Infant botulism is a rare condition caused by the absorption of toxins produced by the Clostridium botulinum bacterium, a rod-shaped spore-forming bacterium. This bacterium grows in the gastrointestinal tract and releases an enteric toxin that can cause intestinal immobility and progressive paralysis.
botulinum is commonly found on surfaces such as carpets and floors, and sometimes, it can also contaminate honey and grape molasses. This is why babies under one year are not fed honey or anything that contains honey (1).
A baby’s intestines lack the protective intestinal flora and Clostridium-inhibiting bile acids, allowing C. botulinum to flourish and colonize the large intestine and cause infant botulism. This bacterial infection mostly affects infants between one to six months of age; however, cases have been reported in babies as early as one week of age and as late as 12 months of age (2)
Infant botulism can be treated through early diagnosis and treatment. Here, we tell you about the causes, symptoms, and treatment options for infant botulism.
Signs and Symptoms Of Infant Botulism
Some of the symptoms of infant botulism include:
- Slowing down of breathing
- Drooping eyelids
- Floppy infant syndrome (low muscle tone)
- Poor feeding and weak sucking
- Loss of head control
- Weak cry
- Muscle weakness
- Reduced gaging
- Paralysis that might spread downward (3)
The time from the appearance of early symptoms to the onset of severe complications ranges from less than 24 hours to more than a week. It is important to identify the signs of botulism early on to prevent complications. Next, let’s discuss the diagnosis of infant botulism.
If your baby shows signs of respiratory distress or has difficulty breathing, it is best to take them to a pediatrician. Also, if the baby shows signs of relapse after getting discharged from the hospital, it is best to consult your doctor.
Botulism in babies can be identified through clinical tests, spinal fluid analysis, and electrodiagnostic testing imaging (EMG). The doctor might isolate the causative organism from the fecal matter to support the diagnosis. EMG is highly reliable for the diagnosis of infant botulism but might have false-positive results in some cases (2).
Risks And Complications Of Infant Botulism
According to a case-controlled study, decreased frequency of bowel movements, such as less than one per day for at least two months, is found to be the risk factor for botulism among infants who are older or less than two months. Breast-feeding and ingestion of corn syrup are also associated with the disease.
In infants younger than two months, living in the rural farming area was the only significant risk factor as per the same study (4).
If the disease is left unrecognized, it can lead to paralysis of the respiratory muscles, leading to low oxygen levels in the blood and respiratory arrest (5).
Other complications such as colitis, anemia, inappropriate antidiuretic hormone secretion, urinary tract infection, and secondary bacterial infections are also seen (6). Talk to your pediatrician if you have any questions.
Treatment For Infant Botulism
The disease’s natural course consists of a progression of weakness over one to two weeks until it worsens. If the baby is supported during this stage to avoid respiratory failure and flaccid paralysis, they may recover from the weakened state in two to three weeks without the requirement for baby immunoglobulins (BIG-IV) (6).
BIG-IV works by neutralizing the free botulinum toxin. It may not show immediate improvement in the symptoms but help prevent the toxin from binding, thus helping in faster recovery. Studies state that babies who were given BIG-IV had a hospital stay for 2.6 weeks, while others stayed for 5.7 weeks (7).
Relapse of infant botulism may occur within 13 days of hospital discharge, so close monitoring is necessary during the first month after recovery (5).
Since bacteria cause the disease, care should be taken to prevent the infection’s spread. The patient’s excreta would contain the bacterial spores for weeks to months after the infection, so dispose of the stools appropriately, and wear gloves to prevent wound botulism (6).
Prevention Of Infant Botulism
Since the infection is spread through bacteria, you can prevent infant botulism by preventing the causative organism. Ensure to keep the premises clean and dustproof, and avoid feeding honey or products that may contain honey to babies under 12 months(4).
Infant botulism does not have any long-term health complications. However, ensure you diagnose the infection early on and provide necessary treatment after consulting the doctor to prevent it from becoming a severe condition. Also, take the necessary preventive measures to avoid botulism, and ensure you do not allow the spread of infection.
2. Eren Cagan, et al.; Infant Botulism; The Eurasian Journal Of Medicine (2010)
3. Infant botulism; MedlinePlus
4. JS Spika, et al.; Risk factors for infant botulism in the United States; American Journal of Diseases of Children (1989).
5. Nadine Cox and Randy Hinkle; Infant Botulism; American Family Physician (2002).
6. Emma McCutcheon, et al.; Infantile Botulism In British Columbia: A Case Report; British Columbia Medical Journal (2019).
7. Laura Jackson, et al.; Infant Botulism in the Very Young Neonate: A Case Series; AJP Reports (2017).