Infant botulism treatment and prevention program

Important Notice

The Infant Botulism Treatment and Prevention Program (IBTPP) is currently receiving a high volume of calls and emails.

Parents and caregivers

If you have questions, e-mail IBOHotline@cdph.ca.gov.
The Infant Botulism Hotline (1-833-398-2022) is available Monday to Friday 8 a.m. –5 p.m. Pacific Time (PT).

Health care providers

The clinical support line (510-231-7600) remains open 24/7 for suspected infant botulism cases. Calls from medical providers receive priority response.

If your child has clinical symptoms or you are concerned about their health, contact your health care provider. In an emergency, seek medical care immediately.

About Infant Botulism Testing

This page includes scientific and laboratory information for health care providers who diagnose and test for infant botulism.

If you are a parent or caregiver seeking general information about symptoms, treatment or what to do if you are concerned about your baby, see the Infant Botulism webpage.

Clostridium botulinum

Clostridium botulinum is a spore-forming, obligately anaerobic, Gram-positive bacillus that produces a heat-labile neurotoxin and is commonly found in soil. Infant botulism differs from foodborne botulism.

Two other clostridial species have acquired the gene to produce botulinum toxin. Very rare strains of C. butyricum and C. baratii have been found to produce botulinum toxin type E and toxin type F, respectively. Most of these rare toxigenic C. butyricum and C. baratii strains were discovered because they caused intestinal (infant) botulism.

How C. botulinum Causes Infant Botulism

In infant botulism, babies ingest spores which then grow in the colon and produce toxin from within the child. In foodborne botulism, people ingest toxin that is in spoiled food. There are eight antigenically distinct toxin types (A-H) but most cases of infant botulism are caused by types A and B.  All of the botulinum toxin types act by cleaving proteins necessary for the release of acetylcholine into the neuromuscular junction. The result of the toxemia is a descending, bilateral, symmetric, flaccid paralysis.

Signs of Infant Botulism

Common signs of infant botulism include:

Difficulty feeding, sucking or 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.

Laboratory Diagnosis

Infant botulism is first suspected based on clinical features and the decision to treat should not be delayed for lab confirmation.
Follow the CDC’s steps:
Step 1: Call
Step 2: Treat
Step 3: Test
Step 4: Notify

Lab testing varies based on the state in which the patient resides. Clinicians should contact their local or state public health department to inquire about testing.
Laboratory diagnosis, as performed in California, has two parts:

The first component is to perform a direct toxin analysis. This requires the extraction of toxin directly from the fecal specimen and the use of specialized techniques to identify and type the toxin.
The second part is to culture the feces using specialized media and techniques in order to isolate Clostridium botulinum.

Fecal specimens for infant botulism diagnostic testing can be collected before or after antitoxin administration. BabyBIG® does not neutralize botulinum toxin present in the lumen of the intestine, nor does it kill or prevent the growth of C. botulinum or inhibit the formation of botulinum toxin in the infant’s large intestine.