This protocol applies to infants aged under 1 year with botulism acquired from food or the environment. When an infant presents as part of a group of botulism cases, exposure to a toxin from a food or environmental source is the likely cause, and the presentation is consistent with botulism in an infant rather than the distinct syndrome of infant botulism. The approved antitoxin dose for this age group is calculated differently from adult dosing.
Initial management includes supportive care — with intubation and mechanical ventilation when clinically necessary — plus botulinum antitoxin heptavalent (BAT) at the age-appropriate dose by intravenous infusion. The goal of antitoxin is to halt the progression of flaccid paralysis: neurologic signs should not continue to worsen for more than 1 day after BAT is administered. When paralysis continues to progress beyond 24 hours after the first antitoxin dose and the diagnosis of botulism is secure, escalation to the next step is clinically indicated.
For infants in whom paralysis continues to progress despite initial antitoxin therapy, the structured protocol addresses retreatment via intravenous infusion — with specific guidance on indications and safety considerations that extend beyond this summary.
The FDA-approved BAT dose for infants (persons aged <1 year) is 10% of the adult dose, regardless of weight.
If an infant is affected as part of a group of botulism cases, the infant has likely been exposed to a toxin from food or the environment, and the illness is likely to be botulism in an infant rather than the syndrome of infant botulism.
If a child needs a second dose of BAT (a situation that is highly unusual and is clinically indicated by progression of paralysis >24 hours after administration of a first dose of antitoxin, with high confidence in the diagnosis of botulism), the dose is unlikely to result in a hypersensitivity reaction because of sensitization caused by the first dose.
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