Health officials say four infants in Texas have developed botulism poisoning after consuming honey. The children, all less than a year old, had all been given pacifiers containing honey before they became sick.

The first baby became ill in mid-August, with the most recent having symptom onset at the end of October. Texas officials say all four babies had to be admitted to hospitals for life-saving treatment. Botulism poisoning attacks the nervous system and often paralyzes muscles used to breath, causing death quickly if the patient does not receive immediate medical attention.

“Honey can contain spores of Clostridium botulinum, an organism that produces a potent neurotoxin known to cause severe illness in infants,” according to a notice from the Texas Department of State Health Services.

“Infant botulism occurs when C. botulinum spores in food, dust, or other materials are inhaled or ingested and germinate in the gut of infants who have not yet developed mature intestinal flora. For this reason, parents are advised not to feed honey — raw or otherwise — to children younger than 12 months old.”

The American Academy of Pediatrics and the Centers for Disease Control and Prevention and have long advised that children less than 12 months old should not consume honey.

The four infants reported sick yesterday are not related and live in West Texas, North Texas and South Texas. Each had been given a honey-containing pacifier purchased in Mexico. However, the warning from Texas health officials, and another posted the same day by the U.S. Food and Drug Administration, both say such pacifiers are available in the United States and from online retailers.

Most such pacifiers aren’t designed for the honey to be consumed, public health officials reported, but some have a small hole so a child could eat the honey, or the pacifier could accidentally rupture or leak. Parents are warned to avoid pacifiers containing any food substance, because they could also pose a risk of botulism.

In addition to warning the public, Texas health officials also posted a warning for health care providers. It urges doctors and others treating sick infants to consider botulism poisoning if the children have symptoms associated with the illness. Some of the symptoms can mimic other illnesses.

Infants with botulism poisoning can have symptoms that often start with constipation and may include poor feeding and/or weak sucking, weakness, drooping eyelids, loss of head control and difficulty breathing. Severity can range from mild illness with gradual onset to paralysis, respiratory failure, and death.

“prompt recognition of a suspect case, administration of antitoxin, and initiation of supportive care can halt progression of the disease,” according to the Texas health department alert for medical practitioners.

The department will coordinate confirmatory testing at its laboratory. To obtain the antitoxin (Baby BIG) for treatment, physicians can contact the Texas Emerging and Acute Infectious Disease Branch or the California Infant Botulism Treatment and Prevention Program.

In its warning, the FDA recommended that parents and caregivers do not give pacifiers filled with or dipped in honey to their infants or young children. Anyone who has purchased a pacifier filled with or dipped in honey should stop using it and discard it immediately. The FDA recommends online retailers discontinue sales of honey filled pacifiers.