Pediatric HospitalistInfant Botulism Presenting With Poor Feeding and Lethargy A Review of 4 CasesClemmens, Michael R. MD*; Bell, Laurel MD†Author Information *Anne Arundel Medical Center and Children's National Medical Center, George Washington University School of Medicine, Annapolis, MD and †Howard County General Hospital, Johns Hopkins University School of Medicine, Columbia, MD. Address correspondence and reprint requests to Michael R. Clemmens, MD, Chief of Pediatrics, Assistant Professor of Pediatrics, Anne Arundel Medical Center and Children's National Medical Center, George Washington University School of Medicine, 2001 Medical Parkway, Annapolis, MD, 21401. E-mail: [email protected]. Pediatric Emergency Care: July 2007 - Volume 23 - Issue 7 - p 492-494 doi: 10.1097/01.pec.0000280516.51655.69 Buy Metrics Abstract Infant Botulism is a rare cause of hypotonia in young infants. It may present with vague symptoms such as poor feeding and lethargy. We present 4 cases of infant botulism presenting to 2 community hospitals in central Maryland. In each case, poor feeding and lethargy were the chief complaints. One patient was referred to the emergency department with suspected sepsis and one with suspected intussusception. Three patients required endotracheal intubation. All were teated with botulism immune globulin, and all eventually made full recoveries. We discuss the differential diagnosis and provide an overview of infant botulism. © 2007 Lippincott Williams & Wilkins, Inc.