Botulism in Infants

Overview, Causes, & Risk Factors

Botulism is a condition caused by a toxin made by bacteria called Clostridium botulinum. This toxin triggers sudden, progressive weakness and paralysis. Infant botulism is usually seen in babies younger than 6 months old.

What is going on in the body?

In adults, botulism occurs only after eating foods that contain the full-blown toxin. In infants, tiny spores from the bacteria that would not be harmful to an adult can grow in the baby's gut. Once there, they mature and release toxins.

These toxins enter the bloodstream and are carried to the ends of the nerves that control muscles. They block the release of a chemical called acetylcholine that transmits signals from nerves to muscles. If this chemical is not released at the right time, the muscle cannot contract. This causes muscle weakness or paralysis.

The diaphragm is a strong layer of muscle below the lungs. If nerves in the diaphragm are blocked, the baby will not be able to breathe. If untreated, this can cause death.

What are the causes and risks of the infection?

The Clostridium botulinum bacteria makes one of the most poisonous substances known to man. Just a small amount of the toxin it produces can be fatal. Some sources of the bacteria and its toxins include:

honey, which should never be fed to babies younger than age 12 months

soil, which can infect a wound

canned or home-preserved foods that were not cooked enough to destroy the spores

Symptoms & Signs

What are the signs and symptoms of the infection?

Usually, symptoms start 12 to 36 hours after the bacteria spores enter the body. It can take just a few hours, though, or as long as a week. The symptoms include:

constipation as muscles in the gut stop working properly

muscle weakness

fewer movements of the arms and legs

loss of head control

problems feeding

a weak cry

loss of the gag reflex and other nervous system problems

worsening paralysis of the muscles of the body

respiratory failure, which is the inability to breathe

Diagnosis & Tests

How is the infection diagnosed?

Diagnosis includes a thorough exam by a doctor. The diagnosis can be made based on the infant's signs and symptoms . Be sure to tell the doctor about any possible exposures. Tests to confirm the diagnosis include the following:

a stool sample to check for the bacteria

testing of the food that may have caused the botulism

an electromyogram, also called an EMG, which may show signs of abnormal muscle function. An EMG is a study of how the muscles respond to electrical stimulation.

Prevention & Expectations

What can be done to prevent the infection?

To keep babies safe, follow these steps.

Never give honey to an infant under age 1in a bottle, on a nipple, or in any other way.

Do not allow soil or dirt to get into the belly button before the cord stub falls off at around 2 weeks of age.

Handle food carefully and make sure it is fully cooked.

Never eat canned goods if the can is swollen or the safety button on the lid has popped up before the lid was opened. Food safety cannot be judged by appearance. Food may not taste or look spoiled even if the toxin is present.

Botulinum spores are heat-resistant. Although the toxin may be destroyed by heat, by boiling foods for 10 minutes or heating at 176 degrees to 212 degrees Fahrenheit for 30 minutes before eating, only high temperatures obtained in a pressure cooker can destroy bacterial spores in food. All low-acid foods must be canned in a pressure canner at 240 degrees Fahrenheit (or 115.6 degrees Celsius) to destroy botulism spores.

Commercially canned foods are rarely responsible for botulism. But when sealed foods are not processed at high enough temperatures to kill the organism, the toxin and spores can thrive in the sealed container. The bacteria do not need oxygen to survive.

What are the long-term effects of the infection?

When botulism is not treated, the death rate is very high. In recent years, it has decreased among adults due to the development of an antitoxin.

If a baby survives the first few days after botulism has been diagnosed and treated, recovery is usually complete. If serious respiratory paralysis occurs, this condition may be fatal.

What are the risks to others?

This illness does not spread from one person to another. However, tainted food or soil may affect anyone who comes into contact with it.

Treatment & Monitoring

What are the treatments for the infection?

Treatment of infant botulism includes:

hospitalization

supportive measures, such as bed rest, fluids given through a vein, comforting the infant and family

special enemas, which may be used to clear out the spores in the intestinal tract

penicillin to kill the bacteria in the gut

a ventilator, or artificial breathing machine

It is not clear whether antitoxin can help in infant botulism.

What are the side effects of the treatments?

Side effects vary depending on the treatment used. Penicillin can cause stomach upset and allergic reactions. Before the botulism antitoxin is given, a doctor may order a skin test to make sure the baby does not have an allergy to the antitoxin.

What happens after treatment for the infection?

Once a baby has been treated and symptoms have gone away, no further treatment is needed. If a baby survives the first few days of botulism, it may take months for symptoms to subside. Recovery is usually complete. If necessary, physical therapy or occupational therapy may help a baby recover muscle function.

How is the infection monitored?

A doctor may monitor the baby closely over the first few months while symptoms of botulism disappear. The baby's ability to breathe properly and muscle control will be watched closely. Any new or worsening symptoms should always be reported to the doctor.