Doctors Diagnose a Rare Case of Botulism

A swift diagnosis of infant botulism by Stanford Medicine Children’s Health Pediatrics – Monterey pediatricians saved the life of young Emmett Welden-Smith. Infant botulism is a rare and potentially fatal illness caused by a toxin that affects the nerves, according to the Centers for Disease Control and Prevention (CDC).

Elizabeth Welden-Smith knew something was off when her 4-month-old son, Emmett, started drooling and behaving differently. “I thought he was teething because he was drooling and he didn’t want to eat, and then he just had a really horrible night where he was clearly very upset,” she recalled.

Spurred by her mother’s intuition, Elizabeth decided to call the after-hours nurse for her pediatrician, Sara Liu, MD, at the Stanford Medicine Children’s Health Pediatrics – Monterey. That call led to an office visit the next day with Dr. Liu, who examined Emmett; she agreed that something just wasn’t right with the baby and referred them to the local emergency room.

“I felt that something was wrong with Emmett from his mother’s story and upon observation of Emmett,” Dr. Liu explained. “Things that stood out to me were his inability to feed … his moaning in the office (weak cry) … his lack of other features that are typical for a viral illness. He had no fever; he had drooling but no significant cold symptoms. (Because of the botulism, he wasn’t able to handle his secretions.) I knew in my gut that something wasn’t right, but it wasn’t a typical illness that we see every day—that was clear to me! I then sent him to the ER for further studies.”

Doctors in the emergency department were searching for an explanation for Emmett’s symptoms when Kirk Mulgrew, MD, another doctor at the Stanford Medicine Children’s Health Pediatrics – Monterey, stopped in to check on the patient.

Dr. Mulgrew immediately suspected that the problem was infant botulism, based on his texts with Dr. Liu and his experience with it as a resident, and he had Emmett airlifted to Lucile Packard Children’s Hospital Stanford.

“I felt that if we got him to Stanford quick enough, they could see him prior to intubation and get a sense of the diagnosis and possibility of botulism (or not), get treatment started right away, and intubate him (if necessary) with their own pediatric specific ICU team and ventilator equipment. I think that allowed him to get the antitoxin much sooner.” said Dr. Mulgrew.

Once Emmett was at Packard Children’s, the diagnosis was confirmed, and the health care team was able to have the antitoxin used to treat the botulism flown in right away. Emmett’s father, Mark Welden-Smith, was impressed with the level of care his son received at the hospital. “When I think back on what we went through, the support was so overwhelming. … It didn’t matter which person walked through the door, they all seemed to have the same level of care and investment in Emmett,” he said.

He also credits Dr. Mulgrew’s actions with saving his son’s life. “Thank God Dr. Mulgrew was insistent, because the longer you wait, the longer the recovery period can be, and the higher the risk of mortality due to respiratory failure. Even one extra day could have meant months longer recovery for the nerve endings to rebuild. It was just incredible—everybody made the right call at the right time.”

The CDC reports that the effects of botulism can last for months, and sometimes the damage can be permanent. However, Emmett made a full recovery and was able to leave the hospital in less than two weeks with no lasting effects.

His father is grateful that the quick diagnosis saved Emmett from potentially months of rehabilitation. “The fact that we got him up to Stanford so quickly meant we avoided that whole rehabilitation process. The neurological team that assessed him at follow-up appointments just a month or so later said it’s like he never had it. He wasn’t only not behind developmentally, he was ahead somehow,” Mark said.

Emmett’s mother also reflected on how the doctors at the Stanford Medicine Children’s Health Pediatrics – Monterey responded to her concerns. “Dr. Mulgrew literally saved my child’s life. He advocated for us, as did Dr. Liu. We weren’t treated like we were crazy. We were supported, and I knew that people were looking out for us and making sure that Emmett got the best care possible,” Elizabeth said. “We were treated like parents with legitimate concerns. They took us seriously and were amazing at keeping us very engaged in the process, and we were never pushed aside. We were part of his recovery in a really meaningful way.”