Garlic, Honey & Infant Botulism

Parents are often warned about the risks of botulism with respect to honey and infants, but the risks of botulism from the improper storage of garlic is also of concern—for babies and adults alike. This article covers what you need to know about the risk of botulism.

What is infant botulism?

Botulism is a rare but potentially fatal infection caused by consuming the Clostridium botulinum bacteria, which produces a poison that can affect the nervous system, leading to fatigue, weakness, digestive abnormalities, paralysis, and even death. Babies are more at risk of botulism because they have underdeveloped gut microbiomes which are one of the first lines of defense against germs like bacteria. Botulism, while rare, is most common in infants between 1 and 6 months of age but has been reported in infants as young as one week old and as late as 12 months of age.

Unlike many bacteria that are killed off in the cooking process, botulism spores are heat resistant and thrive in environments with limited oxygen, such as canned foods. Contaminated food is one common source of botulism infection.  

Why are babies more at risk of botulism?

When it comes to infant botulism there is additional risk and concern. Babies have underdeveloped gut microbiomes. The gut microbiome is a garden of bacteria, fungi, and viruses housed within the digestive system and one of the first lines of defense against unwelcome germs and bugs. As a result, when babies consume a food containing botulism bacteria spores, they can be at risk of severe illness.

What foods can cause infant botulism?

Any low-acid food (including, but not limited to asparagus, green beans, beets, corn, potatoes, meats, fish, seafood, and even some tomatoes) that is improperly preserved can foster the growth of botulinum bacteria. While the risk is generally highest with home canning and fermented goods, some foods, like honey and garlic stored in oil, carry additional risk. This is why it’s recommended to avoid offering honey to babies until after 12 months of age.  However, improperly homemade canned and fermented goods, along with improperly stored garlic are high-risk foods for botulism, presenting a risk for everyone. Note: You cannot see, smell, or taste the botulinum toxin. Never taste food that may be contaminated.

To learn more about honey and when it is safe to introduce, see our honey page in our First Foods® database.

What are the symptoms of infant botulism?

Botulism is a rare, but potentially fatal medical emergency. If you suspect that your child has botulism, call emergency services immediately.

Symptoms of botulism may include:

What is the risk of honey and infant botulism?

When babies consume honey, they are at an increased risk of infant botulism—a rare but potentially fatal condition caused by Clostridium botulinum spores, which can colonize a baby’s gut and produce toxins that attack the nervous system.  Children younger than 12 months of age are more at risk because their gut microbiome is still developing.  Never serve honey to a baby before their first birthday.

What do I do if baby ate honey?

First, prevent any further honey ingestion and contact your child’s health care provider to let them know what occurred. Then take a deep breath: the rate of infant botulism is quite rare with about 110 cases of infant botulism per year in the United States and the average age being only 13 weeks old (and not all of these cases are even from honey).   Remain vigilant over the next several days. The most common initial symptom is constipation. If the infant begins experiencing any of the symptoms listed above, do not hesitate and seek urgent medical care.

What is floppy baby syndrome and how does it relate to honey?

“Floppy baby syndrome” refers to a long list of conditions that are characterized by hypotonia or poor tone. Within this list, conditions can be grouped into the following categories: nervous system abnormalities, myopathies, genetic disorders, endocrinopathies, metabolic diseases, and acute or chronic illness. Botulism in infants is considered a peripheral nervous system abnormality occurring at the neuromuscular junction. Infants with botulism are floppy but most floppy infants do not have botulism.

What is the risk of garlic and botulism?

When not stored properly, certain preparations of garlic can increase the risk of botulism. The risk is particularly high when fresh garlic is stored in oil. Clostridium botulinum thrives in environments with minimal oxygen and low acid. Home-prepared garlic oil creates a low oxygen environment, and garlic is low in acid; the combination creates a high-risk food for botulism for everyone, not just baby.    Never keep homemade garlic oil at room temperature, avoid serving baby garlic oil (even if it has been refrigerated) and avoid garlic confit entirely. While it’s thought that fresh homemade garlic oil can be safely refrigerated for 2-4 days, it’s not worth the risk.  

What is garlic confit and why is it dangerous?

Garlic confit is made by cooking peeled garlic cloves in oil or fat until they are creamy and lightly tanned or browned. If consumed immediately, garlic confit can be safe but just as with storing garlic in oil, confit provides a low-acid, low-oxygen environment in which botulism spores can thrive. Unlike many bacteria that are killed off in the cooking process, botulism spores are heat resistant.

