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  • From: Marty Hanks <marty AT justbeenc.com>
  • To: NaturalBeesinNC AT yahoogroups.com, Orange County Bees <ocba AT lists.ibiblio.org>
  • Subject: [ocba] honey and infants
  • Date: Thu, 7 Mar 2013 10:00:14 -0500

Hello All,

Some interesting research findings about honey and infants.  


Not giving honey to infants: 
A recommendation that should be reevaluated 

by Mamdouh AbdulRhman, M.D., and Nermeen Tayseer, M.D. 



Editor’s note: The American Apitherapy Society, by publishing this study, seeks to inform readers about 
the controversy regarding feeding honey to infants. The decision to publish the study does not represent 
an endorsement of one or any particular position on this matter. 

Abstract 
The possible association of Clostridium botulinum (C. botulinum) in Bee Honey (BH) and the 
recommendation not to give it below the age of 1 year are controversial. This study aimed at identifying a 
possible relation between BH intake before the age of 1 yr and infant botulism. The study was carried out 
in Al Khafji National Hospital in the Kingdom of Saudi Arabia. We examined 221 BH samples from 
different sources without detecting C. botulinum spores. A questionnaire was conducted among 719 
mothers regarding BH intake during an infant’s first year of life, and we found that 1,525 infants of 545 
mothers received BH during that time without mortality or significant morbidity that could be attributed 
to infant botulism. Furthermore, no case of infant botulism was reported between 1995 and 2002 in all 
hospitals of Al Khafji, nor in the local health office. We thus conclude that the recommendation not to 
give bee honey to children younger than 1 year should be re-evaluated. 

Abbreviations used 
BH 
bee honey 
BHO 
bee honey orally 
C. botulinum 
Clostridium botulinum 
KNH 
Al Khafji National Hospital 
KSA 
Kingdom of Saudi Arabia 

Introduction 
Bee honey is a supersaturated solution of sugars, mainly fructose, glucose and maltose-like sugars, with 
traces of sucrose, glucose oxidase, hydrogen peroxide, phenolics, flavonoids, terpenes, etc. [1]. The sugars 
make honey hygroscopic (moisture absorbing) and viscous, and the sugar concentration plus other factors 
including low pH, hydrogen peroxide, and the flavonoids, phenolics, and terpenes make honey an 
antimicrobial agent [2]. The high acidity of honey plays an important role in the system which prevents 
bacterial growth. The pH of honey varies from 3.2 to 4.5 (average pH = 3.9), making it inhospitable for 
attack by most bacteria. Its low moisture content also forms an important part of the system that 
protects honey from attack by microorganisms. Honey’s hyperosmotic nature prevents the growth of 
bacteria and yeast as it draws water out of the organisms, killing them by desiccation [3]. 
Bee honey was the most used medication in ancient Egypt. Of the almost 1000 different remedies on 
record, more than 500 were honey-based [4]. It has been demonstrated that BH has multiple benefits, 
including anti-inflammatory [5], antimicrobial [2], wound healing [4], and mucolytic expectorant effects [4], 
[5], [6]. Some researchers have identified honey as a possible source of C. botulinum spores. They 
discourage giving it to infants under 1 yr of age because in extremely rare cases the gut flora of some 
infants may not be mature enough to combat these spores, and this may result in infant botulism [7], [8], 
[9], [10]. 

Yet others [11], [12], [13] have not detected these spores in bee honey. Furthermore, infant 
botulism is a mainly unavoidable disease, and most patients probably inhale and then swallow airborne 
clostridial spores; these cases cannot be prevented [7]. It was observed that some people in Al Khafji of 
KSA used to give BH to their children, including those below 1 yr of age, intentionally as a food of good 
nutritive value and as a non-traditional medicine to treat different illnesses, without consulting their 
physicians. 

Aim of the study 
We wanted to find out any possible relation between BH intake before the age of 1 yr and infant 
botulism. This would be achieved by (1) examination of BH samples from different sources for the 
presence of Clostridium botulinum spores and (2) a survey seeking information about frequency of 
BH intake below the age of 1 yr and the prevalence of infant botulism in Al Khafji of the Kingdom of 
Saudi Arabia (KSA). 

