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Infant botulism

Definition

Infant botulism is a potentially life-threatening disease caused by a bacterium called Clostridium botulinum. It grows inside a baby's gastrointestinal tract.

Causes

Clostridium botulinum is a spore-forming organism that is common in nature. The spores may be found in soil and certain foods (such as honey and some corn syrups).

Infant botulism occurs mostly in young infants between 6 weeks and 6 months of age. It may occur as early as 6 days and as late as 1 year.

Risk factors include swallowing honey as a baby, being around contaminated soil, and having less than one stool per day for a period greater than 2 months.

Symptoms

Symptoms may include:

• Breathing that stops or slows

• Constipation

• Eyelids that sag or partially close

• "Floppy" body

• Absence of gagging

• Loss of head control

• Paralysis that spreads downward

• Poor feeding and weak suckling

• Respiratory failure

• Extreme tiredness (lethargy)

• Weak cry

Exams and Tests

The health care provider will do a physical exam. This may show a decreased muscle tone, a missing or decreased gag reflex, missing or decreased deep tendon reflexes, and eyelid drooping.

A stool sample from the baby may be checked for the botulinum toxin or bacteria.

Electromyography (EMG) can be done to help tell the difference between muscle and neurological problems.

Treatment

Botulism immune globulin is the main treatment for this condition. Infants that get this treatment have shorter hospital stays and milder illness.

Any infant with botulism must receive supportive care during their recovery. This includes:

• Ensuring proper nutrition

• Keeping the airway clear

• Watching for breathing problems

If breathing problems develop, breathing support, including the use of a breathing machine, may be needed.

Antibiotics do not appear to help the baby improve any faster. Therefore, they are not needed unless another bacterial infection such as pneumonia develops.

The use of human-derived botulinum antitoxin may also be helpful.

Outlook (Prognosis)

When the condition is detected and treated early, the child most often makes a full recovery. Death or permanent disability may result in complicated cases.

Possible Complications

Respiratory insufficiency can develop. This would require assistance with breathing (mechanical ventilation).

When to Contact a Medical Professional

Infant botulism can be life threatening. Go to the emergency room or call 911 or the local emergency number right away if your infant has symptoms of botulism.

Prevention

In theory, the disease might be avoided by preventing exposure to spores. Clostridium spores are found in honey and corn syrup. These foods should not be fed to infants less than 1 year old.

References

Birch TB, Bleck TP. Botulism (Clostridium botulinum). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 245.

Guptill JT, Sanders DB. Disorders of neuromuscular transmission. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 108.

Khouri JM, Arnon SS. Infant botulism. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 147.

Norton LE, Schleiss MR. Botulism (Clostridium botulinum). In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 237.

Review Date: 8/5/2023

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.