I was on call Thanksgiving Day and got an interesting call at around 11 PM. The exchange/call service called me and said that Mrs X. was waiting on the line and wouldn’t say what the problem was, could they “put her through”. When we were connected, she first of all apologized for the call, that her children were all well, BUT she had to clarify something immediately.

 

It seems their entire family was together for Thanksgiving and while sitting around the dinner table the topic of honey in infants came up and this just about lead to World War Three. She explained that her husband’s aunt, who raised six children of her own, felt that the recommendation by the American Academy of Pediatrics to NOT give honey to children under 1 year of age was, “Nothing but rubbish!”. The outspoken aunt went on to say, “I gave all of my 6 children honey when they were infants. I would dip their pacifier in honey to calm them down and they just loved it and they all turned out just fine…couldn’t have been any healthier.” Before long the entire Thanksgiving table was divided into 2 camps. One for honey, and one against honey. Mrs X. then went on to apologetically say how she wouldn’t even get into the fiery discussion about immunizations and mercury that ensued. The reason she was calling me at 11 PM was that she knew that honey shouldn’t be given to infants under a year of age, but she realized that she didn’t know exactly WHY. She was so upset with herself because she didn’t have the information to support her stance. Out of frustration, her husband told her to call, if anything, to put her mind at ease.

 

I chuckled to myself when I heard this because I am sure that this has happened around many dinner tables over the years. I told her that she was 100% correct and I would explain why.

 

Botulism is a disease that is caused by the bacterium Clostridium botulinum. It produces a toxin that is one of the most lethal substances known to man. Clostridium is present in foods and soil and dust. It is an anaerobic bacteria which means it grows in the absence of oxygen and is more likely to thrive in inadequate food processing such as home canned foods or bottled foods where the storage temperature and preservation techniques are not optimal.

 

Infantile botulism occurs when an infant ingests the spores of the clostridium bacteria. The spores then germinate while in the infants intestinal tract and become the bacteria which colonize the intestines. When mature, they release a toxin into the infants blood stream. The clostridium spores have been found in honey, thus the recommendations by the AAP. There were reports of the spores also being found in corn syrup and other foods such as molasses, but there is no question about honey being the main source.

 

Infantile botulism has been reported in infants up to 1 year of age, but the peak incidence is 6 weeks to 6 months. When an infant ingests the spores, the onset of symptoms occurs within 3-30 days. The toxin binds to the motor neuron at the junction of the nerve and muscle. The first symptoms usually involve constipation, then weakness and lethargy, the infant becomes floppy and has trouble eating with a poor suck. Then the baby may show signs of facial weakness and droopy eyelids and poor head control. The baby then may have a descending weakness and have trouble swallowing and handling it’s secretions. Finally, the baby may go on to have breathing difficulties and ultimately respiratory arrest. Most infants are diagnosed early in the course of the illness before things progress to a terminal event. They are cared for in an intensive care unit and the treatment is mainly supportive along with a specific immunoglobulin that treats the toxin called baby Botulism immunoglobulin or BIG. While the recovery is slow, most baby’s have an excellent outcome. It is important to know that after receiving BIG, a baby should not receive a live vaccination (MMR, Varivax or Rotavirus) for 6 months because the immunoglobulin will interfere with the effectiveness of the vaccine. Another often asked question is whether a breast feeding mom can eat honey and the answer is yes. The spores will NOT pass through the breastmilk to the baby.

 

Infantile botulism is different from the botulism that affects older children and adults. Adults eat food that is contaminated by the clostridium bacteria that have already produced the toxin itself. In essence, they are ingesting the actual toxin. Infants under 1 year of age who eat honey ingest the spores which mature into the bacteria that then produce the toxin while in the infants intestine.

 

The reason that older children and adults can eat honey and not have any problems is that their immune system is fully developed and will destroy the spores before they can mature into the adult form.

 

While the phone call took about 20 minutes, it was probably the most rewarding 20 minutes I have spent on the phone while on call. Mrs. X. was most appreciative and thankful. She finished by saying, “I CAN”T WAIT until Christmas so I can give my in-laws an earful!!”. I then told her if she wanted to discuss the immunization dilemma, that would certainly take longer than 20 minutes, but please…not tonight.