Infant botulism - why honey should be avoided for children up to one year Infant botulism means that Clostridium botulinum colonize and produce toxin in the infant gut, usually during the first year of life. Illness severity varies widely and the incidence may be under-estimated. Infant botulism should be considered in cases of acute muscle weakness or floppiness in infants, especially when accompanied by constipation or feeding difficulties. Respiratory failure and need for mechanical ventilation is common, but full recovery is gradually obtained. Diagnosis is based on stool culture and toxin detection in stool. Botulinum spores are frequently present in honey, which should consequently be avoided for infants.