Prevention
The only known prevention measure for infant botulism is to avoid feeding honey to infants. Breastfeeding may slow the onset of illness if it develops. After 12 months of age, most individuals are not susceptible to botulism from honey ingestion.

The role of breastfeeding and formula feeding as factors possibly predisposing to the development of illness remains unsettled. All studies to date have identified an association between being breast fed and being hospitalized for infant botulism 1-7 . This finding has resulted in one perspective that holds that breastfeeding predisposes to the development of illness 3, 4, 6, whereas the other perspective holds that breast-feeding slows its onset sufficiently to permit hospitalization to occur 1, 2, 8, 9. However, among hospitalized patients, the mean age at onset of infant botulism in formula-fed infants (7.6 weeks) was significantly younger and approximately half that of breast-fed infants (13.8 weeks). In addition, the fulminant-onset infant botulism patients who died at home all were formula-fed. The relative susceptibility of formula-fed and breastfed infants to the acquisition of infant botulism and the resultant severity of their disease may reflect differences in the availability of suitable ecologic niches in the intestinal flora for C. botulinum, differences in the availability of immune factors (such as lactoferrin and secretory IgA) contained in human milk but not in formula milk, 9  or other differences not identified yet.

Honey is an identified and avoidable food reservoir of C. botulinum. While most cases of infant botulism today are not caused by exposure to honey prior to illness, it is the only avoidable dietary source of exposure to the bacterium that has been definitively linked to infant botulism by both laboratory and epidemiologic evidence 7, 10-18

To date, 33 instances worldwide are known in which C. botulinum has been identified in honey associated with infant botulism cases. In each instance, the toxin type (A or B) of the spores in the honey matched the toxin type (A or B) of the C. botulinum that caused the infant's illness; the probability that such perfect concordance occurred by chance is less than 1 in 10 billion. C. botulinum spores have been found in the honey from the United States, Argentina, Australia, Canada, Central America, China, Taiwan, Denmark, Finland, Italy, Norway, Spain, Japan, Kazakhstan, Lithuania, and Poland, 18-30. For these reasons, all major pediatric, public health, and honey industry agencies in the United States have joined in the recommendation that honey not be fed to infants. In 2000, several honey brands sold in the United States began to carry a warning to not feed honey to infants; an equivalent label first appeared on British honey in 1996.

Consideration of the possible role of corn syrup in infant botulism is necessitated by two reports. In 1982, the U.S. Food and Drug Administration (FDA) found C. botulinum type B spores in approximately 0.5 percent (5 of 961) of previously unopened retail samples of light and dark corn syrup 23; the manufacturer then made changes in the production process. In 1989, the CDC reported a 2-year epidemiologic study of U.S. cases from all states except California 6. By subgrouping patients by age and using logistic regression modeling techniques, researchers identified a statistical association between the triad of corn syrup exposure, breastfeeding, and an age of 2 months or older at onset 6, 31.

In contrast to these reports, a 1988 Canadian survey found no C. botulinum spores in 43 corn syrup samples 21. A 1991 FDA market survey of 738 syrup samples (354 of which were light corn syrup and 271 were dark corn syrup) concluded that none contained C. botulinum spores 32. In addition, a 1979 epidemiologic study that simply compared corn syrup exposure rates in 41 cases and 107 control infants identified feeding of corn syrup as a significant protective factor against the acquisition of type A infant botulism 19. The explanation offered for the latter observation was that if a parent chose corn syrup as a sweetener for the infant, honey was unlikely to have been fed to the child as a second sweetener.  Thus, on the basis of evidence presently available, corn syrup does not appear to be a source of C. botulinum spores or a risk factor for the acquisition of infant botulism.

C. botulinum spores also have been identified in bulk and packaged chamomile tea 33 and bulk linden flower tea 34 though there have been no reports to date with definitive laboratory and epidemiological evidence linking a case of infant botulism to herbal tea consumption.

It deserves emphasis that for most cases of infant botulism, no source of C. botulinum spores is ever identified, even circumstantially. In these cases, the illness was likely acquired by swallowing spores adherent to airborne microscopic (invisible) dust.

