What is the diagnosis and treatment of infant botulism (IB), also known as honey disease, in children?

From the Guidelines

Infant botulism should be suspected in children under 12 months of age who present with symptoms such as constipation, weakness, and poor feeding, and treatment should include immediate medical attention, hospitalization, supportive care, and possibly administration of Botulism Immune Globulin Intravenous (BIG-IV), also known as BabyBIG, as stated in the clinical guidelines for diagnosis and treatment of botulism, 2021 1. The diagnosis of infant botulism can be confirmed by laboratory tests, including serum, stool, and gastric aspirate tests, which can detect the presence of botulinum toxin or Clostridium botulinum spores 1.

Key Considerations

• Honey should not be given to infants under 12 months of age due to the risk of infant botulism, as it can contain Clostridium botulinum spores that can germinate in a baby's immature digestive system and produce toxins 1.
• Children over one year old can safely consume honey because their digestive systems have developed enough to prevent the spores from germinating.
• If infant botulism is suspected, treatment should not be delayed, and antitoxin should be administered as soon as possible, along with supportive care, including mechanical ventilation if necessary, as stated in the clinical guidelines for diagnosis and treatment of botulism, 2021 1.

Treatment Options

• Botulism Immune Globulin Intravenous (BIG-IV), also known as BabyBIG, is the recommended treatment for infant botulism, and it can help reduce the severity and duration of the illness 1.
• Supportive care, including hospitalization, mechanical ventilation, and intensive care, may also be necessary to manage the symptoms and prevent complications.
• The use of equine-derived botulinum antitoxin may also be considered in some cases, as stated in the clinical guidelines for diagnosis and treatment of botulism, 2021 1.

From the FDA Drug Label

BabyBIG®, Botulism Immune Globulin Intravenous (Human), is indicated for the treatment of infant botulism caused by toxin type A or B in patients below one year of age. The diagnosis of infant botulism is not explicitly stated in the provided drug labels, but the treatment is indicated as Botulism Immune Globulin Intravenous (Human), specifically BabyBIG for patients below one year of age 2.

• The treatment is aimed at reducing the severity of the disease caused by toxin type A or B.
• BabyBIG has been shown to reduce the length of hospital stay in patients with infant botulism 2. Key points:
• Diagnosis: Not explicitly stated in the provided drug labels.
• Treatment: Botulism Immune Globulin Intravenous (Human), specifically BabyBIG for patients below one year of age.

From the Research

Diagnosis of Infant Botulism

• The initial clinical features of infant botulism include constipation, poor feeding, descending hypotonia, drooling, irritability, weak crying, and cranial nerve dysfunctions 3
• The disease is caused by the neurotoxin of Clostridium botulinum, which can be found in honey and other contaminated foods 4, 5, 3
• Diagnosis is often made based on clinical presentation and epidemiological investigation, as well as laboratory tests to confirm the presence of the toxin or bacteria 3

Treatment of Infant Botulism

• Treatment is aimed at maintaining respiration, stopping the progression of weakness, and preventing complications from paralysis 6
• Botulinum antitoxin, such as equine trivalent botulinum antitoxin or botulism immune-globulin intravenous-human, may be administered to stop the progression of the disease 6
• Supportive care, including intubation and mechanical ventilation, is often necessary to manage respiratory failure and other complications 6
• It is essential to identify the source of the botulinum toxin to prevent additional cases and to educate parents and caregivers about the risks associated with honey and other contaminated foods 4, 5, 3

Prevention of Infant Botulism

• The Centers for Disease Control and Prevention (CDC) and other health organizations recommend that honey not be given to infants under 12 months old due to the risk of infant botulism 4, 5, 3
• Other possible risk factors, such as household pet reptiles and herbal teas, should also be avoided in infants under 12 months old 5
• Education and awareness about the risks of infant botulism are crucial in preventing the disease, particularly among parents and caregivers who may be unaware of the dangers of honey and other contaminated foods 7