Infant Botulism

What is infant botulism?
Infant botulism is a very rare condition that occurs in children under six months of age.

How do babies catch infant botulism?
Infant botulism is caused by anaerobic bacteria called Clostridium botulinum, which live in soil and dust and may contaminate foodstuff. Infant botulism is caused by consuming/ingesting the spores of the botulinum bacteria, which then germinate, multiply in the infant's intestine and release a toxin.

The risk of developing infant botulism is higher in infants who eat honey, and as a result, the Food Safety Authority of Ireland advises that infants under the age of one year are not fed honey. Also, HPSC advises that reptiles should not be kept as pets in a house where there are children under the age of five due to the risk of botulism and other infections.

What are the symptoms?
The symptoms are due to the toxin and begin with constipation, followed by lethargy, listlessness, poor feeding, difficulty swallowing, drooling, loss of head control and progressive weakness. The lack of energy and coordination may lead to the infant appearing "floppy" and "loose-limbed". In severe cases paralysis and difficulty breathing may occur, which can be fatal.

How is infant botulism diagnosed?
The diagnosis of infant botulism is established by identification of C. botulinum organisms and/or toxin in the patient's faeces.

How is infant botulism treated?
Good supportive care in a hospital is the mainstay of treatment, which involves tackling the symptoms. The respiratory failure and paralysis that occur with severe botulism require the infant to be kept breathing on a ventilator for maybe several weeks. The vast majority of patients recover without long-term consequences.

Have there been any cases of infant botulism in Ireland?
There have been cases of infant botulism in Ireland, linked to keeping turtles as pets.  Because a wide range of reptiles can carry harmful bacteria, the HPSC advises that reptiles (especially turtles) are not appropriate pets for small children and should not be kept in households in which there are children under the age of five.  In addition, if you own turtles and you visit a household in which there are children under five (and particularly households with infants under the age of one), you should wash your hands immediately after contact with turtles or their water and again on entering the house in which there are small children. Further information on reptiles and the risk of infectious diseases is available here.

Further information

A recent extensive Epi-Insight article reviews infant botulism.

For information on other forms of botulism please see Botulism.

Last updated: 19 April 2013