Step 1: Take a deep breath. Your baby is most likely fine. More than fine, even, if you factor in the thrill of sweet foods.
Step 2: Do nothing. Unless your baby is motioning for more Cheerios, in which case, pour a few more.
Step 3: Clean the leftover Cheerios off the floor. Or don’t, because floor food isn’t a big deal.
Step 4: Read Part III of The Couch Cheerio Series, below.
In Parts I and II of this series, we’ve used the humble couch Cheerio to explore parents’ fears about germs and choking. In this installment, we’ll answer a few questions about botulism, as well as a bigger question: how do you decide which baby safety messages to take seriously and which ones to ignore?
If you started panic-googling after you realized your baby got an accidental taste of honey, you’re in good company.
Baby messaging boards are filled with parents asking about not just accidental tastes of honey, but also Honey Nut Cheerios. And graham crackers. And Teddy Grahams. And yogurt. And honey wheat bread. And ham.
These message boards are full of reassuring fellow parents, although there are exceptions that should make you wary, if not about botulism then about posting baby safety questions on gaming forums.
Unfortunately, trolls questioning your parenting decisions are not the worst problem of parenting forums, which are also full of misinformation and confusion. Here’s just a taste of the statements made about honey and botulism that pop up when you google “my baby just ate a honey nut cheerio what do i do”:
If the honey is cooked, it’s fine.
Honey is the same as syrup, and it’s safe to give babies syrup.
Honey is the same as syrup, and it’s NOT safe to give babies syrup.
Honey is safe as long as it’s straight from the hive.
Honey is safe as long as it’s NOT straight from the hive.
Only raw honey contains botulism.
You’re not supposed to give babies honey because of possible allergies.
If your baby has eaten honey once and was fine, it’s no problem to eat it again.
Honey from California is the most dangerous.
Processed food won’t cause infant botulism.
Baking kills botulism spores.
Honey Nut Cheerios don’t contain honey.
There is honey in Honey Nut Cheerios, but so little that it doesn’t matter.
Heat kills botulism toxin, and heat’s used to make Cheerios, so they’re safe.
I learned three lessons from this list. First, baby forums are a terrible resource for new parents.
Second, parents may know the what of baby safety recommendations, but not the why, which can lead to unnecessary confusion and panic.
Third—and this is not helping with the confusion and panic problem—the first hit when I googled “my baby just ate a honey nut cheerio what do i do” is Poison Control.
We can’t fix problems one or three, but we can work on number two and learn more about where the honey botulism warning comes from.
Botulism comes from Clostridium botulinum, a bacterium that occurs naturally in soil. The spores of Clostridium botulinum can, under the right conditions, produce botulinum toxin. When a person of any age ingests preformed botulinum toxin from food, it’s called foodborne botulism.
Infants can get foodborne botulism, but because they aren’t eating solid foods, such cases are unlikely. The bigger concern for infants is the Clostridium botulinum spores themselves. Children and adults with well-formed digestive systems can ingest Clostridium botulinum spores without incident. Infants do not have mature intestines to fight off the spores, which stick around and produce botulinum toxin.
Botulinum toxin can be killed by heat, but Clostridium botulinum spores are heat-resistant, making them more difficult to kill. And what food is a good carrier for Clostridium botulinum?
Think of the relationship of honey and infant botulism like squares and rectangles. Honey-related cases of botulism are nearly always infant botulism, but not all infant botulism comes from honey.
Honey can, however, contain Clostridium botulinum spores, and those spores are not always killed by an infant’s immature intestines. According to one review from the American Academy of Pediatrics, honey is involved in 20% of infant botulism cases.
What do the other cases come from? We don’t really know, but dirt is the most likely culprit.
If you’ve been lurking on baby forums, you may have read that California dirt is “worse” than other dirt. Or maybe now you’re running to the pantry to check the origins of your honey to make sure the bees who touched it never touched West Coast soil.
In either case, there are probably more botulism cases in California because there are more people in California. Although it is theoretically possible that soils in some regions might be more likely to contain Clostridium botulinum spores, it’s also possible that some states and countries identify or report botulism cases more frequently than others.
Because some honey contains Clostridium botulinum spores, it’s reasonable to warn parents about feeding honey to babies. Babies do not require honey to survive, so even though the chances of contracting infant botulism are quite low (see below), it’s reasonable to wait to introduce honey until their intestines have matured.
But what about foods that contain honey? Do you have to wait a year to introduce those foods? That’s less clear, because we don’t know the cooking methods used. As long as the temperature was high enough for long enough to kill Clostridium botulinum spores, foods containing honey should be safe to eat. It’s difficult to make those determinations in home kitchens without sensitive temperature and pressure controls, so it’s probably best to leave honey out of cooked dishes if you’re worried about the small possibility of infant botulism.
Food processing often involves much higher temperatures and pressures than home cooking, so processed foods—like that box of Honey Nut Cheerios—are likely fine. While it’s theoretically possible for any honey-containing food to harbor Clostridium botulinum spores, it’s extremely unlikely
It is unlikely that your baby will get infant botulism, from honey or any other source. So unlikely, in fact, that most pediatricians have never seen a case of infant botulism.
In 2016, there were just 150 cases of infant botulism reported in the US. In that same year, Joseph Zenel, doctor and editor in chief of Pediatrics in Review, described a diagnosis of infant botulism as the kind of a “A-ha!” moment you’d expect in an Agatha Christie novel.
The condition is so rare that the pharmaceutical companies don’t try to make money off of the cure. The botulism antitoxin given to babies is an orphan drug, which is a designation given to drugs for rare diseases that are too expensive for drug companies to produce at profit.
Although infant botulism is scary, requiring long hospitalization, the mortality rate is quite low, generally estimated at about 1% of hospitalized infants.
Infant botulism is, in short, an extremely rare condition that is in most cases survivable. And yet, if you trust your search results, you’d assume that ERs are just revolving doors for honey-acquired botulism poisoning.
The real lesson here isn’t about infant botulism, or honey, or the temperatures to which processed foods may or may not be heated. It’s about panic.
Most people’s babies are going to be fine. All the time. In case we need reminding of that fact, let’s pop back into the parenting forums, which in addition to all the misinformation about hidden dangers also offer pretty decent generalized parenting advice:
“Try not to worry!!”
”Relax she’ll be fine.”
”I’ve done it too.”
”Even if you did give real honey by accident, it's not really anything to stress out over.”
”I wouldn’t be too concerned honestly.”
”I wouldn’t worry with such a a small amount.”
”Don’t stress about this at all.”
”He'll be fine!”
”They’re delicious, fortified, and allow me to clean the kitchen.”