Recent reports of infant botulism serve as a reminder to counsel families on the risks
of feeding honey to children under age 12 months. The AAP advises against putting
honey in food, water or formula that is fed to infants. Processed foods containing
honey also should not be given to infants.
Honey contains Clostridium botulinum spores which can grow and release toxins in an infant’s intestines, causing infant
botulism. It is the most common category of botulism, affecting 150 infants in 29
states and the District of Columbia, according to 2016 data from the Centers for Disease
Control and Prevention National Botulism Surveillance summary.
Families cite a variety of reasons why they offer honey to infants, including tradition,
infant preference and perceived health benefits (e.g., to prevent constipation or
Honey-filled pacifiers have been implicated as a source of illness for four infants
in Texas. The Food and Drug Administration is now warning families not to use or purchase
honey-filled or honey-dipped pacifiers. The pacifiers containing honey had been sold
online and in Mexico.
Honey pacifier use has been observed among indigent pediatric populations in Texas,
with 80% of mothers reporting that they didn’t know of the dangers to infants, according
to a 2013 Pediatrics study.
The Red Book outlines the following symptoms of infant botulism: constipation, followed by “decreased
movement, loss of facial expression, poor feeding, weak cry, diminished gag reflex,
ocular palsies, loss of head control, and progressive descending generalized weakness
and hypotonia” (see link below).
Recovery can take weeks to months, according to the Red Book. Human botulism immune globulin (BIG-IV; trade name Baby BIG) administered immediately
can reduce days of mechanical ventilation and intensive care unit stay. Administered
through state public health officials, Baby BIG is an FDA-licensed antitoxin and the
first-line therapy for naturally occurring infant botulism.
If you suspect that a patient has botulism, contact your state health department as