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Infant botulism

Definition

Infant botulism is a potentially life-threatening disease in which the bacteria Clostridium botulinum grows within the baby's gastrointestinal tract.

Causes, incidence, and risk factors

Clostridium botulinum is a spore-forming organism that is common in nature. The spores may be found in soil and certain foods (such as honey and some corn syrups).

Infant botulism occurs mostly in young infants between 6 weeks and 6 months of age. It has been reported to occur as early as 6 days and as late as 1 year.

Risk factors include swallowing honey as a baby, being around contaminated soil, and having less than one stool per day for a period greater than 2 months.

Symptoms

• Breathing stops or slows
• Constipation
• Eyelids sag or partially close
• Infant appears "floppy"
• Infant doesn't gag
• Loss of head control
• Paralysis that spreads downward
• Poor feeding and weak suckling
• Respiratory failure
• Tired all the time (lethargy)
• Weak cry

Signs and tests

The doctor will perform a physical exam. The doctor may note decreased muscle tone, a missing or decreased gag reflex, missing or decreased deep tendon reflexes, and eyelid drooping.

A stool sample from the baby may be examined to check for the botulinum toxin or bacteria.

Electromyography (EMG) can be done to help tell the difference between muscle and neurological problems.

Treatment

Botulism immune globulin is the main treatment for this condition. Infants that receive this treatment have shorter hospital stays and less severe illness.

Any infant with botulism must receive supportive care during their recovery. This includes:

• Ensuring proper nutrition
• Keeping the airway clear
• Watching for breathing problems

If breathing problems develop, breathing support, including the use of a breathing machine, may be needed.

Antibiotics do not appear to help the baby improve any faster, and are not needed unless another bacterial infection such as pneumonia develops.

The use of human-derived botulinum antitoxin may also be helpful.

Support Groups

Expectations (prognosis)

Full recovery is expected with early recognition and supportive treatment. Death or permanent disability may result in complicated cases.

Complications

Respiratory insufficiency can develop, requiring assistance with breathing (mechanical ventilation).

Calling your health care provider

Since infant botulism can be life threatening, go to the emergency room or call the local emergency number (such as 911) immediately if your infant has symptoms of botulism.

Prevention

Theoretically, the disease might be avoided by preventing exposure to spores. Since honey and corn syrup are sources of Clostridium spores, they should not be fed to infants less than 1 year old.

References

Arnon SS. Botulism (Clostridium Botulinum). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 207.