What Parents Need to Know About Botulism

On our inpatient unit of pediatric patients with gastrointestinal (GI) disorders, we often see babies with issues related to eating. Some babies can’t eat normally. This means they do not take in enough calories, or there is some problem with the GI tract, which runs from the mouth down to the baby’s bottom. These babies do not get enough nutrition to grow. Some babies need surgery, or tubes to help them get the nutrition they need. We commonly admit babies to the hospital who feed poorly, seem dehydrated or are not growing. One day, we admitted a baby who had these symptoms, and may have contracted botulism.

This interested me because botulism seems rare. To learn more, I researched facts from the Centers for Disease Control and Prevention (CDC), and connected with Liza Mackintosh, MD, pediatric resident at Children’s Hospital Los Angeles. My thoughts were spot-on—botulism is rare, but it can cause significant illness and even death. There are 80 to 145 cases of botulism a year reported in the United States.

At this point, you’re probably wondering, what is botulism? What does it look like and where does it come from? Continue reading to learn about botulism, symptoms, treatment and prevention.

What is botulism?

Botulism is a paralytic illness, causing muscle weakness that moves down the body. It is a serious medical emergency that is caused by a nerve toxin made by one of three bacteria: 1. Clostridium botulinum 2. Clostridium bytyricum 3. Clostridium paratii There are five types of botulism, which are all considered fatal if contracted:

1. Infant—when a baby consumes bacteria spores which then grow in the intestines
2. Food-borne—caused by eating food with one of the three bacteria listed above
3. Wound—caused by bacteria that reside in a wound
4. Iatrogenic—caused by an accidental overdose of botulism toxin
5. Adult intestinal toxemia, which is very rare

Approximately 65 percent of botulism cases are infant botulism. When an infant is diagnosed, it can cause severe sickness and hospitalization.

Signs and symptoms of botulism

If your infant has botulism, the symptoms will include some or all of the following:

• Constipation
• Dilated or sluggish pupils
• Lethargy or decreased movement
• Loss of facial expression
• Poor feeding
• Poor muscle tone (floppy arms, legs) and head control
• Poor gagging and sucking reflexes
• A weak cry

The symptoms can progress to difficulty breathing when the muscles that help the baby breathe get weaker or paralyzed.

These symptoms can look a lot like other diseases such as infection, dehydration, viral illness, pneumonia or meningitis, just to name a few. This is a medical emergency and requires hospital care to assist with breathing and to provide an anti-toxin. Special tests have to be run to figure out which of these diseases is the culprit so that the right treatment can be given.

In older children and adults, signs and symptoms can be:

• Blurred or double vision
• Difficulty swallowing
• Drooping eyelids
• Dry mouth
• Muscle weakness
• Slurred speech

Prevent botulism

There are some preventative measures that can be taken to prevent food-borne botulism. The four other forms of botulism are harder to prevent. The CDC and the U.S. Department of Agriculture (USDA) state that food-borne botulism can often be traced to home canning of food or improperly canned store-bought food. Here is what the agencies recommend:

• If home canning, follow strict hygiene guidelines from the U.S. Department of Agriculture. FoodSafety.gov is a good resource.
• Boil any home-canned foods for 10 minutes.
• Do not open or eat from any can that is leaking, bulging, damaged, cracked or dented.
• Do not taste canned food that smells bad, is discolored, foams or squirts liquid when the can is opened. Instead, put the can in a sealable bag and throw in the garbage (do NOT pour down the drain).
• Wash hands for two minutes if you open such a can.
• Clean up any spills with a solution of ¼ cup bleach in two cups of water. Cover the spill with the solution, and then cover that with five to 10 paper towels. Leave for 15 minutes; wrap up the paper towels with double sheets of newspaper, wash area with liquid soap and water. Discard any sponges that might have touched the liquid. Wash hands for two minutes.
• When in doubt, throw it out.
• Refrigerate any oils containing garlic.
• Seek professional medical help with any wounds that are slow to heal.

For infants under 12 months of age, honey should be completely avoided. Honey can contain spores and cause infant botulism. FoodSafety.gov also recommends not giving infants home-canned vegetables, fruits or any corn syrup.

Botulism spores are also in soil and dust even after cleaning, so it is hard to prevent environmental exposure. Some cases occur near new construction sights, when spores are released into the air by digging.

If your baby or child is showing any of the symptoms listed here, be sure to seek immediate medical attention.