1. Arnon SS. Breast feeding and toxigenic intestinal infections: missing links in crib death? Rev Infect Dis. 1984 1984;6(Suppl 1):S193-S201.
2. Arnon SS, Damus K, Thompson B, Midura TF, Chin J. Protective role of human milk against sudden death from infant botulism. J Pediatr. 1982 1982;100(4):568-573.
3. Long SS. Epidemiologic study of infant botulism in Pennsylvania: report of the Infant Botulism Study Group. Pediatrics. 1985 1985;75(5):928-934.
4. Long SS, Gajewski JL, Brown LW, Gilligan PH. Clinical, laboratory, and environmental features of infant botulism in Southeastern Pennsylvania. Pediatrics. 1985 1985;75(5):935-941.
5. Morris JG, Jr., Snyder JD, Wilson R, Feldman RA. Infant botulism in the United States: an epidemiologic study of cases occurring outside of California. Am. J. Public Health. 12/1983 1983;73(12):1385-1388.
6. Spika JS, Shaffer N, Hargrett-Bean N, Collin S, MacDonald KL, Blake PA. Risk factors for infant botulism in the United States. Am J Dis Child. 1989 1989;143(7):828-832.
7. Thompson JA, Glasgow LA, Warpinski JR, Olson C. Infant botulism: clinical spectrum and epidemiology. Pediatrics. 1980 1980;66(6):936-942.
8. Arnon SS. Infant botulism. Annu Rev Med. 1980 1980;31:541-560.
9. Arnon SS, Damus K, Chin J. Infant botulism: epidemiology and relation to sudden infant death syndrome. Epidemiol Rev. 1981 1981;4(3):45-66.
10. Jung A, Ottosson J. Infantile botulism caused by honey. [Danish]. Ugeskr Laeger. 2001 2001;163(2):169.
11. Abdulla CO, Ayubi A, Zulfiquer F, Santhanam G, Ahmed MA, Deeb J. Infant botulism following honey ingestion. BMJ Case Rep. 2012 2012;7.
12. Fenicia L, Ferrini AM, Aureli P, Pocecco M. A case of infant botulism associated with honey feeding in Italy. Eur J Epidemiol. 1993 1993;9(6):671-673.
13. Balslev T, Ostergaard E, Madsen IK, Wandall DA. Infant botulism: the first culture-confirmed Danish case. Neuropediatrics. 1997 1997;28(5):287-288.
14. Smith JK, Burns S, Cunningham S, Freeman J, McLellan A, McWilliam K. The hazards of honey ingestion: infantile botulism. BMC Case Rep. 2010 2010;2010:pii: bcr0520103038.
15. van der Vorst MM, Jamal W, Rotimi VO, Moosa A. Infant botulism due to consumption of contaminated commercially prepared honey. First report from the Arabian Gulf States. Med Princ Pract. 2006 2006;15(6):456-458.
16. Harris RA, Tchao C, Prystajecky N, Cutler J, Austin JW. A summary of surveillance, morbidity and microbiology of laboratory-confirmed cases of infant botulism in Canada, 1979-2019. Can Commun Dis Rep. 2021;47(78):322-328.
17. Arriagada SD, Wilhelm BJ, Donoso FA. Infant botulism: case report and review. [Spanish]. Rev Chil Infectol. 2009 2009;26(2):162-167.
18. Sakaguchi G, Sakaguchi S, Kamata Y, Tabita K, Asao T, Kozaki S. Distinct characters of Clostridium botulinum type A strains and their toxin associated with infant botulism in Japan. Int J Food Microbiol. 12/1990 1990;11(3-4):231-241.
19. Arnon SS, Midura TF, Damus K, Thompson B, Wood RM, Chin J. Honey and other environmental risk factors for infant botulism. J Pediatr. 1979 1979;94(2):331-336.
20. Aureli P, Franciosa G, Fenicia L. Infant botulism and honey in Europe: a commentary. Pediatr Infect Dis J. 2002 2002;21(9):866-868.
21. Hauschild AHW, Hilsheimer R, Weis KF, Burke RB. Clostridium botulinum in honey, syrups and dry infant cereals. J Food Prot. 1988 1988;51(11):892-894.
22. Huhtanen CN, Knox D, Shimanuki H. Incidence and origin of Clostridium botulinum spores in honey. J Food Prot. 1981 1981;44(11):812-815.
23. Kautter DA, Lilly TJ, Solomon HM, Lynt RK. Clostridium botulinum spores in infant foods: a survey. J Food Prot. 1982 1982;45(11):1028-1029.
24. Nakano H, Okabe T, Hashimoto H, Sakaguchi G. Incidence of Clostridium botulinum in honey of various origins. Jpn J Med Sci Biol. 1990 1990;43(5):183-195.
25. Midura TF, Snowden S, Wood RM, Arnon SS. Isolation of Clostridium botulinum from honey. J Clin Microbiol. 1979 1979;9(2):282-283.
26. Nevas M, Hielm S, Lindstrom M, Horn H, Koivulehto K, Korkeala H. High prevalence of Clostridium botulinum types A and B in honey samples detected by polymerase chain reaction. Int J Food Microbiol. 2002 2002;72(1-2):45-52.
27. Sugiyama H, Mills DC, Kuo C. Number of Clostridium botulinum spores in honey. J Food Prot. 1978 1978;41(11):848-850.
28. Grenda T, Grabczak M, Sieradzki Z, et al. Clostridium botulinum spores in Polish honey samples. J Vet Sci. Sep 30 2018;19(5):635-642.
29. Wojtacka J WB, Kabasinskiene A, Wiszniewska A, Gomolka-Pawlicka M, Szteyn J, Malakauskas M, Migowska-Calik A. Prevalence of Clostridium botulinum Type A, B, E and F Isolated From Directly Sold Honey in Lithuania. Journal of Agricultural Science and Technology. 2017;19:335- 343.
30. Mustafina R MB, Wisniewski J, Tracz M, Anusz K, Grenda T, Kukier E, Goldsztejn M, Kwiatek K. Contamination of honey produced in the Republic of Kazakhstan with Clostridium botulinum. Journal of Veterinary Research. 2015;59(2):241-246.
31. Olsen SJ, Swerdlow DL. Risk of infant botulism from corn syrup. Pediatr Infect Dis J. 2000 2000;19(6):584-585.
32. Lilly T, Jr., Rhodehamel EJ, Kautter DA, Solomon HM. Clostridium botulinum spores in corn syrup and other syrups. J Food Prot. 1991 1991;54(8):585-587.
33. Bianco MI, Lúquez C, de Jong LI, Fernández RA. Presence of Clostridium botulinum spores in Matricaria chamomilla (chamomile) and its relationship with infant botulism. Int J Food Microbiol. 2007 2007;121(3):357-360.
34. Bianco MI, Lúquez C, de Jong LI, Fernández RA. Linden flower (Tilia spp.) as potential vehicle of Clostridium botulinum spores in the transmission of infant botulism. Rev Argent Microbiol. 2009 2009;41(4):232-236.