Subjects and methods 
This study was carried out at Al Khafji National Hospital (KNH) of KSA between February 1998 and 
November 2002. It consisted of (1) an examination of BH samples for the presence of Clostridium 
botulinum spores, (2) a questionnaire about BH intake during the first year of life, and (3) an 
estimation of the prevalence rate of infant botulism in Al Khafji between 1995 and 2002 as shown in 
the records of the hospitals of Al Khafji (KNH, Government Hospital, and Arabian Oil Company 
Hospital) and the local health office of Al Khafji. 

Examination of BH samples for C. botulinum spores 
A total of 221 BH samples were examined for the presence of C. botulinum spores by direct gram- 
stained films and cultures for 48 hours under strict anaerobic conditions [14]. One hundred and 
fifteen (115) samples were products of KSA; 70 of these were of commercial origin, while 45 were 
from local producers. The remaining 106 BH samples were from the U.S., Germany, Switzerland, 
China, Australia, Pakistan, Turkey, Al Shishan, Egypt, Yemen, Sudan, Syria, and Iran. 

Survey of BH intake during the first year of life 
Questions were posed directly to 719 mothers who were randomly chosen from the family files of 
KNH. They were asked how many children received bee honey orally (BHO) before the age of 1 yr, 
and at what age BHO was started, and whether there was any mortality or significant morbidity that 
could be attributed to infant botulism among these children. 

Results 
Clostridium botulinum spores were not detected in any of the BH samples examined. The 
questionnaire revealed that 545 out of 719 mothers (75.8%) gave BHO to their infants (1,525 infants) 
at least once before the age of 1 yr without mortality or significant morbidity that could be 
attributed to botulism. None of those infants developed manifestations suggestive of botulism, and 
none developed serious respiratory illness requiring intubation or ventilation. A total of 378 mothers 
(69%) used BH intentionally as a food and as a medicine with which they observed recovery from 
illnesses and subsequent less frequent physician consultations. On the other hand, 167 mothers 
(31%) used BH intentionally as a food only. 

Table1. Age of onset of giving BHO as revealed from the questionnaire (total no. of infants = 1,525) 


Age 

Number of infants (%) 

1 – 28 days 
57 (3.7) 

1 – 6 mo. 
611 (40.1) 

6 mo. – 1 yr. 
857 (56.2) 


In addition to the findings presented in Table 1, the survey revealed that 19 mothers started
giving BHO to their infant during its first few days of life. Of them, 10 (52.6 %) used it to treat 
neonatal jaundice. No case of infant botulism was reported between 1995 and 2002 in the 3 hospitals 
of Al Khafji or in the local health office. 

Discussion 
The ideal medicine is both safe and effective; this applies to BH, which has been used successfully for 
centuries and has proved to have many curative properties [2], [3], [5], [16], [17] while serious side 
effects have been reported. 

Yet controversy surrounds the possible existence of C. botulinum spores in BH. Some 
researchers [7], [8], [9], [10] detected these spores, while this study and other studies [11], [12], 
[13] found no such spores. In none of the research was the type of honey — comb (raw, 
unprocessed) or processed — specified. Huhtanen and his colleagues [13] tried to find out the 
incidence and origin of C. botulinum spores in honey. They tested 80 honey samples. All were 
negative by one method, while five and six respectively were positive by two other testing methods, 
with some ambiguous results when these were re-tested by yet another method. They 
experimentally inoculated the bees with spores by feeding a sugar-water solution and they found that 
the spores were incorporated into the honey produced. 

C. botulinum spores are widely found in nature: in soil, dust, air, and raw agricultural products. 
They have also been detected in corn syrup, fresh and processed meats, and fruits and vegetables 
[7]. Therefore the recommendation not to give BH before the age of 1 yr should also include all 
other sources of C. botulinum spores, and this may be not be feasible. Furthermore, pacifiers, 
feeding bottles, toys, a baby's hands, and food may be contaminated by house dust, which is another 
source of C. botulinum spores. 

