Infant Botulism

Infant botulism is a rare, life-threatening condition that can cause a slow form of paralysis in infants. This form of botulism affects babies under 1 year old. While similar to botulism in those over 1 year old, there are major differences, too.

Unlike botulism in older children and adults, infant botulism can come on slowly and get gradually worse over time. That means parents and other caregivers can make a big difference in noticing the symptoms early and getting medical care.

Symptoms of infant botulism

Symptoms of infant botulism can include:

• Choking when trying to feed
• Constipation
• Weaker suck or poor feeding
• Eyelid drooping (ptosis)
• Lack of facial expressions, being unable to lift their head, or other signs of muscle weakness or paralysis
• Weaker crying
• Weakness or decreased muscle tone, especially starting at the top of their body and limbs, making your baby feel “floppy” and keeping them from reaching or grabbing
• Bowel movement changes, like not pooping for days or even weeks at a time

Babies can’t tell you their symptoms or answer questions about what they’re feeling. That means it’s important to know and recognize potential trouble signs. Infants with botulism will be alert, they won’t have a fever and will seem well otherwise.

Infant botulism causes

Babies get botulism if they eat something containing spores from the bacteria Clostridium botulinum. The bacteria change to a spore form to survive harsh environments. Inside your baby’s digestive system, the spores return to their bacterial form, multiply and start making a toxin. That toxin then enters your baby’s bloodstream and eventually disrupts their nervous system, causing this condition’s symptoms.

The best-known way that babies can get Clostridium botulinum spores in their gut is from honey. That’s why you should NEVER give honey to babies under a year old.

Babies can also get botulinum spores from other sources, but most of the time, healthcare providers and experts can’t identify other sources.

Why infant botulism is different

Foodborne botulism in people over a year old happens when bacteria make the toxin in your food. You’re mainly getting sick from eating the toxin, not the bacteria themselves. But infant botulism happens because bacteria are making the toxin inside your baby’s body. That’s why infant symptoms are usually slow to appear and only get worse gradually, compared to sudden, severe symptoms that are more likely in adults.

Everyone has healthy bacteria that live in their digestive tract (gut microbiome). In people over 1 year old, healthy bacteria usually keep botulism-causing bacteria from staying long enough to make the toxin. But babies’ gut microbiomes can’t always do that.

Botulism-causing bacteria can live (colonize) inside those over a year old and make the toxin from inside, but that’s rare.

Risk factors

Infant botulism happens in babies under 1 year old. About 95% of cases happen to babies younger than 6 months old.

Complications of botulism

Botulinum toxin blocks nervous system signals. Those signals tell your muscles when to activate and when to relax. Blocking those signals causes paralysis. And botulism can be deadly when the paralysis blocks signals to the muscles you use to breathe.

How doctors diagnose infant botulism

A healthcare provider at a hospital or emergency room can suspect infant botulism based on your baby’s symptoms and by doing a physical exam and neurological exam. Lab testing is also important. The most likely way a provider can confirm your baby has infant botulism is testing their poop (stool) for botulinum toxin.

How is infant botulism treated?

Infant botulism is extremely treatable. For babies, the treatment starts with an antitoxin called botulism immune globulin (BabyBIG®). Healthcare providers will give that to your baby through an intravenous (IV) line. This antitoxin works like an antidote, neutralizing the toxin circulating in your baby’s blood.

Antibiotics aren’t usually part of the treatment for infant botulism. The bacteria that make the toxin release it when they die, so antibiotics can actually make your baby sicker. The exception to this is for treating other infections that your baby has at the same time.

In general, the sooner the treatment starts, the better it usually is for your baby. That’s why providers will often start treatment before confirming the diagnosis.

Recovery time

If your baby has infant botulism, they may need to stay in the hospital for a few days or a few weeks to recover. Some babies need physical therapy to make a full recovery.

Can infant botulism be prevented?

Botulism-causing bacterial spores are widespread, so there’s no way to prevent infant botulism with 100% certainty. The main way to prevent infant botulism is to not give honey to a child under a year old. That means not even tiny amounts, like a drop of honey on a pacifier or your nipple when trying to get them to latch and feed.

Can babies have processed or cooked honey?

Experts recommend not giving your baby honey in ANY form before their first birthday.

What can I expect if my baby has infant botulism?

Infant botulism develops more slowly and more gradually than it does in adults. But diagnosing and treating infant botulism quickly is still important. If you can call your child’s pediatrician during office hours, they can advise you on what to do. But when in doubt, it’s better to be safe and take your baby to the nearest hospital or emergency room.

Infant botulism is serious, but fortunately, it’s also very treatable. The survival rate is between 98% and 100%. And babies commonly make a full recovery from infant botulism.