Infant Botulism Is Back in the News

Every now and then a story hits the news about a food that is making people sick.  We’ve certainly read and heard lots of press about romaine lettuce in recent weeks.  But there’s another food that’s been implicated in a cluster of illnesses, this time in infants.  Unlike romaine lettuce with its recent publicity, we’ve known about this one for a while:  the risk of honey and infant botulism.  According to a recent report, four infants in Texas got sick from the disease after using pacifiers containing honey.

Infant Botulism Through the Ages

Those of us of a certain age remember a scare from the early 1970s when a brand of gourmet canned soup led to two cases of adult botulism—the romaine lettuce of its time!  It was actually a few years after these cases that infant botulism was “discovered,” although the disease has certainly been with us indefinitely.

What, then, happens to a baby who contracts infant botulism?  The disease is due to infection with the bacteria Clostridia botulinum (more recently, a few other related bacteria have also been found to cause the infection).  The bacteria form protective coatings known as spores, which allow them to survive more extreme conditions, including an infant’s stomach.  The baby ingests (eats) the spores which then multiply in the stomach and produce a poison known as a toxin.   

The toxin, which is considered to be the most poisonous substance known to man, affects the body’s nerves, particularly the ones that control muscles.  It acts on nerves to prevent them from sending the correct messages to the muscles.  Without the nerves’ messages, the muscles can’t work, leading to muscle weakness and ultimately paralysis.   

An older person who contracts botulism can complain and show signs of weakness, but infants can’t tell us much.  There may be constipation, poor feeding, a weak cry, or what looks to be just a sleepy baby.  Since infants who act like this can have one of a number of illnesses, and since infant botulism is still rare compared to some of these others, the disease may not be on the radar of providers.  They’re likely to look for more common problems like infection with more common bacteria or even head injury.  While there is now treatment for the illness and most babies who contract it do recover, they are usually very sick for a while.  Infant botulism certainly can be fatal, particularly if it is not found early; many cases of sudden infant death syndrome (SIDS) are actually thought to be due to infant botulism.

The Honey Link

Although people of all ages can get botulism from the toxin (this is what was behind those famous cases from the early 70s), it appears that infants, in particular, are at risk to getting disease from the spores themselves.  Spores don’t take root and multiply in adult stomachs; one reason for this is that with age people acquire “good” bacteria that help take care of them.  Not so for immature (under the age of 12 months) stomachs, which can act like little spore factories.

Thus, infants are at greater risk for disease from the botulism spores themselves.  Where do they get them?  Spores are present in soil, and many cases show up from routine household exposure.  However, it also turns out that the spores are present in honey.  While we can’t put a baby in a bubble and avoid soil exposure altogether, we can certainly abstain from giving babies honey.  Avoiding honey thus remains the one preventive measure parents can take against infant botulism.

The problem we run into is that many caregivers do give honey to infants.  Much of this appears to be due to certain cultural practices.  Closer to home, many families may feel that honey may help fix such common baby problems as constipation and colic.

Beliefs such as these appear to have created a market for honey pacifiers.  Although these are not produced in the United States, they’re available in foreign countries and online.  A few years ago, some researchers in Texas found that 10 percent of patients in their clinic were using a pacifier filled with or dipped in honey.  Although at the time no cases of infant botulism had been found linked to this practice, that all changed when those four infants in Texas were hospitalized with the disease.  This led the FDA to issue a special warning not to use the honey filled pacifiers.

We all have a natural tendency to use food products if we think it might make us or our loved ones better.  But the risks of honey and honey-containing products for infants under one year of age are just too great.  If a remedy containing honey is recommended to you by anyone for your little one, talk to your doctor about alternatives!

One final point to also talk to your provider about:  it’s unknown whether cooked honey (say, in a baked good) or other liquid sweeteners such as corn syrup are safe for babies.  Providers do differ on this issue; since sweeteners are not essential to a baby’s diet, it’s best not to give them before that discussion.  And realize that the latest cold medicines for children contain honey and are not recommended for infants.  That first birthday will come soon enough!

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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