Infant Botulism

Multiple formula recalls and several reminders to not give honey to infants under 1 year old have reignited parental concerns about botulism. While rare, botulism in infants is very serious. But when caught early, a highly effective antidote can help babies fully recover.

Sarah Boggs, MD, pediatrician and infectious disease specialist, shared more information about how to spot botulism in your baby and what to do.

What Is Botulism?

Infant botulism is caused by the spores of the Clostridium botulinum bacteria. This bacteria is very common and is found in soil, dust, honey, and – rarely – as a contaminant in infant formula. For reasons we do not fully understand, infants less than one year of age who ingest these spores then generate the botulinum toxin. This toxin causes symptoms of poor suck, weak cry, and facial paralysis that then spreads down the body leading to respiratory failure and death without treatment. 

Older children and adults are not susceptible to botulism in the same way as infants; they must ingest the pre-formed toxin in things like improperly canned foods to get sick with this illness. Simply ingesting the spores in things like honey is not enough for them to get sick. 

How Rare is Botulism?

Infant botulism is very rare, occurring in about 100 babies born in the United States each year.  More than half of the cases occur in California, likely because there is more of the C. botulinum bacteria in the soil. The majority of affected infants are less than six months old. Typically, the high standards around formula regulation and babies being restricted to formula or breastmilk for the first six months of life help prevent exposure.

How Will I Know if My Baby has Botulism?

Sometimes,  infant botulism is referred to as “floppy baby syndrome.” The most distinct symptom is a progressive muscle weakness, starting in your baby’s face. If you notice your child having a poor suck and difficulty eating, eyelids drooping, and responding less (especially in terms of facial expressions), you should bring them to the emergency department. Having a weak cry and significant constipation (together with the other symptoms listed) are other common findings of botulism in infants.

Pediatric neurology and infectious disease specialists will evaluate and order tests. The most definitive test, a stool test, takes a week to return results. Treatment is often begun before test results are back if there is a high level of suspicion for infant botulism.

Do Babies Recover from Botulism?

Botulism is one of those words that inspires fear. It was tested as a weapon in World War II. If left untreated, it can be fatal.

Fortunately, there’s an antitoxin that can be given for botulism that helps aid recovery. The sooner the antitoxin is given, the better the chance for recovery. Most babies are able to recover in 1-3 weeks, though some have to remain in the pediatric intensive care unit for a lot of that time to get support for breathing and feeding.

Can I Avoid Botulism?

There’s no way to absolutely avoid botulism. The recent formula outbreaks have been incredibly hard for parents. Over 51 cases of infant botulism connected to the formula outbreak were reported. All infants required hospitalization.

Some opportunists used this as an opportunity to shame parents who formula feed, but that ignores that every year many cases are caused by botulism found in soil and dust particles, which are unavoidable.

Avoid Risky Behaviors, Seek Help When Needed

There are things you can do to lower the risk of botulism exposure:

• Don’t give honey to babies under 1 year old
• Monitor food recalls and safety advisories
• Be cautious with home canned foods

But even if you do all of this perfectly, your baby still may end up exposed to botulism. If you notice a general ‘floppiness’ go to your nearest emergency department as soon as possible.