Babies and Botulism: One Baby's Story

November 4, 2009

Logan Douglas, 16 weeks old, is in an Edinburgh, Scotland hospital, in "critical but stable condition" today – the first Scottish victim of infant botulism since 1983 (as far back as can be traced in the country's electronic records).

Six weeks ago, according to BBC, Logan was admitted to Edinburgh's Royal Hospital for Sick Children with symptoms of infant botulism. A lab test confirmed the diagnosis. Doctors suspect that Logan contracted the disease as a result of sucking on a pacifier that had been dipped in honey.

Infant botulism occurs when a baby or toddler with an immature digestive system eats something – usually honey – that contains live spores of Clostridium botulinum. These spores, which are unable to develop in a mature digestive system, are able to grow and produce a deadly toxin in the digestive tract of infants who are less than one year old.

The toxin produced by Clostridium botulinum is a neurotoxin; it affects the nervous system, causing a progressive paralysis. In babies, the first symptom usually is constipation. This is usually followed by poor feeding, weakness and lethargy. The baby has difficulty holding up its head.

There are few treatment options for infant botulism. Antibiotics do not work. In 2003, US Food and Drug Administration approved an orphan drug, BabyBIG®, to treat infant botulism. BabyBIG® consists of human-derived antitoxin antibodies that bind to and neutralize the botulism toxin.

BabyBIG® is not readily available outside of the United States and Canada. In its absence, a patient simply receives supportive care until the microbe and the toxin clear out of the body. This takes time, as Logan's parents are finding out.

Fortunately, infant botulism is an infrequent occurrence. There have been only a half-dozen cases in the UK since 1976. In the United States, there are fewer than 100 cases reported annually. It also is a totally preventable disease.

The odds of survival are in Logan's favor. Fewer than 2% of botulism cases are fatal – usually as a result of respiratory arrest. But it could take months for him to recover fully.

Protect your infant from infant botulism. DO NOT feed honey or corn syrup (another source of spores) – not even a tiny amount – to any infant or toddler who is younger than 12 months old.

Note: Thanks to eFoodAlert reader Mats Peterz for pointing me to the BabyBIG® treatment information.

A Honey of a Dilemma

A recent study reported by Pennsylvania State University has confirmed what Grandma told us many years ago. The best remedy for a sore throat is a spoonful of honey. Unfortunately, for children under one year old, eating honey carries a risk of developing infant botulism.

Infant botulism was first diagnosed in California nearly 30 years ago, and is thought to be one of the causes of Sudden Infant Death Syndrome. In the typical form of botulism, the microbe grows in a food and produces its toxin before the food is eaten. But infant botulism results when the victim ingests spores of Clostridium botulinum (or one or two other species of Clostridium). Those spores then germinate inside the intestines, and the toxin-producing bacteria multiply.

Symptoms of infant botulism include lethargy, constipation, and poor muscle tone. Infant botulism can be deadly if untreated. It is essential to have your infant seen by a doctor as soon as you suspect that something is wrong. Victims of infant botulism require an extended hospital stay - often in a pediatric intensive care unit and, usually, with mechanical breathing assistance for part of their stay. Intravenous treatment with Botulism Immune Globulin can speed up the recovery period. With appropriate care, the chances for a full recovery are good.

There is some controversy over the extent to which honey is the source of infant botulism. It is certainly not the only source of C. botulinum spores. The microbe is a normal inhabitant of soil and has been found in house dust and the contents of vacuum cleaner bags. But contaminated honey has been linked to some of the cases that have been reported in the United States, Japan and a handful of other countries, including Denmark.

An obvious question is whether certain types of honey (raw, pasteurized, organic, commercial) are safer than others. I have not found any evidence that this is so. The spores of C. botulinum are heat-resistant. They can easily survive pasteurization. And while C. botulinum will not multiply in the honey, its spores are very capable of surviving in a resting state until they reach a more welcoming environment, such as an infant’s large intestine.

The authors of the Pennsylvania State University study have suggested that honey is a better choice for relieving a child’s sore throat than commercial cough suppressant syrups. They have also - correctly - included a caution that honey should not be used for this purpose with children younger than one year. It’s far better for you and your infant to spend a few sleepless nights due to the infant’s sore throat than to risk exposing your baby to a potentially life-threatening illness.