The Full Story
Children under the age of twelve months are at risk of infant botulism if they are fed honey or anything with honey in it. Botulism spores can be found in honey; when swallowed, the spores release a toxin. Infants' systems are too immature to prevent this toxin from developing. In fact, most cases of botulism in the U.S. are in infants.
When botulism toxin is absorbed from the intestines, it affects the nervous system. The most common symptoms in infants are muscle weakness – the infant feels "floppy" and the eyelids can droop; constipation, sometimes for several days; poor sucking and feeding; and an unusual cry. Poor feeding can quickly lead to dehydration. Muscle weakness can lead to breathing difficulties.
No one knows exactly how long it takes for symptoms to develop, but it's thought to be about 3 to about 30 days. Over a period of a few days, a child can become acutely ill. Treatment in an ICU, including a respirator and feeding through an IV or a tube may be needed. If botulism is thought to be the cause of the child's illness, there is a treatment available, but it takes a day or so for this unusual drug to be delivered to hospitals. Children usually recover, even without this drug, but receiving it can shorten the length of time that a child spends in the hospital.
There are other sources of botulism spores, especially soil, so that honey is not the only way that infants can be exposed. However, NOT giving honey in any form to infants is an easy, safe way for parents to limit the risk.
Rose Ann Gould Soloway, RN, BSN, MSEd, DABAT emerita
Abdulla CO, Ayubi A, Zulfiquer F, Santhanam G, Ahmed MAS, Deeb J. Infant botulism following honey ingestion. BMJ Case Reports. 2012; doi:10.1136/bcr.11.2011.5153.
Brook I. Infant botulism. Journal of Perinatology. 2007;27:175–180. doi:10.1038/sj.jp.7211651.
Do not feed honey or products containing honey to infants under 12 months old.
This Really Happened
A 6-week-old boy was brought to the emergency room with a 2-day history of decreased activity, weak cry and poor feeding. He had been fed one teaspoon of honey every day for 2 weeks prior because of constipation. The brand and country of origin of the honey were not recorded in the medical record. The baby was admitted to the hospital and became increasingly limp, showing movement only of his fingers and toes. He had facial and eyelid drooping and flaccid paralysis (characterized by weakness and poor muscle tone) including his breathing muscles. A diagnosis of infant botulism was confirmed by cultures of stool and honey samples. The baby remained on a ventilator for 67 days. On discharge 3 months after admission he still had muscle weakness and required feeding by a nasogastric tube. However, at the end of the third month after hospital discharge his neurological examination was unremarkable and further follow-up was normal.
Reference: Van der Vorst, M.M.J., Jamal, W., Rotimi, V.O., & Moosa, A. Infant botulism due to consumption of contaminated commercially prepared honey. Medical Principles and Practice. 2006;15:456-458.