Botulism and Babies: What Parents Need to Know

When you are caring for a baby, it can be hard to know which symptoms are part of normal development and which ones deserve closer attention. Botulism is a rare, but   serious, condition that can severely affect infants. Knowing the warning signs can help parents act quickly when it matters most.

Jennifer Mullen, DO, a pediatrician with Children’s Memorial Hermann Pediatrics, explains that botulism is uncommon but potentially dangerous. “Botulism is caused by a bacterium called Clostridium botulinum and causes problems with muscle weakness,” she says. “It’s most commonly found in the soil or in foods that are contaminated.”

Why Botulism Is Different in Babies

Anyone can get botulism, but it presents differently in infants. The reason for this, Mullen explains, comes down to gut health. Infants are still developing “good, healthy bacteria or microbiomes” that adults or older kids have already developed. “Spores from the bacterium can be present in some foods, such as honey,” Mullen says, “and because infants don’t have a fully developed, healthy gut microbiome, the dangerous bacterium can grow in their stomachs.”

As the bacterium grows, it produces a neurotoxin that causes all the symptoms that you see with infant botulism. However, because it takes time for bacteria to grow in the gut, symptoms can be slow to develop.

Common Sources of Infant Botulism

The most well-known cause of botulism in infants is honey consumption. “Honey is the main source of botulism. Knowing this, pediatricians will always stress that infants under the age of one should not consume honey,” Mullen says. “We know that honey contains bacteria spores because of the way it’s produced, and because you never know which batch might have spores and which don’t, it’s best to avoid feeding honey to babies.”

Parents are often surprised to learn that honey can appear in unexpected places. “Honey Nut Cheerios is an obvious one to avoid,” Mullen explains. “But you also have to be cautious with many baked goods because honey is a common alternative sweetener.”

She also notes that some over-the-counter products, such as cough medications and all-natural home remedies, may also contain honey.

If you’re looking for a safe alternative to sugar and honey, agave can be a good choice. “Agave is a sweetener substitute that can be used without fear of causing botulism,” Mullen says. Another common concern parents have is whether honey can pass from mother to baby through breast milk. Mullen reassures parents that it does not. “Mom is able to consume honey,” she says. “The spores of the bacterium are larger molecules that are less likely to pass through mom’s body into her milk.”

Product recalls are another important safety measure. “Do not ignore recalls,” Mullen advises. “You’ll want to make sure you heed them and err on the side of caution. If there is a recall, check the lot numbers on your items, especially formula, because they’ll tell you which batch your items come from and whether you need to discard them or not.”

Finally, other potential sources include environmental exposure. “The bacterium that causes botulism can be found in the soil,” she says.

It’s reassuring to know of these common causes of botulism, but Mullen says that the source is unknown in over 90% of botulism cases.

Early Symptoms Can Be Easy to Miss

One of the challenges with infant botulism is that the early signs can look like common baby issues. “Symptoms honestly start out very vague,” Mullen offers. “Most of the time,        people will chalk it up to typical infant symptoms. For example, constipation is one of the first symptoms.”

From there, symptoms slowly progress. “They’ll have decreased feeding, not eating as well; their suck may be a little weaker,” Mullen explains.

As muscle weakness develops, parents may notice changes in their child’s movements. “The child will not be able to hold their head up as well as we would typically expect,” she says. “All of their muscles will start to weaken, something we call hypotonia, and they’ll have ‘floppy baby’ characteristics.”

A weaker cry can also be a sign. “You’ll start to see that their cry isn’t as strong,” Mullen says. “This happens when the toxins block the nerve endings and start to affect the muscles.”

These changes often happen gradually and progress over days to weeks.

When to Seek Emergency Care

If there is a known exposure, especially to honey (more information on this below) or concerning symptoms, Mullen stresses the importance of urgent evaluation, encouraging parents to make a trip to the emergency room to get further evaluation and testing.

“The ER doctors will look for that particular bacterium in the stool,” she explains. “Once identified as botulism, there is an immunoglobulin that’s used to treat it, so a positive case would require hospitalization and close monitoring.”

In a clinic setting, the baby’s medical history becomes critical. “I would ask if there was any known exposure,” Mullen says. “Had they or someone in care of the patient exposed the patient to any honey?”

If Mullen is concerned about one of her patients, she does not wait. “If I were truly worried about a botulism infection in a baby I evaluated, I would send them to the ER,” she says. “There’s no testing in the office that we would be able to do, and we’d want to be able to get them evaluated and treated as quickly as possible.”

A Final Word for Parents

Botulism in babies is rare, but recognizing the signs and knowing what to do can make a difference in outcomes. Mullen emphasizes that when something feels off, parents should trust their instincts. “If there are symptoms and signs,” she says, “contact your provider or take your child to the ER.”

Being informed, avoiding honey during the first year and acting quickly when symptoms arise can help keep babies safe during this critical stage of development.