Pediatric Botulism Differential Diagnoses

Updated: Feb 28, 2019
  • Author: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA; Chief Editor: Russell W Steele, MD  more...
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Diagnostic Considerations

Guillain-Barré syndrome (especially Miller-Fisher variant)

Acute poliomyelitis

Myasthenia gravis

Lambert-Eaton syndrome

Tick paralysis


Aminoglycoside toxicity

Atropine poisoning

Paralytic shellfish poisoning (saxitoxin)

Pufferfish ingestion (tetrodotoxin)



Congenital myopathy

Electrolyte imbalance

Genetic metabolic disorders

In infants, it is especially important to consider the diagnoses of sepsis, CNS infections, electrolyte disorders, dehydration, inborn errors of metabolism, spinal muscular atrophy, infantile myasthenia gravis, muscular dystrophy and hypothyroidism. [26]  It should be noted that metabolic disorders, such as Pompe Disease which can present with hypotonia (“a floppy baby”), tend to present with a more chronic history of weakness, whereas botulism has a more acute onset of weakness and respiratory distress. [30]

Differential Diagnoses