Starting in November 2024, a botulism outbreak linked to baby formula has affected at least 51 infants across 19 states. While physicians have led the medical management of these cases, speech-language pathologists (SLPs) have played an essential role in supporting recovery, particularly in feeding and swallowing rehabilitation.
Overview of Infant Botulism
Infant botulism is an intestinal toxemia caused when spores of Clostridium botulinum or related species are ingested. These spores colonize the infant’s large intestine and produce botulinum neurotoxin, which disrupts acetylcholine release at cholinergic nerve terminals. This interference can lead to:
- Bulbar palsies
- Hypotonia
- Asymmetric, descending, flaccid paralysis
Signs and Symptoms
Infants with botulism may present with:
- Constipation
- Poor feeding
- Ptosis (drooping eyelid)
- Sluggish pupils
- Flattened facial expression
- Diminished suck and gag reflexes
- Weak or altered cry
- Respiratory difficulty, potentially leading to respiratory arrest
Treatment & The Role of SLPs
Medical treatment typically includes BabyBIG®, a human antitoxin for infant botulism. In severe cases, respiratory support via intubation may be required. However, recovery extends beyond antitoxin administration—feeding and swallowing difficulties often persist, and this is where SLPs are indispensable.
SLPs provide comprehensive assessment and intervention for swallowing and feeding issues. Their work includes:
- Bedside clinical exams
- Video fluoroscopy swallow studies
- Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Speech-language pathologists assess an infant’s ability to latch, efficiently transfer liquids, and swallow safely. During BabyBIG® treatment and recovery, many infants require alternative methods of nutrition and hydration. SLP intervention focuses on supporting safe sucking and swallowing while closely monitoring changes throughout the illness and recovery process. Collaboration with occupational and physical therapists ensures a comprehensive, family‑centered approach that supports the infant’s overall development and recovery.
Conclusion: Why SLPs Matter In Infant Botulism Care
Infant botulism is a rare but serious condition that can compromise essential functions like feeding and breathing. While antitoxin therapy addresses the underlying cause, functional recovery depends heavily on restoring safe swallowing and feeding skills. SLPs bring specialized expertise to this process, reducing complications such as aspiration and malnutrition, and promoting developmental progress. Their role is not just supportive—it is critical to survival and long-term health outcomes for effected infants.
Growing Clinician Expertise
Speech-Language Pathologists looking to advance their skills are invited to join our live webinar 3rd Annual Birth to Three Conference on March 26-27, 2026. Taking a whole-child approach, SLPs in all settings can choose your track to:
- Reframe reflux
- Diagnose and treat apraxia
- Manage esophageal dysphagia
- Empower communication with AAC tools
- Maximize trunk support for feeding and speech
- Support Therapeutic Engagement
- Understand the cardiovascular system
Learn more and register. Sign up today!
Citations:
Infant Botulism Treatment and Prevention Program. California Department of Public Health. https://infantbotulism.org
Aleccia, J. (2025, December 10) How a rare drug made from scientists’ blood saves babies from botulism. AP News. https://apnews.com/article/infant-botulism-babybig-byheart-cd5f396324e5d636ed3fae805955acbe
Steiner, B. (2021, May 14) Speech Pathology in the NICU. UF Health Jacksonville. https://ufhealthjax.org/stories/2021/speech-pathology-in-the-nicu
(2024, April 24) Clinical Overview of Infant Botulis. CDC. https://www.cdc.gov/botulism/hcp/clinical-overview/infant-botulism.html
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