Honey and Infant Botulism

Honey and Infant Botulism
Q:
Honey and Infant Botulism

My daughter is now 7 months old. I have been adding locally produced honey to my daughter’s food to help with her allergies. In my opinion, this has decreased her allergy like symptoms. My wife and I have had great success decreasing our allergies with this practice. I was told that honey can hurt an infant. Is this true?
Mark Torrans – Pineville, Louisiana

A:

Dr. Greene’s Answer:

Mark, your care for your daughter comes through clearly in your question. Taking the initiative with preventive measures to insure her health and comfort is a very loving act. Getting information regarding the safety and efficacy of these preventive measures is very wise indeed, and may save your daughter’s life.

Like you, I have heard claims that wild honey might reduce allergy symptoms. In fact, today in a local supermarket I saw a jar labeled “100% Natural Raw Honey, Unfiltered Unblended.” This product went on to promise great health benefits.

And indeed, careful scientific study has recognized great medicinal value in honey. Honey has significant, known antibiotic properties (Journal of Pharmacology, Nov 1996). Honey is also a traditional remedy for upset stomach. It has now been proven to prevent the growth of Helicobacter pylori in the stomach — the organism responsible for many ulcers and much abdominal discomfort (J R Soc Med, Jan 1994). Honey also reduces the gastritis caused by drinking too much alcohol (Scandinavian Journal of Gastoenterology, Mar 1991).

Honey has been proven to decrease the cancer-producing effects of many carcinogens, and to be effective in eradicating yeast (Cytologic Genetics, Nov-Dec 1996). Topical honey is known to be useful in treating gangrene, preventing both death and amputation (Surgery, Feb 1993). Burns heal faster when treated with honey than when treated with OpSite burn dressings (British Journal of Plastic Surgery, Jun 1993). There is also less pain, less scarring, and fewer contractures when burns are treated with honey rather than with Silvadene dressings (British Journal of Surgery, Apr 1991). In Russia, honey was even proven to effectively preserve vision when cataracts begin to form in the elderly (Vestn Oftalmol, Nov-Dec 1990). Honey is an amazing substance — but …

As it turns out, NOT giving your daughter honey while she is an infant is an important preventive health measure. It may save her life.

The concern is with infant botulism.

Botulinum spores are found widely in soil, dust, and honey. Adults who swallow botulinum spores are almost never affected. When infants swallow the spores, however, the spores can germinate in their immature gastrointestinal tracts and begin producing botulinum toxin. This has occurred even when the honey was only used to sweeten a pacifier (European Journal of Epidemiology, Nov 1993).

Botulinum toxin is the most poisonous natural substance known to man. The lethal dose is only 0.0000001 mg per kg of body weight — an amount that would be invisible to the naked eye. This tiny amount in the blood stream can cause death within minutes through paralysis of the muscles used in breathing.

Infant botulism has been found on every continent except Africa (Journal of Perinatology (2007) 27, 175–180). In the United States it is most common in the states of California, Utah, and Pennsylvania. While infant botulism can occur from taking in soil or dust (especially vacuum cleaner-bag dust), eating honey is a more easily preventable cause. Corn syrups are not sterilized and may also be a source of contamination (The AAP Red Book, 2000).

Infant botulism can occur any time in the first year of life, but like SIDS it is most common in the first six months. In fact it has been suggested that it might be the cause of death in up to 10% of SIDS cases (Nelson Textbook of Pediatrics; Saunders 1992).

Thankfully, in most instances of infant botulism, the amount of toxin is so incredibly minuscule that the case remains mild. For this reason it is often misdiagnosed.

The first symptom of infant botulism is constipation (which is also a common benign finding in many infants). This can appear 3 to 30 days following ingesting spore-containing honey (The AAP Red Book, 2000). Typically, the parents then observe increasing listlessness, decreased appetite, and weakened cry over the next several days. Nursing mothers often report new engorgement. Sometimes this is the full extent of the disease. If the disease progresses, however, the child moves less and less and might begin to drool from the mouth. Gagging and sucking reflexes diminish. Loss of previous head control is also an important sign. Complete respiratory arrest can occur either suddenly or gradually.

If an otherwise healthy baby develops constipation, followed by weakness and difficulty in sucking, crying, or breathing, then infant botulism should be considered the most likely diagnosis until proven otherwise.

