A: Thank you for your question. It is still the clear recommendation of the American Academy of Pediatrics to avoid feeding honey to children under age 12 months of age. We also advise against putting honey in food, water or formula that is fed to infants.
Another source of honey is processed foods containing honey, which also should not be given to infants. Honey-filled pacifiers have been implicated as a source of illness for infants.
The Food and Drug Administration warns families not to use honey-filled or honey-dipped pacifiers. Despite honey’s purported health benefits, honey is not safe for infants.
It is common to hear that honey can help with seasonal allergies, is a healthier sweetener than sugar and can help with constipation and colic. While it may be tempting to give your infant honey for those benefits, infants should not eat honey. Honey is not safe for infants.
The reason is, it contains the spores of a bacteria called clostridium botulinum. These spores can germinate in the baby’s intestine and release a neurotoxin that can cause muscle weakness and respiratory failure. This bacteria is ubiquitous in our environment and is commonly found in soil.
It is not known why honey in particular is known to carry clostridium spores. Perhaps as bees fly around they pick up the spores and bring them back to the hive, and then into the honey. Those spores remain in the honey, or in food products containing honey, and then get ingested by people.
In children over the age of 1, their gut flora has developed sufficiently to prevent the clostridium spores from germinating and growing inside the child. Babies under the age of 1 have immature gut flora, and there is no competition in the gut against the clostridium spore.
So the spore germinates, produces more bacteria, which produce a neurotoxin that makes babies ill. This neurotoxin causes constipation, then weakness and finally paralysis of the baby. This can be a life-threatening condition because it affects the babies’ ability to breathe.
These spores can be present in the intestine of older children but will not cause these same serious effects, therefore it is safe for older children to eat honey.
You may be wondering, “What exactly is a spore?” A bacterial spore is one of the most highly resistant life-forms on earth and allows bacteria to survive exposure to extremes of temperature, desiccation, radiation, disinfectants and, in the case of Clostridium species, lack of oxygen.
Clostridium species cause illness through the generation of toxins. Clostridium botulinum produces a neurotoxin (injures nerves).
Clostridium perfringens produces an endotoxin (causes fever and affects blood pressure). Clostridium difficile produces a cytotoxin (damages tissue).
The ability of these bacteria to produce spores which survive for a long time in hostile environments is why they are so effective at causing and spreading illness. In older children and adults, clostridium diseases can cause food poisoning from canned foods, and cause severe skin and soft tissue infections.
The symptoms of infant botulism include constipation, followed by decreased movement, loss of facial expression, poor feeding, weak cry, diminished gag reflex, loss of head control, and progressive weakness and low tone.
Recovery can take weeks to months. Human botulism immune globulin (BIG-IV; trade name Baby BIG) administered immediately can reduce days of mechanical ventilation required to support the infant’s breathing. If you suspect that a patient has botulism, contact your state health department as soon possible.
Parents often ask if infant botulism can be prevented. Unfortunately, experts don’t know why some infants get botulism while others don’t. One way to reduce the risk of botulism is to not give infants honey or any processed foods with honey before their first birthday. Honey is a proven source of the bacteria that causes infant botulism.
Anjali Subbaswamy is a Pediatric Intensive Care Physician at UNM. Please send your questions to firstname.lastname@example.org.
Editor’s note: Due to an error, Dr. Melissa Mason’s April 19 column on ADHD was abbreviated in print. To read the full column visit abqjournal.com/category/health.