Infant botulism treatment and prevention program

Frequently Asked Questions (FAQs)

General Questions

What is infant botulism?

Infant botulism is a rare, but serious illness. It happens to babies one year old or younger. Most babies who develop infant botulism are under 6 months of age.
Infant botulism is caused by a poison (toxin) that is made by a germ (bacteria) called Clostridium botulinum. When ingested, it can produce a neurotoxin in the body. This can affect a baby's nerves and muscles.
This poison can make it hard for the baby’s muscles to work. The illness gets worse over time. Babies might seem floppy.
Babies who have these signs should get medical care quickly. The illness is treatable, and most babies fully recover.
Sources of the bacteria can include honey or contaminated formula. Not all babies who consume contaminated formula or food will develop infant botulism.

How does infant botulism affect my baby?

Babies get sick when they swallow spores of a particular bacterium, Clostridium botulinum. This bacterium multiplies in the baby's large intestine and creates the toxin. Botulinum toxin causes weakness and loss of muscle tone. It blocks the nerve's ability to signal muscles to contract. It causes a form of paralysis.

What are the signs of infant botulism?

Difficulty feeding (sucking and swallowing)
A weak cry
Decreased facial expression
Loss of head control
Overall muscle weakness
Constipation
Difficulty breathing

Severe cases can lead to a need for a tube down the baby's throat to help them get air for babies unable to breathe.

If not treated, it can lead to paralysis and death.

How soon do signs of infant botulism appear?

Signs of infant botulism can appear more quickly or may appear up to 30 days after a baby swallows something that contains the bacterium including drinking contaminated formula Infant botulism is a very rare disease. Not all babies who consume contaminated formula or food will develop infant botulism.

That's why it's important for you and caregivers to watch your baby closely if they used ByHeart formula. Even if the baby seems fine at first, signs of infant botulism could still develop later.

If you notice any of these signs, contact a doctor right away.

How does a baby get infant botulism?

Babies get sick when they swallow spores of a particular bacterium, Clostridium botulinum. This bacterium multiplies in the baby's large intestine and creates the toxin. Infants cannot stop the toxin from developing. It is not fully understood why a baby is susceptible. Honey is the one identified and avoidable source of botulinum spores.

What should I do if my baby shows signs of infant botulism?

Call your baby's doctor or go to the emergency room immediately.
Infant botulism is serious and needs quick medical care. Early treatment can help your baby get better faster.
Tell the doctor your baby drank ByHeart formula.
This helps the doctor know what to look for and decide the best treatment.
It's also important to know that these signs can be caused by other illnesses, not just botulism. That's why it's so important to have your baby checked by a medical provider to find out what's going on.

Can my baby get infant botulism again?

No. Infants treated with BabyBIG^® will have protection for at least six months. This allows time for elimination of the toxin from the baby. This illness was recognized over 45 years ago, and there are no records of an infant getting sick more than once.

How is infant botulism treated?

Infant botulism is treated with supportive care. There is special attention to feeding and breathing needs. In the United States, the drug BabyBIG^® is used to shorten hospital stay and reduce complications. BabyBIG^® is botulism antitoxin that is approved by the FDA.

Are there any long-term consequences of infant botulism?

No. It is expected that infants will have a full and complete recovery after treatment. Recovery means the nerve endings are able to signal the muscles to contract. The toxin does not enter the brain. So the baby will have the intelligence, skills, and personality they were born with.

Food Consumption Questions

How does infant botulism differ from foodborne botulism?

Infant botulism: It affects babies under 1 year old. If they swallow botulism spores, then a toxin is created inside the baby's large intestine.
Foodborne botulism: Children and adults get this by eating food that is already toxic.

My infant was fed a commercial product containing honey. Should I be worried about infant botulism?

See the American Academy of Pediatrics guidelines about feeding solid foods to infants. Many foods and commercial products contain honey. Plus, the manufacturing processes vary. CDPH is unable to know if the food product contains the bacteria that causes infant botulism.

My infant was fed honey. What should I do?

See the American Academy of Pediatrics guidelines for feeding solids to infants.
Although honey may have the bacteria that causes infant botulism, a single feeding is not high risk. Not every jar of honey has botulinum spores in it.
Avoid feeding honey to infants 12 months of age or younger.
If, in the next few weeks you think your baby shows signs of infant botulism, reach out to your doctor.

Should I continue to breastfeed when my baby has infant botulism? What if I eat honey?

Yes, it is ok for a breastfeeding mother to eat honey. Botulism is not transmitted by breast milk. Continue breast feeding or the feeding of expressed breast milk even when the baby is ill. Hand washing should be strictly enforced. This is especially important in homes where honey is regularly consumed by caregivers. This will prevent honey on surfaces that may come into contact with the infant's mouth.

Even if a mother was to eat botulism spores in honey, the spores cannot get into her breast milk. Breast milk is not a source of the bacterial spores or the toxin that cause infant botulism.

Breast milk is the optimal nutrition for infants. Mothers should be encouraged to continue breastfeeding through their infant's illness and recovery. Refer to the Prevention section below.

How should I handle my baby's diapers during recovery?

Babies will still be getting rid of the toxin and bacteria for weeks to months after the illness begins. So, good handwashing should happen after each diaper change. Dispose of soiled diapers quickly in a secure place where no one else can come into contact with them. Persons with open cuts or wounds on their hands should wear gloves when changing diapers. During this time it is advisable for adults to:

Limit close contact of the patient with other infants and children.
Supervise any contact of the patient with other infants and children.

This is to prevent other children from coming into contact with a leaky diaper.

How can infant botulism be prevented?

The only known way to prevent infant botulism is to avoid feeding honey to infants 12 months or younger. Breastfeeding may slow the onset of illness if it develops.

How soon after BabyBIG® treatment can my child be immunized?

Immunizations should be delayed until the infant has good to full recovery of muscle strength and tone.

For some vaccines, 6 months must pass since BabyBIG® treatment. This is true for:

measles
mumps
rubella
varicella (chicken pox)

For some vaccines, there must be sustained return of normal bowel function after BabyBIG® treatment. This is true for vaccines for the rotavirus.

How do I contact other families in my area whose children also had infant botulism?

Call the Infant Botulism Treatment and Prevention Program (IBTPP). You can call collect and ask for help.
Visit the Infant Botulism Facebook page. If the link doesn't work, then just search for infant botulism.