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Causes, signs and symptoms of infant botulism each and every parent should be aware of

By Dr. Sean Michael McTigue
University of Kentucky

You have probably heard of food-borne botulism illness in adults, but there is a very rare version of botulism that occurs in infants as well. This illness poses different risks in infants than it does in adults, so it’s important to be aware of the causes, signs and symptoms.

A patient recovering from infant botulism displaying continued neck muscle weakness with improved muscle tone, ptosis, and facial expression. (Photo courtesy of the California Department of Public Health, via CDC)

What is botulism? Botulism is typically a foodborne illness from a specific kind of bacteria in the soil where your food comes from. When that food is canned or jarred unproperly, those bacteria cells can germinate and release the toxin which causes botulism illness. This toxin is what is used in Botox injections, but when ingested through food, can cause someone to have severe paralysis to the point of death.

Botulism in infants. Botulism in infants is completely different than botulism in adults. Babies who are less than one year of age don’t have the immune system to fight off botulism bacteria. Therefore, when they ingest the spores of the bacteria themselves, those spores are able to actually germinate inside their stomach and slowly begin to release the toxin into their bodies. In this case, it will lead to the same type of paralysis as in adults, but the initial signs are much different.

Where does the bacteria come from? When a baby comes in with botulism, we typically find that there is a soil disruption happening in their area, which can happen in any way. A dry windy day or heavy construction can be a cause of this bacteria spreading.

Looking for signs. This is a rare disease, but there have been some unusual cases in Kentucky lately. Some signs you will want to be looking for include:

• Not being able to suck from a bottle or difficulty with feeding
• Trouble swallowing
• Pooling of breastmilk or formula in the mouth
• Drooling of formula or breast milk from the mouth
• Gurgling or choking sounds when trying to suck and swallow
• Baby becoming weak and floppy

If you see these symptoms occur, this is when you will want to reach out to your pediatrician or go to the emergency room.

Recovery. Fatalities from infantile botulism are very rare because these infants typically are brought to the hospital before the paralysis gets serious. Even if a baby does end up with respiratory paralysis, they can be put on a ventilator and supported until they fully recover. The babies are also treated with botulism immunoglobulin, which are antibodies that bind to the toxin and can help a baby heal.

Dr. Sean Michael McTigue, M.D., is medical director for pediatric infection control at University of Kentucky HealthCare

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