Botulism, Infant

CHLA Board Review 2005

Weakness and hypotonia in newborns can be caused by disorders of the neuromuscular junction. They are characterized by abnormal neuromuscular transmission leading to muscle fatiguability and weakness. Although most of these disorders are transient, congenital forms sometimes may be permanent.
 These rare conditions include

Infant botulism results from intestinal colonization by Clostridium botulinum The disease presentation and severity are variable, most likely due to variations in the size of the bacterial inoculum and in host susceptibility.
The initial presentation may involve constipation, shortly followed by weakness, feeding difficulties, descending or global hypotonia, drooling, anorexia, irritability, and weak cry.
For suspected infant botulism occurring in any state, the California Department of Health Services, Infant Botulism Treatment and Prevention Program should be contacted ( or 510-231-7600).


Clinical features — 

Diagnosis — 

Details of specimen collection and testing


In clinical practice, spinal muscular atrophy type I and metabolic disorders are the most frequent mimics of infant botulism.


Management of infant botulism is otherwise supportive and includes close monitoring to detect sudden worsening.
There has been concern that antibiotics used to treat secondary bacterial infections could cause lysis of the C. botulinum vegetative cells within the intestine and thereby increase the amount of toxin that can be absorbed. However, this concern is ameliorated by BIG-IV treatment because a single BIG-IV infusion will neutralize all botulinum toxin available for absorption for at least six months
Aminoglycosides should be avoided because they can potentiate the effects of the toxin (Excess aminoglycoside levels, especially in combination with neuromuscular blockers, may lead to prolonged weakness caused by a presynaptic block. Bladder, bowel, and pupillary functions may be depressed. Hypocalcemia accentuates the neurotoxic effects of aminoglycosides and hypermagnesemia.)

UTD (last updated 2009)

Neuromuscular junction disorders in newborns and infants

Olaf A Bodamer, MD, FACMG, PhD
Geoffrey Miller, MD

Section Editors
Marc C Patterson, MD, FRACP
Joseph A Garcia-Prats, MD

Deputy Editor
John F Dashe, MD, PhD

Last literature review version 16.3: October 2008  |  This topic last updated: May 31, 2008
And anecdotally: