Food poisoning in babies and toddlers

Why babies are at higher risk

The CDC says children under 5 are more likely to get sick from germs spread through food, like Salmonella and E. coli, because their immune systems are still developing. Young children are three times more likely to be hospitalized if they get a Salmonella infection. The main danger is that diarrhea and vomiting can lead to dehydration quickly in a small body (CDC).

Most food poisoning is mild and gets better within a week (NHS). Knowing which foods carry more risk, and which signs mean your baby needs help, makes the biggest difference.

Higher-risk foods

The CDC lists these as riskier choices for children under 5, with safer swaps:

• Raw or undercooked meat and poultry. Cook poultry (including ground chicken and turkey) to 165°F (74°C), ground meat to 160°F (71°C), and whole cuts of beef, pork and lamb to 145°F (63°C) with a 3-minute rest. Use a food thermometer: you can’t tell by color.
• Raw or runny eggs, and foods made with them, like raw cookie dough, raw batter, homemade eggnog or Caesar salad dressing. Cook eggs until the yolk and white are firm, and egg dishes to 160°F (71°C), or 165°F (74°C) if they contain meat or poultry. (UK advice on eggs is different: see below.)
• Raw or undercooked fish and shellfish, including sushi and ceviche. Cook fish to 145°F (63°C) or until it’s opaque and flakes easily, and shellfish until the shells open or the flesh is pearly or white and opaque.
• Unpasteurized (raw) milk, juice and cider, and cheese made from unpasteurized milk, such as some queso fresco, brie, camembert and blue cheeses. Choose products clearly labeled pasteurized.
• Unwashed fruit and vegetables. Rinse produce under running water. The CDC says washed and then cooked is safest for young children.
• Raw or undercooked sprouts, like alfalfa and bean sprouts. Cook them until steaming hot.
• Cut melon left out for more than 2 hours (1 hour if it’s hotter than 90°F / 32°C).
• Raw dough or batter made with uncooked flour.

Two risks are specific to babies:

• Honey can cause infant botulism, a very serious illness, so don’t give honey in any form before 12 months (NHS). See honey and botulism.
• Powdered infant formula isn’t sterile. Cronobacter infection is rare, but it can be deadly for babies, especially newborns, babies under 2 months, babies born early and babies with a weakened immune system. The CDC says infections in babies under 12 months are often linked to powdered formula, so prepare it and clean bottles carefully. See choosing and preparing formula. In babies under 1, Cronobacter usually starts with a fever and poor feeding, a lot of crying, or very low energy, and some babies have seizures. The CDC says to get your baby to a doctor as soon as possible if you see these signs. For a seizure, or a fever in a baby under 3 months, follow the lists below.

For the full list of foods babies shouldn’t have, see foods to avoid for babies.

Keeping food safe at home

The CDC’s four steps are clean, separate, cook and chill:

• Clean. Wash your hands for at least 20 seconds before preparing food, after touching raw meat, eggs or flour, and before feeding your baby. Wash boards and utensils in hot, soapy water.
• Separate. Use a separate board for raw meat, poultry and seafood. Don’t wash raw chicken: it spreads germs around the sink.
• Cook. Cook to the temperatures above, and reheat leftovers to 165°F (74°C), then let them cool before serving.
• Chill. Keep your fridge at 40°F (4°C) or below. Throw away any food left out at room temperature for more than 2 hours (1 hour if it’s hotter than 90°F / 32°C).

Symptoms of food poisoning

The most common symptoms are (CDC, NHS):

• diarrhea
• vomiting or seeming sick
• tummy pain or cramps
• a high temperature
• seeming generally unwell

Symptoms usually start within a few hours or days of eating the food, but sometimes not for a few weeks (NHS). Many stomach bugs, like norovirus, also spread from person to person, so it isn’t always possible to tell which food, if any, was the cause.

