Botulinum is a toxic compound that affects nerves. It is produced by a bacteria called Clostridium botulinum. This common bacterium is found in soil, water and air. The bacteria are not toxic but the toxins (A & B) they produce are. The toxins are colorless, odorless and tasteless and are one of the deadliest substances known. In children over one and adults who have healthy guts with normal stomach acid, the bacteria are destroyed and there is no toxin produced.
Infantile botulism is the most common form of botulism in the US accounting for about 70% of the cases. It is associated with contaminated formula (food) and dust particles. Infantile botulism occurs exclusively in children younger than 12 months due to their immature immune system, reduced gastric acidity, and limited normal bacterial flora. Older children have sufficient gastric acidity to prevent the C. Botulimun from growing. 20% of the cases affecting infants are associated with honey exposure and it is recommended that infants under one year NOT be given honey.
Once in circulation, the botulinum toxin works by blocking the release of acetylcholine. This is the major neurotransmitter between the nerves and the muscles. This toxin stops the nerve signals from reaching the muscles which leaves the muscles weak and limp (flaccid). The toxin binds on the receptors on the nerve endings, enters the nerve ending and blocks the process of transfer across the nerve endings.
Early symptoms include constipation, dry mouth, blurred vision and difficulty swallowing. As it progresses it can cause flaccid paralysis and difficulty breathing. Severe cases can lead to respiratory failure requiring prolonged mechanical ventilation.
To diagnose stool culture and direct toxin assay are needed. Supportive care should continue, and treatment should be given while awaiting tests. Other causes of paralysis need consideration.
Treatment is not antibiotics but an IV treatment of Human BIG-IV (Botulism Immune Globulin-IV). While this is very expensive, it can reduce hospitalization by 2-3 weeks. BIG-IV is antibodies collected from immunized adult plasma donors. When this is given to the infant these antibodies bind to the toxin and neutralize it so it can no longer cause any damage and prevents further paralysis. The damaged nerve ending must grow back which can take weeks to months.
These deadly toxins (in very diluted mixtures, such as Botox) can be useful in the following: cosmetic relaxation of muscles causing wrinkles, relaxation of spastic muscles in cerebral palsy and post stroke, in eye muscles causing crossed eye, in neurogenic bladders and in chronic migraines. Research is being done in Ukraine using Botox to reduce pain in amputated limbs (phantom limb pain) with some good relief. Botulinum toxin also helps decrease inflammation around the nerve endings in the stump.
We must insist that strict government oversite is needed in all food production especially in the making of formulas. Further funding for research in pain relief should be encouraged.
By Heart Formula has been linked recently to infantile botulism. Stop using it and call your doctor for advice.
By Sally Robinson
Sally Robinson, MD Clinical Professor
Keeping Kids Healthy
12/2025
Also See: UTMB Pediatrics - Pediatric Primary Care