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Spoonful of Honey

Author: Dr. Asha Bonney, MedSchoolForParents.com Expert
Those dreadful evenings when a 5 week old starts crying with colic and nothing works, are a memory a lot of parents want to forget. Some parents will pay a fortune to take away this alarming, annoying at times, tiring cry. So how about a spoonful of sugar, as per Mary Poppins? Or, even better a spoonful of honey? 
In a recent study from Texas, it was found that 11% of participants or parents used honey pacifiers. These parents stated that they did so for the perceived health benefits of honey, for instance with colic, and also as a result of infant preference. Around 80% of these women were not aware of any risks associated with honey and infants under the age of 1 year.
But ask any pediatrician and they will squint their forehead and say no to the ‘honeybunch’ liquid.  They will become serious and warn you about botulism.
What is infantile botulism?
Infantile botulism is the result of bacterial colonization by Clostridium Botulinum. These bacteria and their spores can be found in food such as honey and substances contaminated by soil. It enters the body when your child ingests the contaminated product.  The spores take over the intestine and produce a harmful substance called a neurotoxin. This toxin then binds to nerves and blocks the transmission of neurotransmitters resulting in neurological symptoms.
Now this all sounds pretty scary, but you don’t hear health officials warning adults to stay away from honey.  The reason children under the age of one are especially at risk is because of their intestinal system, which has not been properly colonized by the ‘good bacteria’ – it's those fighters against an overload of Clostridium Botulinum. Moreover, infants lack the bacteria-inhibiting bile acids that we have already developed as adults. The result of this toxic ingestion and colonization is neuromuscular weakness that can lead to devastating consequences such as difficulty breathing.
Fortunately infantile botulism is a rare disease, with only 8 cases in the United Kingdom in 2009 to 2013.  The United States had the highest number of reported cases in 1992 to 2006, with 1349 cases in infants. 95% of all cases in Texas occurred in infants 6 weeks to 6 months of age.
What can I do to keep my child safe of botulism?
The risk factors for developing infantile botulism can be summarized as consumption of clostridium botulinum spores and factors that weaken normal gut bacteria such as antibiotic treatment or weaning.
It is as simple as avoiding honey under the age of one. This is not common knowledge or something they teach you in the ‘parent school of life’, so many parents are unaware of the risks associated with honey and end up smearing the bee-heaven on their child’s pacifier or straight to their little mouth. The pacifiers that can be filled with honey should just disappear from this Earth.
What should I look out for?
In an interview for MedSchoolforParents.com, Dr. Corinne Amar, Head of Foodborne Pathogens Reference Services at Public Health England, London UK, highlights symptoms like constipation, lethargy and poor feeding as classic symptoms of infant botulism. In fact, constipation can be one of the first signs of this disease. Infants can also develop poor head control, droopy eyelids, have a weak cry and may struggle to suck or swallow. The progressive weakness can lead to difficulty in breathing.
These symptoms can be quite vague, and so infant botulism can sometimes be difficult to diagnose.  "Parents should be concerned if their child has constipation , defined as no bowel movements for 3 days, followed or accompanied by poor feeding, poor cry, and lethargy/listlessness" suggests Dr Amar.  If you have any concerns about your child, you should seek medical attention. The laboratory diagnosis is usually made with a stool sample. Honey has been associated with infant botulism and is recommended not to be given to infants under the age of one year.
In 2003, the United States introduced an antitoxin called Baby BIG, which reduces length of stay and improves recovery if given early to those proved to have botulism. This antidote is a significant advancement in treatment as previously the only treatment was supportive care. The recovery process can take between weeks to months depending of the time needed to regenerate the damaged nerves, although a full recovery occurs in most cases.
At the end of the day, it is unlikely that your child will develop infantile botulism in North America. That being said, with such devastating consequences, is the risk really worth giving your child an extra year of honey? Experts say NO.
Updated 03/08/2017


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