During our last blog post, we talked about the danger of nitrates in homemade baby food. Today I want to introduce another possible danger…botulism.
Botulism is a disease caused by the bacteria Clostridium botulinum. This bacteria produces a substance called botulinum toxin, which works at the cellular level, causing muscle paralysis. As it turns out, botulinum toxin isn’t all bad, and when limited quantities are injected into targeted areas, it can actually be quite helpful. Botulinum toxin is the active ingredient in Botox, which not only erases facial wrinkles, but also controls debilitating muscle spasms in conditions such as cerebral palsy. But when large amounts of botulinum toxin run through the body unchecked, bad things happen.
So How Does My Baby Get Botulism from Homemade Baby Food?
Clostridium botulinum lives in the soil… so (as with nitrates) high risk foods include potatoes, carrots, beets, squash, spinach and green beans. The bacteria exists in two forms: active bacteria (which make the botulinum toxin) and spores (an inactive form surrounded by a tough shell). Boiling food for 10 minutes will usually kill active bacteria and destroy the toxin, but it will not eliminate the spores.
The spores present a couple problems.
If high-risk foods are improperly canned, active bacteria may emerge from the spores and start making toxin. The toxin accumulates within the food and poses a serious danger to anyone who eats it, regardless of their age.
The other problem with spores occur when they are eaten. While spores usually pass safely through the intestinal tract and exit the body in stool, there is the rare possibility that active bacteria will emerge from the spore and start making toxin while still inside the intestine. Infants under 12 months of age… and children and adults with compromised immune systems… are most prone. When this happens, toxin slowly accumulates and is eventually distributed throughout the body.
What Symptoms Does Botulism Cause?
In the case of improperly canned food, symptoms are swift and severe. Within 12 to 48 hours, what starts as blurry vision, droopy eyelids and a dry mouth progresses to difficulty swallowing and speaking. Muscles of the arms and legs become paralyzed, and breathing becomes difficult. Without rapid diagnosis and intervention, death occurs.
In the case of botulism from ingested spores, the build-up of toxin is slow and the first symptoms are mild. You may not notice them immediately. Babies may initially demonstrate a weakened cry, diminished facial expression, slow feeding and/or constipation. Then, as toxin accumulates over days and weeks, paralysis and floppiness and respiratory difficulty settle in. Without intervention, death is likely.
So How Common Is This?
Fortunately, it’s rare. But when it does happen, the results can be devastating.
Has infant botulism ever been linked back to homemade baby food?
No. But that doesn’t mean there is no risk. In most cases of infant botulism, the bacterial source is not found. Remember, toxin accumulation in the intestine is a slow process. By the time symptoms develop, the culprit food is gone and not available for testing.
What About Honey?
While out collecting pollen, bees pick up botulinum spores and transport them to the hive. In this way, honey may contain large numbers of spores. And while these spores usually pass safely through the body, they do represent a potential danger for babies under 12 months of age (and anyone with a compromised immune system). Unlike homemade baby food, when honey is the source of botulism, the source is typically discovered… because the honey jar remains on your kitchen shelf for a long period of time!
So What’s a Parent to Do?
Never feed honey to a baby younger than 12 months of age.
When canning food at home, know you are taking a risk, and be sure to follow all canning instructions perfectly. The American Academy of Pediatrics also recommends you boil foods for 10 minutes, throw out any food that appears spoiled, and discard any food containers that are bulging because these may contain gas produced by Clostridium botulinum.
At the end of the day, fresh is best. You should still boil high-risk fresh foods for 10 minutes, and know the risk is not zero. And while you can rest in the assurance that infant botulism is a rare occurrence, you should still know and be vigilant for the early symptoms.
Dr Mike Patrick is an Assistant Professor of Pediatrics at the Ohio State University College of Medicine and Medical Director of Interactive Media for Nationwide Children's Hospital. Since 2006, he has hosted the award-winning PediaCast, a pediatric podcast for parents. Dr Mike also produces a national podcast for healthcare providers—PediaCast CME, which explores general pediatric and faculty development topics and offers free AMA PRA Category 1 Credit™ to listeners.
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