Infant Botulism

Important information about infant botulism:

Infant botulism is a rare illness caused by ingestion of a toxin from the bacteria Clostridium botulinum. Botulinum toxin causes weakness by stopping nerves from telling muscles to move. It can affect your baby’s ability to move, eat, or breathe. Infant botulism only happens in babies under 12 months old. Most babies fully recover over weeks to months.

How Babies Get It

Babies swallow spores from:

• Honey: Never give honey to infants under 1 year of age

• Soil or dust: Spores are found naturally in the environment

Early Signs and Symptoms

• Constipation

• Poor feeding or weak sucking

• Weak cry

• Floppy arms or legs

• Droopy eyelids

• Trouble breathing

Diagnosis

Healthcare providers diagnose infant botulism by looking at your baby’s symptoms and exam results, and by running tests to rule out other causes.

A stool sample will be collected using an enema and sent to the state Public Health Department to test for the botulism toxin.

• Preliminary results may come back in a few days.

• Final results usually take about 4 weeks.

The local Public Health Department will contact you about your baby’s test results.

Instructions during hospitalization:

Your baby will stay in the hospital for treatment. The care team will watch their breathing, nutrition, and hydration. Most hospital stays last 2 to 3 weeks, depending on how your baby is doing.

During the hospital stay:

• Your baby will stay in the ICU at first, until breathing muscles get stronger.

• After that, your baby will move to the general pediatrics floor for monitoring and therapies as feeding muscles improve.

• A breathing tube may be needed while your baby recovers.

• Most babies will need a feeding tube in the hospital, and some go home with a temporary feeding tube while their feeding muscles continue to recover.

Your baby will be cared for by several teams, including:

• ICU healthcare providers and nurses

• General pediatricians

• Neurologists

• Physical and occupational therapists

• Speech/feeding specialists

• Nutrition team

Treatment

If your team suspects infant botulism, they will give BabyBIG® (botulinum immunoglobulin).

• BabyBIG is a medicine made from antibodies that help remove the toxin from your baby’s body.

• This treatment helps babies recover faster and spend less time in the hospital.

• BabyBIG comes from a national supply and usually arrives within 12–24 hours.

Recovery happens slowly over weeks to months as the muscles and nerves become stronger and communicate better.

• Oral feeding is usually the last skill to come back.

• It’s normal for babies to look strong, maybe even sit up again, but still struggle to coordinate the small muscles in the mouth and throat needed to feed safely.

• Many babies go home with a temporary feeding tube while continuing speech therapy as an outpatient.

• Some older babies may need inpatient rehabilitation if they need more support.

Instructions after Discharge:

Recovery at home can take a few months to a year. Your child may need ongoing follow-up appointments with various teams and therapies.

Follow-Up

• Appointments with pediatrician, neurologist, physical and speech therapists

• Early Childhood Intervention services (ECI) to support development

• Tell all caregivers (daycare, babysitters) of your baby’s special care needs

Diapers

• Handwashing is essential. Always wash hands with soap and water for at least 15 seconds. The botulism toxin can shed in the stool for weeks to months.

• Dispose of soiled diapers quickly in an area away from people and animals. Wear gloves when changing diapers if open cuts or wounds are on caregiver hands.

Return to Daycare

Limit close contact with other infants and children. Your baby may continue to release the toxin for weeks to months, and limiting close contact ensures other infants under 12 months do not encounter the toxin. All contact should be closely supervised by an adult.

Vaccines

• Live-virus vaccines (measles, mumps, rubella, varicella) should be delayed 6 months after receiving BabyBIG. It can interfere with effectiveness of live-virus vaccines.

• Avoid rotavirus vaccine until your baby’s bowel function returns to normal.

• Talk to your primary care provider about your child’s vaccine schedule.

Call your healthcare team if you have questions, concerns or if your child:

• Shows new weakness, or changes in activity level, or abnormal movements.

• Your baby has difficulty breathing or has long pauses when breathing while sleeping.

• Has signs of dehydration, including:

  • They will not take breast/bottle or tube feedings.

  • Vomiting or diarrhea that makes it hard to keep feeds down.

  • Wetting fewer diapers or urinating less often. Infants under 6 months of age should not go longer than 4 to 6 hours without urinating.

  • Difficult to soothe or appear weak.

  • Few or no tears when crying.

Reviewed September 2025 by Jordan Royer MSN, RN, CPN, CPHON