Practice Based Learning: Infant botulism due to honey-sweetened pacifiers

Bhavya Doshi

Presented by Bhavya Doshi, MD
Resident, Department of Pediatrics
Emory University

Key points: 

  • Use of honey-sweetened or honey pacifiers has been shown to cause botulism
    • Approximately 10% of honey samples are contaminated with Clostridium botulinum
    • 15% of all infant botulism is linked to honey ingestion in the US
  • The most heralding signs for infant botulism are a history of constipation, poor feeding and hypotonia
  • If strongly suspected, botulism immune globulin should be given within 3 days of admission but has been shown to have benefit up to 7 days after admission
  • We need to provide better anticipatory guidance, especially to immigrant parents, about the use of honey in infants


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Benjamins LJ, Gourishankar A, Yataco-Marquez V, Cardona EH, de Ybarrondo L. Honey pacifier use among an indigent pediatric population. Pediatrics. 2013 Jun;131(6):e1838-41. doi: 10.1542/peds.2012-3835. Epub 2013 May 6.

Brook I. Infant botulism. J Perinatol. 2007 Mar;27(3):175-80. Review.

Midura TF, Snowden S, Wood RM, Arnon SS. Isolation of Clostridium botulinum from Honey. J Clin Microbiol. 1979 Feb;9(2):282-3.

Muensterer OJ. Infant botulism. Pediatr Rev. 2000 Dec;21(12):427. Review.

Schreiner MS, Field E, Ruddy R. Infant botulism: a review of 12 years’ experience at the Children’s Hospital of Philadelphia. Pediatrics. 1991 Feb;87(2):159-65.

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