in 3 days.

Other symptoms can include:

• flat facial expression
• poor feeding (weak sucking)
• weak cry
• decreased movement
• trouble swallowing with excessive drooling
• muscle weakness
• breathing problems

Infant botulism can be treated, but it's important to get medical care as soon as possible. Call your doctor right away if you see any of the warning signs in your baby.

Treatment

Infant botulism is treated in the hospital, usually in the intensive care unit, where doctors will try to limit the problems the toxin causes in the baby's body. The toxin can affect the breathing muscles, so doctors may put the infant on a ventilator. Because the toxin can affect the swallowing muscles, they may give the baby intravenous (IV) fluids to provide nourishment.

An antitoxin is now available for the treatment of infant botulism called Botulism Immune Globulin Intravenous (BIGIV), which should be given as early in illness as possible. Babies with botulism who have received BIGIV recover sooner and spend less time in the hospital.

With early diagnosis and proper medical care, a baby should fully recover once the effects of the toxin wear off.

Prevention

Like many germs, the Clostridium botulinum spores that cause botulism in infants are everywhere in the environment. They're in dust and dirt, and even in the air. Experts don't know why some infants contract botulism while others don't.

One way to reduce the risk of botulism is to not give infants honey or any processed foods containing honey (like honey graham crackers) before their first birthday. Honey is a proven source of the bacteria and has led to botulism in infants who've ingested it. Light and dark corn syrups were thought to be a source of spores, but no proven cases of infant botulism have been attributed to ingesting them. However, check with your doctor before giving these to an infant.

Reviewed by: Joel Klein, MD
Date reviewed: October 2011