BACKGROUND: Infantile botulism is the result of ingestion of Clostridium 
botulinum spores, and is the most common form of infection with botulism in the 
United States. Ninety percent of cases occur in infants <6 months old. The 
infants typically present with vague symptoms such as hypotonia and poor 
feeding. This article reports an infant with confirmed infantile botulism that 
presented to the Emergency Department (ED) with complaints of decreased feeding 
and absence of bowel movements for >1 week.
OBJECTIVES: Review a case of infantile botulism, its diagnosis, and treatment.
CASE REPORT: A 4-month-old healthy Caucasian male presented to the ED with a 
6-day history of decreased feeding after referral from the pediatrician. He had 
not had a bowel movement for 9 days, and his parents were also concerned about 
increasing weakness, as he was no longer able to hold his head up on his own. In 
the ED, he was minimally interactive. His vital signs were within normal limits, 
and he had hypoactive bowel sounds and decreased tone throughout. He was 
admitted to the Children's Hospital and eventually transferred to the Pediatric 
Intensive Care Unit requiring intubation and mechanical ventilation. The 
botulism immunoglobulin was administered, and a diagnosis was confirmed with 
positive botulinum toxin in the stool samples. Full recovery was made by the 
infant.
CONCLUSION: Awareness of the symptoms of botulism and a high degree of clinical 
suspicion is needed to make a prompt diagnosis.