Honey and infant botulism  

What is infant botulism?
Infant botulism is a neuroparalytic disease which affects otherwise healthy children less than one year old. It was first recognized in 1976. Early symptoms of infant botulism are constipation, generalized weakness and a weak cry. While most cases require hospitalization, fatal cases are rare.

What causes the illness?
Infant botulism is caused by the food poisoning bacterium Clostridium botulinum. This is the same bacterium that causes the food poisoning known as "botulism". Spores of these bacteria are ingested by the infant, grow and produce a neurotoxin (i.e. poison) in the infant's intestine.

Spores of C. botulinum may be easily ingested as they are common in soil and dust. This may lead to botulism in children younger than one year. Many infants who develop infant botulism have been fed honey, the only identified food source of C. botulinum spores causing infant botulism. Three of the sixteen infant botulism cases (as of June 1999) reported in Canada since 1979 have been associated with honey.

What are the symptoms?
The most common and earliest symptom is constipation. Other symptoms include generalized weakness, a weak cry, poor sucking reflex, irritability, lack of facial expression, and loss of head control. Paralysis of the diaphragm may result in respiratory collapse. While most cases require hospitalization, fatal cases are rare.

How common are C. botulinum spores in honey?
C. botulinum spores have been found in honey that was implicated in infant botulism. Random surveys of honey produced in Canada indicate that C. botulinum spores are rare. Spores of C. botulinum are present in less than 5% of honey and are typically found in very low numbers.

How can honey become contaminated with C. botulinum?
It is not known how honey becomes contaminated with C. botulinum. Spores of C. botulinum, which are commonly found in the environment, may be picked up by bees and brought to the hive. Other microorganisms found in the environment around honey (ie. bees, hives, pollen, soil, flowers, etc.) are also likely to occur in honey.

How common is infant botulism?
Infant botulism is rare in Canada. Only sixteen cases of infant botulism have been recorded in Canada since the first case in 1979. Three of these were associated with feeding honey to the infant. More cases of infant botulism may go unreported due to misdiagnosis. In the United States, approximately 70 to 90 cases of infant botulism are reported every year. 

How is infant botulism treated?
If your baby develops this disease, he/she may need to be cared for in a hospital for days or weeks. Close attention is paid to proper nutrition and pulmonary aid. Approximately one in four infants affected requires mechanical ventilation. Neither antibiotics nor antitoxin are usually administered. A complete recovery is made in nearly every case.

How can infant botulism be prevented?
Honey is the only food implicated in infant botulism. Since it is not essential for the nutrition of infants, parents and caregivers are reminded not to feed honey to infants less than one year of age. Honey should never be added to baby food or used on a soother to quiet a fussy or colicky baby. Concerned parents should discuss alternative methods for quieting their baby with their pediatrician or family doctor.

When should you call your physician?

  • if your baby is too weak to cry or suck as usual
  • if your baby does not move his or her bowels and has weak muscles
  • if your baby has a wobbly head because the neck is weak
  • if your baby has weak arms and legs
  • if your baby cannot swallow

What is Health Canada doing about infant botulism?
The Botulism Reference Service for Canada receives clinical and food samples to analyze for C. botulinum and botulinum neurotoxin. The Botulism Reference Service also assists in the investigation of suspected outbreaks of botulism and maintains a supply of antitoxin.

Health Canada is conducting research to determine the source of contamination of honey with C. botulinum and conducts periodic national surveys of honey to determine the incidence of C. botulinum in honey sold in Canada.