FDA Warns Public Of Botulism Danger After Four Infants Are Hospitalized Due To Honey-Filled Pacifiers

Though pacifiers from Mexico seem to be the source of bacteria in these cases, honey in any form poses a risk to infants under 12 months. Min C. Chiu/Shutterstock

The US Food and Drug Administration has issued an alert reminding parents not to feed honey to infants younger than one year of age after four babies in Texas were hospitalized with botulism transmitted through honey-filled and honey-dipped pacifiers.

According to the Texas Department of State Health Services (DSHS), the four infants are unrelated and from different regions of the state. After all four were treated for life-threatening infections of Clostridium bacteria, the genus that produces the potent nervous system toxin botulinum, health workers tracking the source revealed that each had been given a honey-containing pacifier bought in Mexico. The illnesses occurred from mid-August to the end of October. Information regarding the four affected infants’ current status has not been released.

Though the state agency has not been able to confirm that the pacifiers were contaminated with Clostridium through microbial testing, DSHS spokesperson Chris Van Deusen has stated that they are fairly confident these items are the culprit.

“Honey-filled pacifiers are not common in the United States but may be available in some specialty stores and through online retailers,” the DSHS report said. “Most aren’t designed for the honey to be consumed, but some have a small hole so a child could eat the honey, or the pacifier could accidentally rupture or leak. Parents should also avoid pacifiers containing any other food substance, because they could also pose a risk of botulism.”

As the FDA explains, consuming small numbers of Clostridium in honey or other foods does not pose a risk to children over one year or adults because older individuals have established gut microbiomes whose resident strains outcompete newly introduced Clostridium. But in newborns, the gut is sparsely populated, allowing the pathogenic bacteria to settle in and multiply rapidly. As they grow, the Clostridium produce botulinum: the most lethal toxin yet discovered (just 0.07 millionths of a gram is enough to kill a 70 kg [154 lb] person).

A scanning microscopy image of Clostridium botulinum bacteria. Cedric Woudstra/ResearchGate

Like other nerve agents, botulinum impairs the activity of acetylcholine, a neurotransmitter found in the brain and in the junctions of motor neurons and muscles. The toxin is able to enter nerve cells, whereupon it cuts apart the proteins required to release acetylcholine into the cell junction, thus preventing muscles from responding to signals from the nervous system. Symptoms of botulinum poisoning include lowered muscle tone or paralysis and difficulty breathing.

Naturally occurring in soil and aquatic sediment around the world, botulinum-producing Clostridium are known to show up inside or on the surfaces of many foods. Because honey is typically a non-pasteurized food (and you can’t exactly wash it), live spores of the bacteria can persist in honey products.

The FDA is calling for online retailers to discontinue sales of honey-filled pacifiers.

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