Waiting, watching, and trying not to worry

Baby E was crying while I prepared breakfast.

Since she seemed hungry despite having nursed recently, I asked the girls to give her some food while I fixed their oatmeal. I mixed up some rice cereal and yams for her, then gave AJ the little cup of baby food and a spoon to feed Baby E. Both girls have gotten so good at doing this that I let them feed her by themselves (with close supervision of course).

Then I gave each of the girls some oatmeal with honey, and turned to bake some muffins. All three girls were happy at the table nearby, eating their breakfast.

A minute later, A said, "Mommy? I just realized I accidentally gave E some food out of my bowl instead of hers."

My first thought was that the fine, mushy oatmeal wouldn't hurt the baby. Then I remembered. Raw honey. My 5-month-old had just eaten raw honey.

I knew that under no circumstances should babies under a year old eat honey. I thought I remembered it had something to do with botulism poisoning. How long does it take for botulism poisoning to kick in, I wondered? Minutes? Hours?

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Watching Baby E intently, I felt so helpless. I should never have given AJ two dishes and expected her not to get them mixed up.

I dialed the phone with shaking hands, left a message on the pediatrician's machine, and thankfully didn't have to wait long for a reply.

The nurse called back within a few minutes. She talked to me, asked questions, and said that she didn't think the amount Baby E had ingested (maybe 1/8 of a teaspoon at most) would be likely to cause problems. She hung up and talked to a doctor and called poison control. Then she called me again.

Poison control had told her the chances weren't very high that Baby E would get botulism poisoning, but that we need to watch her carefully for signs and take her to the emergency room IMMEDIATELY if she develops any of the symptoms or just doesn't seem "right" any time in the next few days.

The nurse read me the information about botulism poisoning from her big book of medical information:

Onset can vary from 4 hours to 9 days. Usual onset 12-36 hours.

Possible symptoms include neuromuscular issues, visual disturbances, dry mouth, difficulty swallowing, muscle weakness, vomiting and diarrhea with no fever, trouble breathing, and excessive drooling.

All we can do is watch and wait.

When I got off the phone, I looked up honey and botulism poisoning in infants. The CDC website and the American Academy of Family Physicians website have a wealth of information, as do many other sites.

I found out that adult and infant botulism poisoning are two completely different things. The nurse had given me information on the adult, ingested-toxin form--not the infant form from ingesting spores.

There are three kinds of botulism poisoning: One is caused by ingesting the botulism toxin already created by spores growing in food, one is caused by botulism spores inhabiting an open wound and creating toxin, and the last (usually seen only in infants) is caused by the ingestion of botulism spores which then propagate in the intestines and create botulism toxin.

Infant, or intestinal, botulism takes much longer to present than botulism from ingesting the already-formed toxin. Apparently the time can vary greatly, but some statistics I found were that it could take between 3 and 30 days from ingesting the spores to start exhibiting signs of poisoning.

Infant botulism can have many of the same symptoms as adult botulism poisoning. The most common symptoms in infants seem to be constipation (which can precede other symptoms by as much as weeks), poor feeding, muscle weakness, lethargy, irritability, an altered cry and lack of facial tone/expression. This often progresses to extreme lack of muscle tone and difficulty breathing. About 2% have seizures. Contrary to what the nurse told me, fever (sometimes 105 degrees) can also be a symptom.

Occasionally, intestinal botulism will onset quickly and lead to sudden respiratory distress and death without presenting other noticeable symptoms beforehand. Some cases of SIDS are probably the result of botulism poisoning.

The treatment is to hospitalize the baby and give assistance with functions like eating and breathing if necessary until the toxin clears from the system. Well over 75% of diagnosed cases in infants lead to intubation, usually including a feeding tube and often several weeks on a respirator. If diagnosed early enough, most cases of infant botulism will eventually recover with proper care. About 2% die despite hospitalization or before they can be hospitalized.

Honey and dirt are the two known sources of botulism spores. The dirt in particular areas of the country (and presumably the world) varies in concentration and likelihood of finding botulism spores. There are "hot rings" (such as Staten Island, New York) which have significantly higher concentrations in the soil than other areas.

Honey ingestion is the most common source of intestinal botulism poisoning in infants, and most cases of botulism poisoning in the USA are in infants. There are known cases of poisoning resulting from very small amounts of honey being consumed--in at least one case, a pacifier sweetened with a small amount of honey led to botulism poisoning.

Incidentally, the spores are much harder to destroy than the toxin itself. While baking or boiling will neutralize the toxin in foods, it may not destroy the spores in honey. So children under a year should probably not have honey even in cooked foods, although commercial canning processes are probably enough to kill the spores.

As much as 25% of honey in the USA may be contaminated with botulism spores. Some infants and almost all adults will not be harmed by ingesting them. But in children under a year old, and especially before 6 months, the acid and intestinal flora levels in the intestines tend to allow the spores to grow. As they propagate, they release the botulism toxin which causes botulism poisoning.

I'm going to give Baby E some infant probiotics (acidophilus and other helpful intestinal flora) in hopes that it will help prevent any botulism spores from growing.

So there's nothing we can do but watch her like a hawk, for who knows how long. And wait.

And pray.