A baby who is constipated, feeding poorly, with drooping eyelids and a weak cry may have infant botulism — and if so, treatment should start before any laboratory confirms it. CDC's guidance for clinicians comes down to four steps: consult, treat, test and notify.
What it is
Infant botulism is an intestinal toxemia. It begins when an infant swallows spores of the bacterium Clostridium botulinum or related species. The spores temporarily colonize the large intestine and produce botulinum neurotoxin, which binds to cholinergic nerve endings and cuts the proteins needed to release acetylcholine. The result can be bulbar palsies, low muscle tone (hypotonia), and a symmetric, descending, flaccid paralysis.
A patient recovering from infant botulism still has weak neck muscles.
Signs and symptoms
Patients may have some or all of:
- constipation;
- poor feeding;
- drooping eyelids (ptosis);
- sluggish pupils;
- a flattened facial expression;
- weakened sucking and gag reflexes;
- a weak, altered cry;
- difficulty breathing, possibly progressing to respiratory arrest.
Four steps
| Step | What to do |
|---|---|
| 1. Consult | If you suspect infant botulism, immediately call 510-231-7600, available 24/7. The on-call physician at the Infant Botulism Treatment and Prevention Program (IBTPP) of the California Department of Public Health gives a free clinical consultation and releases BabyBIG, the human-derived antitoxin, if the findings indicate infant botulism. Then call your state health department for guidance on collecting, storing and submitting specimens, testing, and mandatory reporting. |
| 2. Treat | If the consultation supports infant botulism, start BabyBIG as soon as it is available. Diagnosis is clinical at first — do not wait for laboratory confirmation. |
| 3. Test | Definitive diagnosis needs a stool or enema specimen; enemas should use sterile, non-bacteriostatic water. Testing is done by the state public health laboratory (CDC tests for some states) and often takes days; follow up if there are no results within five days. |
| 4. Notify | Infant botulism is notifiable. Physicians must promptly report suspected cases to the state health department, and laboratories all confirmed cases; IBTPP also notifies the state after BabyBIG is given. States report confirmed cases to CDC through the National Notifiable Diseases Surveillance System. |
Sources
Based on "Clinical Overview of Infant Botulism," Centers for Disease Control and Prevention, a work of the United States government in the public domain.
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