BACKGROUND: Honey can contain spores of Clostridium botulinum, an organism that produces a potent neurotoxin known to cause severe illness in infants. Infant botulism occurs when C. botulinum spores in food, dust, or other materials are inhaled or ingested and germinate in the gut of infants who have not yet developed mature intestinal flora. For this reason, parents are advised not to feed honey (raw or otherwise) to children younger than 12 months old.
Infant botulism: Symptoms of botulism in infants under 12 months of age typically start with constipation and may include poor feeding and/or weak sucking, weakness, drooping eyelids, loss of head control and difficulty breathing. Severity can range from mild illness with gradual onset to paralysis, respiratory failure, and death. Prompt recognition of a suspect case, administration of antitoxin, and initiation of supportive care can halt progression of the disease.
The Texas Department of State Health Services will coordinate confirmatory testing at the DSHS laboratory. To obtain the antitoxin (Baby BIG) for treatment, physicians can contact the DSHS Emerging and Acute Infectious Disease Branch or the California Infant Botulism Treatment and Prevention Program.
Recent trends: Cases are rare; between 2013 and 2017, Texas has averaged 7 to 8 cases of infant botulism annually. However, since August, four patients have been treated for infant botulism and have a history of using a honey pacifier purchased in Mexico.
Investigators noted that these honey pacifiers and other food-containing pacifiers are available for sale at retailers as well as online, and that parents may not be aware of their potential danger.
Recommendations: Infants (children less than 12 months of age) should not be given honey, or pacifiers containing honey or other food products, because of the risk of contracting infant botulism. Consumption of honey is widely recognized as a risk factor for infant botulism by healthcare and public health professionals.
Infant botulism is a serious illness that requires urgent medical attention. All suspect cases should be immediately reported to public health officials.
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