Why Can’t Babies Have Honey? Understanding Infant Botulism

Introducing solids is a fun milestone, but it’s also one that comes with a lot of questions. One common question many parents ask is, why can’t babies have honey? This article explains the science behind why infants under 12 months old shouldn’t consume honey. It also covers infant botulism, including its risks, how common it is, its treatment, what to do if an infant accidentally consumes honey, and why honey is safer for babies to consume after one year of age. 

What Is Infant Botulism? 

Botulism is a rare but serious illness caused by Clostridium botulinum, a bacterium capable of producing a powerful neurotoxin (1). This neurotoxin blocks the release of acetylcholine, a chemical messenger necessary for communication between nerves and muscles, leading to progressive muscle weakness and, in severe cases, paralysis (1,2). The spores of Clostridium botulinum are naturally found in the environment with spores sometimes being present in soil, dust, and certain foods like honey (3). Clostridium botulinum spores are extraordinarily resilient, capable of surviving extreme conditions for long periods (3). 

In infants, botulism most commonly occurs when spores are ingested and germinate within the underdeveloped digestive tract. The infant’s gut, which is less acidic and has an immature microbiome, provides an environment where the bacteria can grow and produce toxins. When botulism spores are ingested by a baby and subsequently colonize and release botulinum toxins, it is referred to as infant botulism (4).   

Infant botulism is distinct because it results from toxin production within the body after spore colonization. When adults experience botulism, it is usually experienced as food borne botulism, which occurs when pre-formed botulinum toxin is ingested through contaminated food (5). Unlike infant botulism, where spores germinate and produce toxins within the digestive system (4), foodborne botulism involves consuming food or drink that already contains the active neurotoxin. This happens when improperly canned, preserved, or stored foods create an anaerobic (oxygen-free) environment ideal for the bacterium to produce toxins (5). 

It is noteworthy that infants could also theoretically consume pre-formed toxins present in contaminated food, like adults do in cases of foodborne botulism. This scenario is exceedingly rare because of food safety measures. 

In either case—spore germination or ingestion of pre-formed toxin—the effects of botulism can manifest as flaccid paralysis (4,5). Early signs in infants include constipation, weak cries, poor feeding, and reduced muscle tone, which can progress to respiratory distress and life-threatening paralysis if left untreated (4). 

Symptoms of Infant Botulism 

The symptoms of infant botulism typically appear between 3 and 30 days after exposure to the spores (5). These symptoms can vary in severity but often include the following (5,6): 

• Constipation: This is frequently the first noticeable sign and may persist for several days. 

• Generalized weakness: Infants may appear floppy (hypotonia) or have reduced muscle tone. (This is a medical emergency!) 

• Poor feeding: Difficulty sucking or swallowing can occur due to weakened facial muscles. (This is a medical emergency!) 

• Diminished reflexes: The absence of a gag or sucking reflex due to weakened muscles. (This is a medical emergency!) 

• Respiratory distress: Shallow breathing or respiratory failure can occur in severe cases. (If you notice respiratory distress in your infant, call 911 immediately.) 

• Weak or altered crying: A quieter or less vigorous cry may be observed. (This requires prompt medical care.) 

Because these symptoms can progress rapidly, early recognition and treatment are very important. If you notice any of the above signs (outside of occasional mild constipation with no known prior honey consumption), please seek emergency medical care. 

Honey and Infant Botulism 

Infants can contract botulism from a variety of sources, including dust and soil (3). It would be near impossible to avoid exposure to spores that can be present naturally in the environment, but honey is something that we can control our exposure to, making it worthwhile to restrict until your baby’s digestive system matures. 

Honey can be contaminated with Clostridium botulinum spores due to its proximity to soil and dust during production. Even pasteurized or processed honey may contain spores because they are highly heat-resistant, and temperatures required to kill the spores are higher than those generally used in commercial food preparation processes (7). 

Per the FDA, botulism spores can also be present in improperly canned foods or foods that have been improperly stored (8).  

Relative Risk: How Common Is Infant Botulism? 

Infant botulism is very rare: there are about 100-200 cases reported each year in the United States (9,10,11). California reports a higher prevalence of infant botulism (12) — with one study reporting the occurrence of infant botulism to be three times higher in California compared to the rest of the country (12), likely due to its environmental conditions that favor Clostridium botulinum spore presence (12). To put things in perspective, there are about 3,660,000 live births in the US, so infant botulism affects only 0.004 percent of babies born each year. This number is likely helped by the general adherence to the guideline of avoiding honey under age one.  

