Over the last few years, I’ve written about the potential therapeutic benefit that could be achieved by utilizing injectable neuromodulators, such as BOTOX® to help manage a variety of orofacial pain and TMD problems. Most commonly, BOTOX and other neuromodulators (NM) like Xeomin® and Dysport® have found their way into the treatment plans of dentists and other health care practitioners to address tooth grinding and clenching (Bruxism) both during the day and night, and symptoms associated with TMD problems.
With the knowledge that BOTOX and other NM blockers (that contain the bacterium Clostridium Botulinum) prevent the initiation of nerve signals that cause muscles to contract, the critical steps that lead to muscle contraction are inhibited. The end result being a partial incapacitation of muscle function. The muscles impacted just can’t contract with the same force and therefore, normal and excessive function associated with the involved muscles is compromised.
This outcome is certainly desired if the goal is to make a person’s underarm sweat glands work less efficiently, reduce age-associated facial wrinkling, or limit the force of jaw muscle contracture during a clench or tooth grinding event. The fact that the bacterium Clostridium Botulinum can produce such potent toxins, however, must be remembered, and brings us to the personal story that needs to be told.
The Story…
In April 2025, my two oldest daughters each gave birth to a boy, six days apart. About seven weeks later, one of my daughters sensed that something was not quite right with her son. His normal bowel movements had stopped completely, he was reluctant and then incapable of sucking formula from the bottle, and in general, he appeared a bit listless.
An 8:00 am Friday call to the pediatrician offered a late-day appointment. Concerned during those early morning hours on that Friday, my daughter and son-in-law took their son to the Weill Cornell Pediatric Emergency room.
Their son’s dehydrated state prompted IV fluids and a battery of tests and scans, as concern was apparent. As early testing results were unrevealing, one of the ER physicians, based solely on my grandson’s appearance and the symptoms and history reported by my daughter and son-in-law, made what appeared at first to be a rather surprising and extremely concerning diagnosis. In his 20 years of practice, he had seen seven similar scenarios. The diagnosis made was that of Infant Botulism.
Understanding Infant Botulism
Infant Botulism is a rare but serious form of food poisoning that occurs when infants under the age of one ingest spores of the bacterium Clostridium botulinum. Unlike adult botulism, which typically results from consuming pre-formed toxin in contaminated food, infant botulism develops when these hardy spores find their way into an infant’s intestinal tract and germinate. The spores can come from various environmental sources, including honey, soil, dust, and improperly processed foods.
Once ingested, the spores take advantage of the unique conditions in an infant’s immature digestive system. The germination process typically begins within 12 to 36 hours after ingestion, though this timeline can vary considerably depending on factors such as the number of spores consumed, the infant’s individual gut flora, and their overall health status. In some cases, symptoms may not appear for several days to a week after exposure.
When the spores germinate in the infant’s gut, they transform into active bacteria that produce potent neurotoxins. These toxins are absorbed into the bloodstream and systematically block nerve signals that control muscle contraction throughout the body. The result is a progressive paralysis that typically begins with the muscles of the digestive tract and throat, exactly as we witnessed with my grandson’s inability to have bowel movements and difficulty swallowing.
The Clinical Picture
Infant botulism affects approximately 100-150 infants per year in the United States, making it quite rare but not unheard of in pediatric emergency medicine. The condition typically presents with what physicians call “The 4 Cs”:
- Constipation (often the first sign)
- Poor Cry (weak or altered voice)
- Poor Control of head movements
- Poor Coordination of sucking and swallowing
As the toxin spreads, infants develop what’s known as floppy baby syndrome – they become increasingly listless, their muscle tone decreases, and they may have difficulty supporting their own head. Other common symptoms include a weak cry that sounds different from their normal voice, droopy eyelids, decreased facial expression, and progressive weakness in their arms and legs. In severe cases, the paralysis can affect the muscles needed for breathing, making this a potentially life-threatening condition.
A Likely Source – Construction
In our case, we suspect soil exposure rather than the more commonly cited honey or improperly canned foods. Clostridium botulinum spores are naturally present in soil worldwide, and construction activities can aerosolize these microscopic spores, making them airborne. In New York City, where my daughter lived, construction work began on the sidewalk directly outside their building the very day they brought their son home from the hospital after birth.
With their apartment facing the street and the timing being so coincidental, we can’t help but wonder whether spores released from disturbed soil found their way into the building’s ventilation system and ultimately to my grandson. While this remains speculation, construction sites are recognized sources of environmental exposure to botulinum spores, particularly in urban settings where soil disturbance occurs near residential buildings.
