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One known and avoidable cause of infant botulism is honey — both raw and pasteurized. Although the natural sweetener is sometimes used on soothers, as a natural cough suppressant or to replace sugar in homemade baby food, doctors recommend that parents keep honey away from children under the age of one. Here’s everything you need to know about infant botulism and honey.

What is infant botulism and what causes it?

It’s a rare illness caused by food contaminated with Clostridium botulinum bacteria. The spores colonize and grow in the infant’s large intestine and produce a neurotoxin. It only affects infants because adults and children more than 12 months old have more good bacteria in their gut that can help to quickly move the botulism bacteria spores through their gastrointestinal system before it has time to grow and release the toxin. Botulism can also occur in adults who have altered gut flora or if the toxin has already been produced on contaminated food. The bacteria can also be inhaled or enter through open wounds.

What are the symptoms?

Paralysis is characteristic of infant botulism, so symptoms tend to revolve around a lack of muscle strength and movement. The earliest signs include difficulty feeding, weak sucking, trouble swallowing and increased drooling. The baby may also make fewer facial expressions and have a different cry or trouble breathing. From there, the baby will become increasingly weak or “floppy.” Although constipation is one of the most common signs, it may be overlooked as it’s also a symptom for many other illnesses. Symptoms usually start to appear between six and 36 hours after ingesting contaminated food or drink, but it can take up to 10 days.