First off, infant botulism is quite rare. There are around 250 infants that contract the bacterial spores and fall ill each year.(1) It may seem like a lot, until you realize 4,000,000 babies are born in the US each year.(3) So your baby actually only has a .00625% of contracting it. While we don't want any babies to become ill, you likely will never meet anyone who has had a baby contract it.
Now let's consider the risk factors. Half of all cases have been found in California. SO if you don't live in CA, cut those statistics in half. Only 125 children in the entire US each year. Another huge risk factor is breastfeeding.
WHAT?! Breastfeeding causes botulism?
Botulism makes babies sick very quickly. The American Academy of Family Physicians explains that, "Breast-feeding may delay the clinical severity of this condition, allowing these infants to receive medical attention before the botulism becomes fatal."(1) So, breastfeeding is very likely to save your child's life on the small chance that they ingest the spores.(2)
Here's another surprising fact: Out of babies that are hospitalized, it is fatal less than 2% of the time. It is a scary illness for sure, but not likely to kill a breastfed infant, and does not have any long-term effects. Babies will recover on their own, and the hospitalization is just to make sure their airways stay open and they have nutrition while they recover.
So did all these babies who got sick eat honey? That seems to be why we're all warned against it.
In reality, only 15% of cases can be traced back even to the possibility of honey contamination. We know honey can't possibly be the culprit in most cases, since the victims, "range in age from six weeks to nine months, with the peak incidence occurring at two to three months of age. About 90 percent of infants with botulism are younger than six months."(1) So it seems more important to stress that parents not give their babies food before six months (as is recommended for other reasons) than it is to harp in the "no honey" rule.
In addition, the one-year cutoff is arbitrary, as there are no documented cases of infant botulism in a child older than 9 months, and only 25 cases on average a year (that means about 2-3 from honey) in babies 6-9 months.(1)
Where do the babies get botulism if not from honey? They get it from soil and dust particles containing spores, even in the air.(2) But since there's no way to prevent that, we simply aren't told about it.
Now, not giving a baby honey for the second six months of their life and breastfeeding for the first six months seems to be a pretty simple way to prevent illness. But I want to make a point that what parents are told to be concerned about is not always logical.
For example, if 90% of all infants were given human milk, it would save around 900 infant lives every year(4). EVERY. YEAR. Although there is more support for breastfeeding now than in the past, the same medical professional that continually remind you to "don't give any honey before one!" are often quicker to suggest artificial milk before a lactation consultation.
Another bitter pill to swallow is the acknowledgement in recent years of the number of harms stemming from the medical system itself. A study(5) found that 1.3% of all hospitalizations of children involve errors. Obviously, these kids are in the hospital for a reason, but it seems our worry over honey might be disproportional to what might happen to our children when they enter a hospital!
This is just a little something to think about when we encounter advice. Do you know the real numbers, risks, and prevention of health problems? There are many, many children and mothers impacted, sometimes for a lifetime, by interventions in the birth process that they are not properly informed about.
We talk about informed consent and many other topics in my childbirth education classes in the Huntsville area.
1) Infant Botulism. NADINE COX, M.D., and RANDY HINKLE, D.O., Mount Carmel Medical Center, Columbus, Ohio. Am Fam Physician. 2002 Apr 1;65(7):1388-1393.
2) Frequently Asked Questions (FAQs) on Infant Bolulism. Infant Botulism Treatment and Prevention Program. CDC.
3) Births and Natality. March 31, 2017. CDC/National Center for Health Statistics.
4) The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. American Academy of Pediatrics Pediatrics. April 2010
5) Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care. Pediatrics
June 2011, VOLUME 127 / ISSUE 6. American Academy of Pediatrics, Policy Statement.