Critical Care and Recovery
The diagnosis of infant botulism, even when suspected, requires immediate action. In my grandson’s case, the experienced ER physician’s clinical intuition proved invaluable. Without waiting for confirmatory stool cultures – which weren’t available in those crucial early hours – he initiated contact with infectious disease specialists and began the process of obtaining botulism immune globulin (BIG-IV) the specific antitoxin treatment.
This antitoxin is controlled and distributed through a specialized program, requiring coordination with the California Department of Public Health and shipment from the nearest supply location, which, in our case, was North Carolina. Time was of the essence, as the antitoxin works by neutralizing circulating toxins but cannot reverse damage already done to nerve endings.
The 16-day hospital stay that followed was a testament to both the severity of the condition and the comprehensive care required. Recovery from infant botulism is typically slow, as nerve endings must regenerate and muscle function gradually returns. Throughout this period, supportive care including IV nutrition, respiratory monitoring, and careful attention to preventing complications like pneumonia is essential.
Ultimately, stool samples obtained about a week after admission confirmed the presence of Clostridium botulinum, validating both the clinical diagnosis and the treatment approach. The relief we felt at that confirmation – and more importantly, seeing my grandson’s gradual return to normal feeding, muscle tone, and development – reinforced how critical that initial clinical judgment had been.
A Broader Reflection
This experience served as a powerful reminder of how the combination of parental intuition, clinical experience, and prompt medical intervention can make all the difference in outcomes that might otherwise be devastating. It also highlighted for me, in a very personal way, the profound respect we must maintain for the potent biological agents we work with in our medical practices, even when we harness them therapeutically.
But perhaps most importantly, this story underscores something we cannot take for granted: the critical importance of continued scientific research and development. The botulism antitoxin that saved my grandson’s life exists because of decades of dedicated research, supported by public funding and institutional commitment to advancing medical knowledge. Without the scientists and researchers who identified the mechanism of botulism poisoning, developed methods for producing safe and effective antitoxins, and established distribution systems for emergency access, stories like ours would have very different endings.
All citizens in this country should hope that scientists and researchers continue to receive the support they need – financial and otherwise – that is critical for the creation of new knowledge and the availability of life-saving treatments like botulinum antitoxins, so that success stories like this can be realized.
The investment in science today becomes the medical miracle that saves lives tomorrow, and my family’s gratitude extends not only to the exceptional medical team who cared for my grandson, but to the generations of researchers whose work made his recovery possible.
You may also be interested in:
BOTOX® & Neuromodulators For Persistent Orofacial Pain & Jaw Disorders – Part 1
BOTOX® & Neuromodulators For Persistent Orofacial Pain & Jaw Disorders – Part 2
About Dr. Tanenbaum
10 FAQs About Infant Botulism
- What is infant botulism and how does it differ from adult botulism?
Infant botulism occurs when Clostridium botulinum spores germinate in an infant’s intestines, producing toxins inside the body, while adult botulism usually results from consuming pre-formed toxins in contaminated food. - What are the early signs and symptoms of infant botulism?
The earliest signs often include constipation, weak cry, poor head control, and difficulty sucking or swallowing. These may progress to muscle weakness and “floppy baby syndrome”. - How common is infant botulism in the United States?
Infant botulism is rare, with approximately 100 – 150 cases reported annually in the U.S. - What causes infant botulism in babies under one year old?
Causes include ingestion of Clostridium botulinum spores, which may come from honey, soil, dust, or environmental exposure such as construction-disturbed soil. - Why should infants under 12 months not eat honey?
Honey can contain Clostridium botulinum spores, which an infant’s immature digestive system cannot safely handle, increasing the risk of botulism. - How quickly do symptoms of infant botulism appear after exposure?
Symptoms can appear within 12 to 36 hours after ingestion, though in some cases, they may take several days to a week to develop. - How is infant botulism diagnosed?
Diagnosis is based on clinical symptoms and history, with confirmatory stool tests for Clostridium botulinum. Because results take time, doctors often begin treatment based on suspicion. - What treatment is available for infant botulism?
The standard treatment is Botulism Immune Globulin Intravenous (BIG-IV), an antitoxin that neutralizes circulating toxins, along with supportive hospital care such as IV nutrition and respiratory monitoring. - Can infants fully recover from botulism?
Yes. With prompt treatment and supportive care, most infants recover as nerve endings regenerate, though recovery may take weeks to months. - How can parents reduce the risk of infant botulism?
Avoid feeding honey to infants under one year, keep living spaces clean of dust and soil, and be cautious of environmental exposures like nearby construction that may disturb soil.
