Recent reports of infant botulism serve as a reminder to counsel families on the risks of feeding honey to children under age 12 months. The AAP advises against putting honey in food, water or formula that is fed to infants. Processed foods containing honey also should not be given to infants.
Honey contains Clostridium botulinum spores which can grow and release toxins in an infant’s intestines, causing infant botulism. It is the most common category of botulism, affecting 150 infants in 29 states and the District of Columbia, according to 2016 data from the Centers for Disease Control and Prevention National Botulism Surveillance summary.
Families cite a variety of reasons why they offer honey to infants, including tradition, infant preference and perceived health benefits (e.g., to prevent constipation or colic).
Honey-filled pacifiers have been implicated as a source of illness for four infants in Texas. The Food and Drug Administration is now warning families not to use or purchase honey-filled or honey-dipped pacifiers. The pacifiers containing honey had been sold online and in Mexico.
Honey pacifier use has been observed among indigent pediatric populations in Texas, with 80% of mothers reporting that they didn’t know of the dangers to infants, according to a 2013 Pediatrics study.
The Red Book outlines the following symptoms of infant botulism: constipation, followed by “decreased movement, loss of facial expression, poor feeding, weak cry, diminished gag reflex, ocular palsies, loss of head control, and progressive descending generalized weakness and hypotonia” (see link below).
Recovery can take weeks to months, according to the Red Book. Human botulism immune globulin (BIG-IV; trade name Baby BIG) administered immediately can reduce days of mechanical ventilation and intensive care unit stay. Administered through state public health officials, Baby BIG is an FDA-licensed antitoxin and the first-line therapy for naturally occurring infant botulism.
If you suspect that a patient has botulism, contact your state health department as soon possible.