Despite garnering many health benefits from curing cough to being a multivitamin source, honey should not be given to a child less than 12 months old. This includes honey which is incorporated into baked and processed foods. This age group of children, according to the American Academy of Pediatrics should also not be fed with baby’s food, water, and formula milk that have been added with honey.

Back in 1976, a neuroparalytic disease called Infant Botulism was first described which affected children less than one year old. Infant botulism is caused by a bacterium Clostridium botulinum that causes food poisoning in the infant’s intestines.

One interesting facet about this disease entity is how it is being linked with the consumption of honey. It is not precisely known how honey becomes contaminated with the bacteria. However, one possible explanation is that the spores (bacteria turn into spore form in order to survive in unfavorable environmental conditions) of these bacteria are commonly found in soil and dust. These spores may be picked up by bees and brought to the beehive and contaminate the honey.

Infant botulism is unique. It exclusively affects children less than one year old because these age group relatively lacks gastric acid, have decreased levels of intestinal normal flora, with immature immune systems (specifically lacking secretory antibody A), making their intestinal environment ideal for spores to germinate. Hence, when the child swallows them, spores revert back to bacterial form and multiply, producing a lot of poison called botulinum toxin.

Usually symptoms of botulism begin 3 to 30 days after the ingestion of spores. Constipation is the first sign of botulism due to slowing down of the intestines. Generally, infant botulism is a temporary partial paralysis that affects muscles of the body in descending order. Babies can present with heavy eyelids, flat facial expression, poor head control, and difficulty swallowing with drooling. When respiratory muscles are affected, a baby can have breathing difficulty. The baby’s legs may assume a frog-leg position due to muscle weakness.

The illness usually lasts for several weeks, but it is treatable. Affected infants are treated in the hospital where an antitoxin called Botulism Immune Globulin Intravenous (BIGIV) should be given. Patients are also provided with supportive care (e.g. ventilator, IV fluids) until the effects of the toxin wears off.

Although infant botulism is rare (fewer than 100 cases occur each year in the US), it can be severe and frightening because it can affect the respiratory muscles which compromises breathing. Hence, it is important to know about the symptoms so you can recognize it early. Most of all, know that honey is a known source of the bacterial spores causing infant botulism. That’s why honey should never be given to babies less than one year old.