When infant botulism is diagnosed, the average Intensive Care Unit stay for the baby is about one month, typically including mechanical ventilation and continuous tube feedings. This is followed by another 2 weeks on the hospital ward, with a total hospital cost often exceeding $100,000 (Pediatrics; Feb 1991). Thankfully if the botulism is correctly diagnosed and the baby receives appropriate supportive care, almost all will recover fully and completely. The fatality rate for babies who have been hospitalized with botulism is less than 1%. Recently, an antitoxin for infant botulism has been developed and shown to reduce hospital days, mechanical ventilation, and tube feedings (The AAP Red Book, 2000).

The single most effective way to prevent infant botulism is for infants to avoid honey. Breast feeding also appears to lessen the severity of botulism cases.

Therefore, despite other health benefits, honey is an unsafe food for any infant. HONEY SHOULD NOT BE GIVEN TO CHILDREN YOUNGER THAN 12 MONTHS.

Breast feeding, though, is a great way to prevent or decrease allergy symptoms. Breast feeding and minimizing your daughter’s being exposed to potential allergens (such as cigarette smoke, cat hair, house dust, etc.) are the best ways to serve your goals of reducing her allergies and her allergy symptoms. These measures will benefit your daughter now, and the benefit will last for years to come.

Reviewed by: Khanh-Van Le-Bucklin, Liat Simkhay Snyder
Last reviewed: July 08, 2008
Dr. Alan Greene

Article written by

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

 

Comments

  • Karenza Mcleod

    can you tell me how many babies have had botulism from honey?

    • Alan Greene

      Great question! On average about 79 babies get infant botulism in the US each year (which also means, about 4 million babies don’t). Most cases happen between 2 and 8 months old – and the average age is only 3-4 months.

      It used to be thought that honey was the top cause of infant botulism, because botulism spores are found in honey, and because lots of babies ate honey, including those who got botulism. However…

      When word spread to avoid honey for babies, honey consumption plummeted, especially before solids were introduced. But the botulism rate and typical age didn’t change as people had hoped.

      Botulism spores are widespread, especially in soil, and especially in certain states (e.g. California, Utah, Pennsylvania – where infant botulism rates are highest). It’s now thought that most cases of infant botulism are environmental, not from honey.

      So, you asked how many babies have had botulism from honey, and the answer must be fewer than the total 79 cases of infant botulism a year. Probably it’s far fewer than half that number.

      Honey has probably gotten a bad rap. I’m not recommending that babies eat honey – but I doubt botulism rates would go up appreciably if they did. Especially if parents avoided honey in the first 6 months, when there are many foods they might want to avoid.

      • Karenza Mcleod

        Thank you Dr Greene. I live in Rotorua New Zealand and we have been using honey for babies for many generations and this is the first I have heard about it. I guess I can contact John Molan who does research about honey in New Zealand. Once again thank you for answering my question.

        • Alan Greene

          You are most welcome Karenza – please keep me posted on what you learn.

  • Christiana Weisel

    My infant loves the vacuum cleaner. Do I need to make sure the vacuum stays locked up so he won’t get any botulism from the dust?

  • Anton Tsjechov

    Sorry, but what you write about Helicobacter pylori seems ill informed, or old-fashioned at least. Even the discoverer of the influence of H. pylori on the stomach ulcer, Martin Blaser, has acknowledged (already in 1996) that the disappearance of H. pylori might be responsible for new disorders that have arisen, and that H. pylori might have benefits as well as costs. Please read Moises Velasquez-Manoff’s ‘An epidemic of absence’, chapter 8.

    • Alan Greene

      I’ve ordered the book you suggested and look forward to reading it. I strongly agree with supporting the body’s natural rhythms and biology. And that H. pylori, acquired from Mom early in infancy, for instance, can be beneficial. But if acquired later, and in different health contexts, it has been linked to stomach problems including ulcers.

      When I was talking about the medicinal use of honey as a tummy remedy, I was talking, not clearly, about honey for older kids and adults, beyond infancy. It’s a gentle remedy with a long history of use, and valuable in part because it is less disruptive of beneficial bacteria than many medical options.

      • Anton Tsjechov

        Thanks for your reply. Very curious what you think of Velasquez-Manoff’s book: it’s one of those books that kind of ‘shattered’ my image of the world and of health.

