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Botulism In Infants

Alternate Names

  • infant botulism

Definition

Botulism is a condition caused by a toxin made by bacteria calledThis toxin triggers sudden, progressive weakness and paralysis. Infant botulism is usually seen in babies younger than 6 months old.

What is going on in the body?

In adults, botulism occurs only after eating foods that contain the full-blown toxin. In infants, tiny spores from the bacteria that would not be harmful to an adult can grow in the baby's gut. Once there, they mature and release toxins.
These toxins enter the bloodstream and are carried to the ends of the nerves that control muscles. They block the release of a chemical called acetylcholine that transmits signals from nerves to muscles. If this chemical is not released at the right time, the muscle cannot contract. This causes muscle weakness or paralysis.
The diaphragm is a strong layer of muscle below the lungs. If nerves in the diaphragm are blocked, the baby will not be able to breathe. If untreated, this can cause death.

Risks

What are the causes and risks of the infection?

The Clostridium botulinum bacteria makes one of the most poisonous substances known to man. Just a small amount of the toxin it produces can be fatal.
Some sources of the bacteria that infants may encounter include:
  • honey, which should never be fed to babies younger than age 12 months
  • dust and dirt
It is important to remember that these bacteria are found in the environment constantly. In some cases of infant botulism, it is not known why the bacteria happened to grow in the intestines of that particular infant and not others.

Prevention

What can be done to prevent the infection?

To keep babies safe, follow these steps.
  • Never give honey to an infant under age 1 (in a bottle, on a nipple, or in any other way).
  • Do not allow soil or dirt to get into the belly button before the cord stub falls off at around 2 weeks of age.
Some cases of infant botulism cannot be prevented.

Diagnosed

How is the infection diagnosed?

Diagnosis includes a thorough exam by a healthcare professional. The diagnosis can be made based on the infant's signs and symptoms. Parents need to tell the doctor about any possible exposures.
Tests to confirm the diagnosis include the following:
  • a stool sample to check for the bacteria
  • an electromyogram (EMG), which may show signs of abnormal muscle function. An EMG is a study of how the muscles respond to electrical stimulation.

Long Term Effects

What are the long-term effects of the infection?

When botulism is not treated, the death rate is very high. If a baby survives the first few days after botulism has been diagnosed and treated, recovery is usually complete. If serious respiratory paralysis occurs, this condition may be fatal.

Other Risks

What are the risks to others?

This illness does not spread from one person to another. Infants ingest bacteria from the environment.

Treatments

What are the treatments for the infection?

Treatment of infant botulism includes:
  • hospitalization
  • supportive measures, such as bed rest, fluids given through a vein, comforting the infant and family
  • special enemas, which may be used to clear out the spores in the intestinal tract
  • penicillin to kill the bacteria in the gut
  • a ventilator, or artificial breathing machine
It is not clear whether antitoxin can help in infant botulism.

Side Effects

What are the side effects of the treatments?

Side effects vary depending on the treatment used. Penicillin can cause stomach upset and allergic reactions. Before the botulism antitoxin is given, a doctor may order a skin test to make sure the baby does not have an allergy to the antitoxin.

After Treatment

What happens after treatment for the infection?

Once a baby has been treated and symptoms have gone away, no further treatment is needed. If a baby survives the first few days of botulism, it may take months for symptoms to subside. Recovery is usually complete. If necessary, physical therapy or occupational therapy may help a baby recover muscle function.

Monitor

How is the infection monitored?

A healthcare professional may monitor the baby closely over the first few months while symptoms of botulism disappear. The baby's ability to breathe properly and muscle control will be watched closely. Any new or worsening symptoms should always be reported to the healthcare professional.

Sources

CURRENT Pediatric Diagnosis&Treatment, APPLETON and LANGE, 1993

Mayo Clinic Family Health Book, David Larson, 1996

[hyperLink url="http://www.foodsafety.org/consumer/co/co003.htm" linkTitle="www.foodsafety.org/consumer/co/co003.htm"]www.foodsafety.org/consumer/co/co003.htm[/hyperLink]

Nelson's Essentials of Pediatrics, Berhman and Kliegman, 2nd edition, 1994

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