How to Store Garlic Safely and Minimize the Risk of Botulism

There are 3 ways to store fresh garlic safely:  

In the pantry (keeps for 1 month).  Store garlic in a cool, dark, dry, and well-ventilated area (never in plastic) at temperatures around 60 degrees Fahrenheit (16 degrees Celsius). The life of your garlic will depend on the type chosen and your pantry temperature. In ideal conditions, unbroken garlic may last 3 to 5 months. To err on the side of safety for infants, we recommend you consider tossing garlic after one month on the counter or pantry. Note: If the bulb is broken, your garlic’s lifespan will start to rapidly decrease. It may only last 3-10 days—so use quickly or consider freezing. Avoid storing in plastic, which will trap moisture and promote spoiling.

In the freezer (keeps for 1 month). Try freezing garlic several ways: pre-chopped, peeled, unpeeled, or pureed.  Fresh garlic can also be puréed in oil and stored in the freezer, but you must immediately freeze the purée. If stored properly, garlic-oil purée can keep up to several months in the freezer.  Always label garlic stored in the freezer with a “discard after" date to be safe and never store garlic in oil at room temperature.

Refrigerated in vinegar (keeps for 4 months). Storing garlic in vinegar is a tried-and-true trick to make your garlic last. This method is loved by many cultures. Peeled garlic cloves can be incorporated into full-strength vinegar (don’t dilute with water) and stored in the fridge for up to 4 months though it would be wise to err on the side of safety and use before then.  This is a fun way to add an acidic zing to garlic dishes.

What Not to Do When Storing Garlic

There are 3 common storage mistakes that people make with garlic:

Mistake #1: Storing garlic in oil. To avoid the risk of botulism, never preserve garlic in olive oil (or any other oil) or as a confit, both of which create perfect environments for botulism spores to thrive. If made fresh, garlic oil should be consumed immediately or immediately frozen. Freshly made garlic oil can be safely preserved if frozen immediately. Frozen garlic oil will generally keep in the freezer for one month and possibly up to several months depending on garlic type and freezer temperature.  To err on the side of safety, avoid storing garlic in oil, consume homemade garlic oil or confit immediately, or opt for store-bought garlic oils instead.

Mistake #2: Storing garlic in the refrigerator for too long. While it is considered safe to store peeled garlic cloves in the refrigerator for 3 to 14 days if refrigerated from the date of purchase, to err on the side of safety, store peeled garlic in the freezer and limit the duration of peeled garlic in the fridge to 3 days.  Note: Cold temperatures promote early sprouting in garlic which can lead to a bitter taste.

Mistake #3: Home canning garlic. Canning garlic at home is not recommended as garlic is a low-acid food that requires a professional pressure canner—and extensive knowledge of managing acidity levels in canning—to be safely preserved.

How to tell if garlic is fresh

When purchasing garlic, choose garlic heads that are firm to touch with the skin intact and mold-free (i.e., no black powdery substance visible). Stored properly, a healthy head of garlic with unbroken outer skin can keep for 1 month. While some organizations will suggest garlic can last up to 5 months it depends on the type of garlic, storage conditions such as temperature and humidity, and other factors. Err on the side of safety and when in doubt, throw it out.

Are store-bought peeled garlic cloves safe?

If properly stored and bought fresh, store-bought peeled garlic in the refrigerated section of the store should be safe and can last 3 to 14 days if refrigerated from the date of purchase. To err on the side of safety, limit the duration of peeled garlic in the fridge to 3 days.

Is store-bought garlic oil safe for baby?

Yes, store-bought garlic oils are safe to offer babies. Store-bought garlic oils are treated with acidifying and/or antimicrobial agents that reduce the risk of botulism and make them shelf-stable.

My garlic doesn’t look right.

When in doubt, throw it out! If anything makes you doubt the quality and safety of your garlic, it’s better to toss it.

My garlic has turned blue, is it safe to eat?

Garlic contains anthocyanins – a term that describes beneficial compounds with a blue hue. When stored in acid (like pickled garlic), they can turn blue. Fear not! As long as it’s been stored properly, it’s safe to consume!

Is sprouted garlic safe to eat?

If garlic has been stored properly, then the sprouted garlic is typically safe to eat. That said, it may have a bitter flavor compared to un-sprouted garlic. If garlic has sprouted, cut the clove in half and remove and discard the sprout.

Can I refrigerate peeled garlic?

Yes, though garlic stored in the fridge doesn’t last long—individual peeled garlic may only keep 3-4 days in the fridge. Furthermore, the cold temperatures promote early sprouting which can lead to a bitter taste.

Can I freeze peeled garlic?

Yes. If frozen from the date of purchase, peeled garlic (as well as chopped or puréed) can last up to one month in the freezer.

Garlic Storage Takeaways:

Garlic Storage Guidelines

Reviewed by:

Venus Kalami, MNSP, RD

Rachel Ruiz, MD Board-Certified General Pediatrician & Pediatric Gastroenterologist

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