  • Jamie Winterton Sam

    I accidentally fed my 8 month-old baby honey about an hour ago. I had used it to sweeten some warm applesauce, she woke up, I fed her 2 dabs off my finger before remembering that I had used honey (I often feed this to her, but don’t use honey). Since I am using local honey from here in Utah, I’m just a little nervous. Is there anything I can do besides just sit and wait to see if she gets constipated, especially since she’s been having trouble with constipation anyways, so that wouldn’t necessarily be the cause?

    • Alan Greene

      Jamie, even though the standard recommendation is to avoid honey for the whole first year, that provides a wide margin of error. The average age of infant botulism is only 3 or 4 months old, and by 8 months old this already-rare disease is even more rare. As you suggest, it is more common in Utah, Pennsylvania and California than in other states – but still quite rare.

      The early warning signs are a weak suck (remember, it’s usually younger babies), droopy eyelids, inactivity, and constipation.

      Healthy gut bacteria lessen the odds of developing infant botulism. To this end, getting probiotics and avoiding unnecessary antibiotics may be helpful. Breastfeeding is also known to be somewhat protective, perhaps in part for the same reason.

      You might find beneficial bacteria in yogurt, kefir, or in a probiotic supplement.

      You sound like a great mom! I’m glad you were sharing some of the same food. And the two dabs of honey-sweetened applesauce from your fingers may be a reason to keep your eyes open, but not a reason for alarm.

  • Chelsea

    My husband fed my daughter raw honey as a sweetener for her baby food. She is 4 months old. I called my pediatrician and was told not to worry because the FDA has been on top of this problem. Our honey, however, is from a farmers market!
    Why should I do?

    • Alex Castillo

      Yes, the FDA is on top of it. The way they are reducing the risk is by NOT feeding it to your infants. Please do not feed honey to infants less than 12 months old.

  • Sila Tasolo

    Hi Doc, I have just come across this information after feeding my baby girl who is 5 weeks old honey recommended to help strengthen her immune system. I brought it locally and I live in Brisbane Australia. My daughter is not being breast fed although I would love nothing more than to have her breast fed! Should this be a worry to me as I have just started a morning routine of giving her honey??

  • Tomaira Billie

    My daughter just turned six months. She’s overall a very happy baby. Friday, my older kids gave her some of their pancakes that was dressed with honey and syrup. Saturday she’s still a happy baby acting normal. Sunday she woke up very fussy. She’s a breastfed baby and today she will only eat if she is falling asleep. I can’t tell if it’s a faint sucking or not. When she’s awake she constantly crying non stop as if she’s in pain. She haven’t had a bowel movement all day but normally, she would have had two by now. I brought the honey at a local Wal-Mart in Oklahoma. I feel as if she’s crying a lot and so irritable because of the constipation. Does botulism cause a lot of fussiness when their awake before shutting down their nerves? Should I take her to the emergency room? That was the first time ever she have been feed honey. She don’t have any fevers or any other symptom besides constipation.

  • Tomaira Billie

    My daughter just turned six months. She’s overall a very happy baby. Friday, my older kids gave her some of their pancakes that was dressed with honey and syrup. Saturday she’s still a happy baby acting normal. Sunday she woke up very fussy. She’s a breastfed baby and today she will only eat if she is falling asleep. I can’t tell if it’s a faint sucking or not. When she’s awake she constantly crying non stop as if she’s in pain. She haven’t had a bowel movement all day but normally, she would have had two by now. I brought the honey at a local Wal-Mart in Oklahoma. I feel as if she’s crying a lot and so irritable because of the constipation. Does botulism cause a lot of fussiness when their awake before shutting down their nerves? Should I take her to the emergency room? That was the first time ever she have been feed honey. She don’t have any fevers or any other symptom besides constipation.

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  • Sam

    My son is 11 months old and will be 1 under a month, he became very sick with cold/ flu like symptoms. I was told to give him lemon wArm water and raw honey.. He had about 2 spoons and he is fine but now i am freaking out! do babies over 6 months get botchulism ?

  • Jessica W. Tanner

    I think it’s important to add that if you are avoiding honey for botulism, you need to avoid all honey products as well. Cooking honey does not kill botulism so honey graham crackers, cereals, and honey powder used as a sweetener should all be avoided.