The implication of honey as a cause of infant botulism has been based on the fact that a small 
number of infants who developed the disease were fed honey that was found to contain the spores. 
However, in our opinion, this is not enough to conclude that honey is responsible for botulism. We 
should first exclude the possibility of swallowing the spores from other sources — such as air [7]. In 
sum, the suggested recommendation not to give bee honey to infants below 1 yr of age should be re-
evaluated. 
¤ 

References 
White JW Jr: Composition of Honey — A Comprehensive Survey (Crane E, editor). Heinemann. London, 
UK. 1975; pp. 157-206. 
Molan PC: The Antimicrobial Activities of Honey. The Nature of the Antimicrobial Activity. Bee 
World. 1992; 73: 5-28. 
Molan PC: Honey as an Antimicrobial Agent, in Bee Products: Properties, Applications and Apitherapy 
(Mizrahi A and Lensky Y, editors). Plenum, London, UK. 1997; pp. 27-37. 
Zumla A and Lulat A: Honey — A Remedy Rediscovered; J. Royal Soc Med. 1989; 82:384-385. 
Mizrahiand Lensky Y: Bee Products: Properties, Applications and Apitherapy. Plenum, London, UK. 1997. 
Ali ATMM: The Pharmacological Characterization and the Scientific Basis of the Hidden Miracles of 
Honey. Saudi Medical Journal. 1989; 10 (3): 177-179. 
Stephen SA and Robert S: Botulism. In Nelson Text Book of Pediatrics, 16th edition (Richard EB, Robert 
MK and Hal BJ, eds). W.B. Saunders Company, Philadelphia, PA. 2000; pp. 875-878. 
De Centorbi OP; Satorres SE; Alcaraz LE; Centorbi HJ and Fernandez R: Detection of Clostridium 
Botulinum Spores in Honey. In Rev. Argent. Microbiol; July-Sep; 1997, 29 (3): 147-151. 
Sugiyama H; Mills CD; and KUO LJ: Number of Clostridium Botulinum Spores in Honey. Journal of 
Food Protection. 1978; 41 (11): 848-850. 
Tollofsrud PA; Kvittingen EA ; Granum PE ; and Vollo A (Norway): Botulism in Newborn Infants, in 
Tidsskr Nor Laegeforen. 1998; Nov. 20; 118 (28): 4355-6 (English abstract). 
Bentler W and Frese E: Mikrobielle Beschaffenheit and Ruckstandsuntersuchungen Von Bienenhonig, 
in Arch. Lebensmittelhygiene. 1981; 32 (4): 130-135 (English abstract). 
Flemig R and Stojanowic V: Untersuchungen Von Vienenhonig auf Clostridium botulinum sporen, in 
Arch. Lebensmittelhygiene. 1980; 31 (5): 179-180 (English abstract). 
Huhtanen CN; Knox D and Shimanuki H: Incidence and Origin of Clostridium Botulinum Spores in 
Honey. Journal of Food Protection. 1981; 44 (11): 812-814, 820. 
Sutter V, Citron D and Finegold S: Wadsworth Anaerobic Bacteriology Manual, 3rd edition. C. Mosby 
Co., St. Louis 1980. 
Henry J: Clinical Diagnosis and Management by Laboratory Methods. 17th edition. Sanjeer Printers, 
Krishma Nagar, Delhi, 1989. 
Yoirish N: The Curative Properties of Honey and Bee Venom. New Glide Publications. 1977; pp. 46-54. 
Molan PC: Why Honey is Effective as a Medicine. 1 — Its use in Modern Medicine. Bee World. 1999; 80 
(2): 80-92. 


Dr. Mamdouh AbdulRhman is a professor of pediatrics on the Faculty of Medicine at Ain Shams University, 
Cairo. 
E-mail: Mamdouh565 AT hotmail.com 

Dr. Nermeen Tayseer is a lecturer of clinical pathology at Ain Shams University. E-mail: 
nanon_555 AT yahoo.com



Cheers,
Marty Hanks
Just Bee Apiary
 
 


  • [ocba] honey and infants, Marty Hanks, 03/07/2013

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