Infant botulism risks exist with all honey, pasteurized or not

Tragic stories around infant botulism have popped up over the past couple of years and, as a dad, reading them is like a gut-punch.

In 2011, infant Amanda Zakrzewski was diagnosed with infant botulism and had to undergo 9 days of antitoxin treatment in hospital. Amanda wouldn’t eat, her eyes glassed over and she wasn’t able to suckle due to the paralysis the botulinum outgrowth caused. The result was months of rehab.Unknown-18

Also in 2011, 16-week-old Logan Douglas was temporarily blinded and paralyzed from infant botulism. He fully recovered after six months, but at one point the illness was so severe that doctors had discussed turning off life support systems as the toxin was attacking his body.

Related to infant botulism, ABC Research Laboratories blog has an interview with Chief Scientific Officer Gillian Dagan about food safety choices she makes as a food scientist. While I agree with most of what she says, she loses me at honey:

We all have fond memories of our grandparents when we were younger. Dr. Dagan remembers when her grandfather kept bees. She was fascinated by the bee hives and loved it when he would lift one of the trays and break off a piece of fresh honeycomb for her to enjoy on the spot. Now she knows better. As much as she loved that as a kid, she probably wouldn’t do that for her daughter. When she was younger she didn’t know that raw honey is a food at risk for botulism and should be pasteurized much like milk. Pasteurized honey is safe honey.

Sort of.

Clostridium botulinum spores, the stuff I’m guessing she’s worried about are tough to address in honey because they are heat-stable. Once the spores get into the digestive system of an infant, which hasn’t fully developed and has a gastric pH higher than 4.6, they can germinate and outgrow. The result is a cell that multiplies and secretes a toxin as a byproduct. The rub, for the honey industry is that consumption is a factor in almost all infant botulism cases. There is also some evidence that infant botulism may be a risk factor for SIDS.

And pasteurized vs. unpasteurized honey is no different when it comes to Clostridium botulinum spores.

According to the National Honey Board, recommended pasteurization treatments include flash pasteurization (170 °F for a few seconds) or heating at 145°F for 30 minutes.

Neither will do much to inactivate the spores. There’s really nice risk profile that the former NZ Food Safety Authority put together in 2006. The authors explicitly say: “Normal cooking temperatures would destroy vegetative cells, although these would not be expected to be present in honey in the first instance (because of the low water activity -ben). Commercially available honey may be pasteurised but this process is not sufficient to destroy the spores.”

I’m not sure if Dr. Dagan was worried about Salmonella that the industry standard wouldn’t do much for the stressed vegetative cells either (there’s a pretty good literature around low water activity and heat resistance , especially with a dry heat).

Honey is pasteurized for other reasons, but it really doesn’t do anything to reduce the risk of infant botulism. That’s why the industry and health authorities suggest that infants not be fed any honey, pasteurized or not, until after their first birthday.

Why babies shouldn’t suck on honey

Maybe this is why few read the Atlantic anymore: because they keep reinventing stuff as news when it’s not.

This time, it’s the risk of infant botulism, and why children under 1-years-old shouldn’t eat honey.

According to James Hamblin of The Atlanticaround 10 percent of honey in the U.S. contains spores from the bacteria Clostridium botulinum. That’s not really a honeyproblem for big humans because it’s just the spores, not the botulinum toxin. In infants (humans less than 13 months old), though, those spores can turn into botulinum toxin in their intestines.

Infant botulism can mean anything from subtle changes in muscle tone to so-called “floppy baby syndrome” to “sudden, unexpected death.” None of this is common, but it’s been repeatedly documented and established that infant botulism from honey does happen. It’s not common for kids to get eaten by alligators, either, but that doesn’t mean you let your baby live with an alligator family. Unless you do. (that would be the witty Atlantic version of grabbing the reader’s attention).

A study last week in the journal Pediatrics found that of 397 parents of infants in the Houston area, 11 percent reported using honey-pacifiers with their infants. That means buying pacifiers that contain honey, which are still sold. Some actually contain corn syrup instead of honey — even if they’re still sold as “honey pacifiers” but that too can contain botulinum spores.

Most of the parents (81 percent) at the clinic where this study took place were Hispanic, most indigent and of Mexican descent. The parents said they use the honey pacifiers either out of tradition, because the infants seem to prefer them, and/or because they felt there were health benefits (e.g., “helps with constipation or colic”).

Honey board to provide info about infant botulism and safe use of honey

Logan Douglas was temporarily blinded and paralyzed as the botulism he contracted at 16-weeks-old ravaged his body.

Six months after his parents, Theresa Fitzpatrick and Alex Douglas, were faced with the decision of whether to turn off his life support as baffled medics feared the worst, Logan is doing great (right, photo from The Sun).

When a limp and ill Logan was first taken to physicians, he was admitted to hospital and, after a battery of tests, a Glasgow-based doctor ordered a test for infantile botulism for Logan.

Devastated Theresa has revealed she still blamed herself after feeding her baby honey.
She wasn’t aware that the food wasn’t suitable for children so young – and unwittingly placed his health in danger.

There are too many cases like Logan. So the U.S. National Honey Board (NHB) is announcing a new partnership with the National Association of Pediatric Nurse Practitioners (NAPNAP). Together, the organizations will develop a honey education program, based on recent research findings that uncovered widespread confusion surrounding the age when honey can be introduced to young children. Focused on health professionals who deal directly with parents of young children, education efforts will dispel honey misconceptions, explain the benefits of honey and remind parents that honey can be given to children older than one year of age.

“It’s widely known that honey shouldn’t be fed to infants, but most people don’t know why or at what age it can be introduced,” said Cheri Barber, DNP, RN, CRNP, President of NAPNAP. “The truth is that honey can be introduced to a child at one year of age. It’s important that health care professionals and families with young children understand the facts about honey.” Barber added that honey has been used for centuries to help soothe coughs, and with the recommended removal of over-the-counter cough medicines containing dextromethorphan (DM), parents are turning to effective natural remedies like honey.

Because infants’ gastrointestinal systems are immature and thus susceptible to contracting infant botulism if spores are present, the Centers for Disease Control, the American Academy of Pediatrics, the California Department of Public Health and other health associations recommend that certain foods not be fed to infants under one year of age, including honey. After 12 months of age, honey may be introduced to a child’s diet. Botulinum spores occur in nature, but honey is one of the potential dietary sources for infant botulism.