I didn’t know much about infant botulism until a call came into the toll-free line that was run out of our Guelph lab. The inquirer wanted to know what the risk of a less-than-one year old kid acquiring botulism from cereal like honey nut cheerios was. After having two kids I now know that Cheerios are often one of the first introduced solid foods – but this was back in my grad school days when babies were an unknown to me.

I was sitting close to Sarah Wilson, then infocenter manager extrordinare, when the call came in and we chatted about cereal processing and whether the baking process would inactivate C. botulinum spores. Spores, a dormant-but-protected state that some bacterial cells resort to when stressed, are tough to address because they are pretty heat-stable. Once the spores get into the digestive system of an infant, which hasn’t fully developed and has a gastric pH higher than 4.6, they can germinate and outgrow. The result is a cell that multiplies and secretes a toxin as a byproduct. The rub, for the honey industry is that consumption is a factor in almost all infant botulism cases. There is also some evidence that infant botulism may be a risk factor for SIDS.

The literature wasn’t much help on the cereal question – we knew that 240-250F was necessary to inactivate the spores but didn’t know what the honey processing/cereal baking situation was. We called a couple of processors’ customer service folks and the response we got was that the incoming honey could be contaminated and that the processing likely wouldn’t reduce the risk. Who knows whether this is evidence-based or not. If the cereal companies are addressing this risk somehow they should share that info.

Public health folks like the CDC in the U.S. and recently Health Canada suggest that honey is an avoidable source of C. botulinum spores and have warned against honey and honey-product consumption for infants. The honey industry’s best practices include labeling warning parents about risks.

Tragic stories around infant botulism still have popped up over the past couple of years.
In Philadelphia Infant Amanda Zakrzewski was diagnosed with infant botulism and had to undergo 9 days of antitoxin treatment in hospital. Amanda wouldn’t eat, her eyes glassed over and she wasn’t able to suckle due to the paralysis the botulinum outgrowth caused. The result was months of rehab.

In 2011, 16-week-old Logan Douglas was temporarily blinded and paralyzed from infant botulism. He fully recovered after six months, but at one point the illness was so severe that doctors had discussed turning off life support systems as the toxin was attacking his body. His mother revealed following the incident that she had fed Logan honey.

I can’t imagine what the parents of a 5-month old in Colorado are going through right now. According to the San Francisco Chronicle,

Keona Hinkel has been on a breathing machine at the Rocky Mountain Hospital for Children for two weeks, but she’s improving.Doctors think indirect honey exposure or contaminated soil from a home under renovation may have sickened Keona.
She wasn’t fed honey but mother Kari Hinkel said that she cooked with honey. It’s possible she touched her daughter with it or it got on her pacifier.