“Just dip the soother in some honey”.  I remember hearing this piece of advice from a well-meaning grandmother when I was struggling with a fussy baby in the grocery store.  My infant was beyond colicky and refusing her soother.  I knew that you should never feed an infant under 12 months of age honey and was mortified to hear someone offer this advice. But what is it about honey that makes it unsafe for babies?  There is actually a risk of botulism in honey that makes it not suitable for children under 12 months old. 

All forms of honey can carry spores from a bacterium called Clostridium botulinum.  These bacteria live in soil so bees can carry it from the flowers or soil to the hive.  This is the bacterium that causes botulism, a very serious though rare illness.  In babies, this illness is called infantile botulism. 

Infantile botulism is a form of food poisoning caused by Clostridium botulinum.  Babies under 12 months of age do not have enough healthy bacteria in their guts to offer protection from the spores.  Clostridium botulinum develops from the spores and produces toxins. Signs or symptoms of infection can occur within 6 hours to 30 days of eating honey. 

Some signs and symptoms of infantile botulism include:

• Constipation
• “Floppy” baby – weakness in the arms, legs and neck
• Poor feeding
• Flat facial expression
• Weak cry
• Trouble breathing

How is infantile botulism caused by Clostridium botulinum treated?

As a parent, if your baby has eaten some honey (even a little bit!) you should watch for signs of constipation or poor feeding.  If these develop you need to go to the hospital. Babies need to be hospitalized if botulism is suspected because without treatment, it can cause paralysis, breathing difficulties and death.  Botulism immune globulin is a treatment for the infection caused by Clostridium botulinum that needs to be given as soon as possible. This medication can shorten the illness and reduce time in hospital, but the mainstay of treatment remains supportive care (IV fluids, nutrition and breathing support).

The bottom line is that all forms of honey, even those present in other foods or baked goods, should be avoided in babies less than 12 months of age due to the risk of botulism in honey.  This is the easiest way to protect your baby from a botulism and serious illness.

This post was co-authored by Erin Manchuk, BScPharm, BCGP and Stephanie Liu, MD, MSc, CCFP, BHSc.

References:

1. Long SS.  Infant botulism.  Pediatr Infect Dis J. 2001;20(7):707
2. https://www.canada.ca/en/health-canada/services/food-safety-vulnerable-      populations/infant-botulism.html.  Accessed 4April2019.
3. Rosow LK, Strober JB. Infant botulism: review and clinical update. Pediatr Neurol. 2015 May;52(5):487–92.
4. E. P, A. P, S. S. Infant botulism and indications for administration of botulism immune globulin. Pediatr Emerg Care [Internet]. 2014;30(2):120–7

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