Up to 12 months, honey consumption may be associated with infant botulism . After 12 months, although honey is no longer associated with this disease, it contains free sugars. Therefore, honey should be completely avoided in children under 2 years of age. What is infant botulism? Infant botulism is a rare but serious disease , coinciding mainly with the dietary transition phase. It is an acquired disease of the neuromuscular junction, potentially lethal, caused by intestinal colonization of the bacterium Clostridium botulinum . This bacteria produce a neurotoxin – the botulinum toxin – which acts on the nervous system and blocks the transmission of information to the muscles, resulting in descending muscle paralysis and respiratory failure. How do babies get infected? Why honey? Babies become infected when they ingest Clostridium botulinum spores. Once in the intestine, these spores germinate, the bacteria multiply and produce botulinum toxin. Spores can originate from contaminated food, with honey being the most common food-related cause of infant botulism, which is also associated with the digestive immaturity of babies , especially the incipient development of their intestinal microbiome. In addition to honey, there is also a greater risk of the presence of spores of that bacteria in certain herbs found in contaminated soils, namely chamomile. Symptoms of infant botulism Typically, the first symptoms are gastrointestinal, such as constipation, nausea or vomiting. Later, neurological symptoms appear, such as difficulty breastfeeding, weak sucking/swallowing reflexes, weak crying, difficulty speaking, ptosis (drooping eyelids), progressing to generalized hypotonia (floppy babies), progressive muscle flaccidity and descending and symmetrical paralysis. When this paralysis affects the respiratory muscles and diaphragm, the disease can progress to respiratory failure and be fatal. And adults, can they eat honey and not get botulism? The digestive systems of older children and adults are more resistant to the presence of Clostridium botulinum spores. In these age groups, the usual form of botulism is also foodborne, but from food contaminated by botulinum toxin (and not by spores), most often homemade preserved foods, which were not subjected to the necessary treatments for correct preservation. Foodborne botulism is the reason why you should not eat canned goods when the cans are swollen. Treatment Treatment involves respiratory and nutritional support. Early administration of anti-toxin immunoglobulin neutralizes free neurotoxin and should not be delayed in the face of a high index of clinical suspicion. In summary and for prevention: The consumption of honey and the addition of honey to other foods is contraindicated during the first 2 years of life. After 12 months, although honey is no longer associated with infant botulism, it continues to be a source of free sugar, so it should be completely avoided in children up to 2 years old. If in doubt, the pediatrician who follows your baby is the best person to advise you. Source: Harris RZ, Dabritz, HÁ. Infant botulism: in search of Clostribium botulinum spores. Current Microbiol 2024;81:306. Author: Inês Medeiros (Pediatrician) Meet the pediatrics clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
