Parent Alert: Don’t Feed Honey to Infants

A record number of rare infant botulism cases was reported in California during 1991, or an increase of more than 70% over 1990 levels, according to unpublished data supplied to The Times by state officials.

Other than environmental sources such as dust, the only known cause of infant botulism is honey. A Department of Health Services educational campaign to warn new mothers against feeding their infants honey is no longer being funded because of budget constraints. Supplies of bilingual brochures discussing the problem and warning about giving infants honey will soon be exhausted. At one point, the booklets were provided to all women discharged from maternity wards after giving birth.

Although the actual number of infections is small at 49, the cost to the state, insurance companies, hospitals and parents far exceeds $4 million annually.

Infant botulism manifests itself in children younger than 12 months of age as a form of paralysis. Most cases require intensive care hospitalization; the average length of stay is six weeks. During that time the victim is in a trance-like state unable to move and without normal muscle tone. Initial symptoms include constipation, a weak cry, expressionless face, head lag and respiratory arrest.

A consumer group effort to have warning labels placed on honey products a decade ago was successfully fought by food industry concerns.

Those familiar with the state’s program say the lack of a formal, educational effort is sure to result in even greater numbers of cases in years to come, particularly in some Hispanic and Chinese populations where cultural wisdom dictates that honey is good for babies.

Medical authorities are at a loss to explain the sharp jump in infant botulism during 1991 over the previous 12 months other than to state that more infants were born last year.

Most infant botulism cases in the United States occur in California, according to a report from the Centers for Disease Control in Atlanta. For instance, in 1990, the last year for which figures are available, 45% of the nation’s reported cases were in this state.

Infant botulism, first diagnosed in 1976 by four physicians and California health officials, is an opportunistic disease that takes advantage of infants’ undeveloped intestine. Clostridium botulinum spores remain dormant unless provided with ideal growing conditions. While older children and adults can consume the spores that may be present in honey without any problem, infants have no such protective mechanisms such as internal bacteria that can defeat the organism.

“Honey is the one known, avoidable source (of infant botulism) and the data implicating honey are ironclad,” said Dr. Stephen S. Arnon, of the California Department of Health Services and one of the researchers who first identified infant botulism as a disease. “Other than avoiding feeding infants honey there is nothing else--currently known--that parents can do to avoid the infection.”

California’s educational effort to alert new mothers to the dangers of honey was effective. The number of cases linked to honey has declined from about 34% in the late 1970s to 5% last year.

However, the end of leaflet distribution may reverse the trend.

An industry representative was unaware that the number of infant botulism cases had risen sharply in California during 1991 but did not dispute the effort to warn mothers about feeding honey to babies.

“Our position is that honey should not be fed to infants under one year of age,” said Mary Humann, at the National Honey Board, a Longmont, Colo.,-based trade group.

Honey’s unique processing is, in part, responsible for its acting as a vehicle for C. botulinum spores. After being removed from the hive, it is not pasteurized and only minimally heated to liquefy the substance. According to a recent industry report, “Efforts to sterilize honey have been unsuccessful so far . . . Any heat treatment that is sufficient to kill botulinal spores will caramelize the sugar and produce undesirable flavor changes. Efforts to filter botulinal spores out of honey have also been unsuccessful.”

Other raw agricultural products may also contain C. botulinum spores but none of these are traditionally fed to infants as has been the case with honey.

Despite the setback to the state’s educational effort, Arnon is enthusiastic about a new treatment for infant botulism that is scheduled to start Feb. 1 in California. Those babies diagnosed as having the disease will be eligible for the free treatment with Botulism Immune Globulin.

“This is the first potential advance in the 15 years since the disease has been discovered,” said Arnon.

Ironically, the three-year clinical study was delayed for about 12 months because of the Persian Gulf war. The Botulism Immune Globulin, which was developed by the U.S. Army, was not released for use in California because Pentagon officials thought that the medication might be needed in the event Iraq used biological weapons against Allied forces. According to military intelligence, the Iraqis had developed biological weaponry that’s active agent was the botulism toxin, considered nature’s most powerful poison.

Physicians who suspect that their patient may be suffering from infant botulism can call a 24-hour telephone service established to administer the program. The number is (510) 540-2646.