Infant Botulism and Honey

What is infant botulism?
Infant botulism is a very rare neuroparalytic disease that can occur in babies under one year of age. It occurs when an infant swallows spores of a particular bacterium (Clostridium botulinum) which grow and produce a neurotoxin in the infant’s intestine. In most adults and older children, this would not happen because the natural defenses which have developed in their intestines would prevent the growth of these spores. In some infants, these defenses have not yet developed, and so this gives the infection a chance to get a foothold and produce the toxin.

Have there been cases in Ireland?
To date there are no records of cases of infant botulism having occurred in Ireland.

What are the symptoms?
The symptoms begin with constipation, followed by lethargy, listlessness, poor feeding, difficulty swallowing, drooling, loss of head control and progressive weakness. The lack of energy and coordination may lead to the infant appearing "floppy" and "loose-limbed". In severe cases paralysis and difficulty breathing may occur, which can be fatal.

Why is infant botulism in the news in 2010?
Three cases were reported in the United Kingdom in the past year. This is highly unusual for this rare disease. All three cases had a history of being given honey.

Why should you not give an infant honey?
Honey can be contaminated with Clostridium botulinum spores and is the only food implicated in infant botulism. International surveys have shown approximately 2 to 7% of honey samples contain C. botulinum spores. Parents and caregivers should not give honey to infants less than one year of age. Honey should never be added to baby food, given to sooth a cough or used on a soother to quiet a fussy or colicky baby. Concerned parents should discuss alternative methods for quieting their baby with their public health nurse or family doctor.

Is it okay for a breastfeeding mother to eat honey?
Yes, it is ok for a breastfeeding mother to eat honey. Botulism is not transmitted by breast milk.

How can honey become contaminated?
Spores of Clostridium botulinum, which are commonly found in the environment (soil and dust) may be picked up by bees and brought to the hive.

How is infant botulism diagnosed?
The diagnosis of infant botulism is established by identification of Clostridium botulinum organisms and/or toxin in the patient's faeces.

How is infant botulism treated?
Good supportive care in a hospital is the mainstay of treatment, which involves tackling the symptoms. The respiratory failure and paralysis that occur with severe botulism require the infant to be kept breathing on a ventilator for maybe several weeks. The vast majority of patients recover without long-term consequences.