Treatment for Infant Botulism 

Treatment for infant botulism requires hospitalization. If your baby has botulism, they will be given Botulism Immune Globulin Intravenous (BIG-IV), a specialized antibody therapy that neutralizes circulating toxins (13,14). In addition to BIG-IV, supportive care may include: 

• Respiratory support: In approximately 50% of cases, mechanical ventilation is required (15). 

• Nutritional support: Infants may need feeding through a nasogastric tube until they regain swallowing ability (15). 

With prompt medical intervention, the prognosis for infant botulism is good, although full recovery can take weeks to months (15). 

Why Is the Risk of Botulism Reduced After the First Year? 

By the time a child reaches their first birthday, their digestive system has undergone significant changes: 

1. Maturation of gastric environment: A young infant has a relative lack of gastric acidity, and a more acidic stomach environment may inhibit the germination of Clostridium botulinum spores (16,17,18). 
2. Mature gut microbiome: The diverse bacterial population in an older child’s gut may be better able to compete with and suppress harmful bacteria (19,20). 
3. Improved immune system function: A stronger immune system provides additional defenses against bacterial colonization (21,22). 

To learn more about immune development during childhood, read this article: Does My Child Get Sick Too Often? Understanding Sickness Frequency in Children 

Alternatives to Honey for Babies Under One 

Honey, especially raw local honey, is a crunchy mom favorite for its natural sweetness plus potential benefits that include soothing occasional sore throats and coughs (23), acting as a natural antimicrobial (24), and providing gentle immune support (25). Parents may wonder where else they can get similar benefits for their babies. 

For soothing occasional respiratory tract discomfort in babies, I like to use mucilaginous herbs, such as licorice root, to gently coat and soothe the lining of the respiratory tract (26) in combination with other time-tested herbs that support respiratory health, such as lovage (27) and wild cherry bark (28). 

When it comes to supporting the immune system, herbal support plans for infants may include echinacea, elderberry, and astragalus (29).  

To learn more about choosing an immune support remedy for your child, read this article: Herbal Immune Support For Kids: When To Use Immunity Boost™ Kids, Elderberry Elixir™, & Nature’s Biotic™ Kids 

If you are looking for natural sources of sweetness for babies, fruits usually provide plenty. For baking, applesauce works well, and maple syrup can usually replace honey 1:1 in most recipes.  

*A note on elderberry for babies: While properly prepared elderberry remedies are generally considered to be safe for use in infants, please be aware that many elderberry syrups are prepared using honey. If you are looking to use elderberry containing herbal remedies for your infant, be sure to look for options that do not include honey. 

To learn more about elderberry, read this article: Elderberry – A Natural Remedy: Benefits, Uses, & Safety Tips for Families 

My Baby Consumed Honey — What Do I Do? 

First, take a deep breath. The risk of infant botulism from consuming honey is very low, and most babies who accidentally eat honey are perfectly fine! It’s worthwhile to familiarize yourself with the potential symptoms of infant botulism: over the next 30 days, watch for signs such as constipation, reduced muscle tone (floppiness), weak crying, feeding difficulties, or trouble breathing. These symptoms develop gradually if they appear. 

You might consider giving your baby an infant-safe probiotic to support gut health, though there’s no evidence this prevents colonization. If you’re concerned, call your pediatrician for reassurance and guidance. Seek immediate medical attention if any symptoms arise.  

Remember, the chance of botulism is very rare, and your baby will likely be just fine! You’ve got this.  

To learn more about common health concerns for infants, click here. 

Summary 

Honey is not recommended for babies under one year of age due to the risk of infant botulism, a rare but serious condition caused by Clostridium botulinum spores that can germinate in an infant’s immature digestive system. Potential symptoms of infant botulism include constipation, weak cries, feeding difficulties, and muscle weakness, which can progress to respiratory distress if untreated. If honey is accidentally consumed, monitor your baby for symptoms but remain calm—most babies will be fine. For natural sweetness, opt for alternatives like fruit and maple syrup, and for occasional immune support, look for infant-safe herbal remedies that do not contain honey. Honey becomes safer as your baby’s digestive system matures, and it is usually regarded as being safe starting around your child’s first birthday. 

References:  

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