Caring for your baby at home

• Keep up breast milk or formula. If your baby is being sick, offer small feeds more often than usual (NHS).
• Make formula at its usual strength. Never water it down (NHS).
• No fruit juice or fizzy drinks. They can make diarrhea worse (NHS).
• Don’t give medicine to stop diarrhea. The AAP says over-the-counter anti-diarrhea medicines aren’t recommended under 2 years and can be harmful in older children, so check with your doctor at any age. The NHS says not to give children under 12 medicine to stop diarrhoea, such as loperamide.
• Offer food when they feel able to eat (NHS). A baby who’s being sick may not want solid food for a day or so. Fluids matter more.

For more on fluids, oral rehydration solution and food during illness, see feeding a sick baby.

Signs of dehydration

Watch closely for these signs and call your pediatrician right away if you see any of them (AAP). In the UK, call 111 if a child under 5 has signs of dehydration (NHS).

• fewer wet diapers than usual (for babies, the AAP uses fewer than 6 a day)
• a dry mouth
• fewer tears when crying
• a sunken soft spot (fontanelle) on top of the head
• playing less than usual

Signs of severe dehydration include sunken eyes, cool or discolored hands and feet, wrinkled skin, being very sleepy, and peeing only once or twice a day (AAP). Call 911 or go to the emergency room.Call 999 or go to A&E.Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department.

When to call the doctor

Call your pediatrician, GP or health visitor if your child:

• is under 12 months old and you’re worried (NHS)
• stops breastfeeding or bottle feeding while ill (NHS)
• keeps vomiting and can’t keep fluids down (NHS, CDC)
• has blood in their diarrhea, or bleeding from the bottom (NHS, CDC)
• has diarrhea for more than 7 days, or vomiting for more than 2 days (NHS)
• is under 3 months old with a temperature of 100.4°F (38°C) or higher: call right away, day or night (AAP). In the UK, the NHS lists this as a reason to call 999 (see below)
• has a fever with repeated vomiting or diarrhea (AAP)

The CDC also lists diarrhea lasting more than 3 days and a temperature over 102°F (about 39°C) as signs of severe food poisoning that need a doctor. In the UK, NHS 111 can arrange a call back from a nurse or doctor.

When to get emergency help

Call 911 or go to the emergency room if your child:Call 999 or go to A&E if your child:Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department if your child:

• vomits blood, or vomit that looks like coffee grounds (NHS)
• has yellow-green or green vomit (NHS)
• has a sudden, severe tummy ache (NHS)
• has a stiff neck, or is bothered by bright light (NHS)
• has a rash that doesn’t fade when you press it (NHS)
• has blue, gray, pale or blotchy skin, lips or tongue (on brown or black skin, this may be easier to see on the palms or soles) (NHS)
• is struggling to breathe, or breathing very fast (NHS)
• is floppy, very sleepy, hard to wake or not responding as usual (NHS)
• has a seizure (fit) (NHS, CDC)
• has signs of botulism, such as drooping eyelids, less facial movement, trouble sucking or swallowing, a weak cry, or weak muscles or poor head control, with or without constipation (AAP, NHS). Constipation alone after honey is a same-day call to your pediatrician or GP.
• hasn’t had a wet diaper or peed in 12 hours (NHS)
• is under 3 months old with a temperature of 38°C or higher, or 3 to 6 months old with 39°C or higher (NHS)is under 3 months old with a temperature of 100.4°F (38°C) or higher and you can’t reach your doctor right away (AAP)
• shows signs of severe dehydration (AAP)

Trust your instincts. If you think something is seriously wrong, get help.

Where US and UK advice differs

• Eggs. US advice (CDC) is to cook eggs until the yolk and white are firm for all young children. In the UK, the NHS says hens’ eggs with the red British Lion stamp are fine for babies raw or lightly cooked. Other eggs, including duck, goose and quail eggs, should be cooked until solid.
• Soft cheese. The CDC says soft cheese is a safer choice if it’s clearly labeled “made from pasteurized milk”. The NHS says babies and young children shouldn’t eat mold-ripened soft cheeses like brie or camembert, ripened goats’ cheese, or soft blue cheese, even if pasteurized, unless they’re cooked.
• Water while sick. The NHS says babies on formula or solid food can have small sips of water between feeds. US advice for vomiting babies leans on breast milk, formula and oral rehydration solution: see feeding a sick baby.
• Who to call. In the US, call your pediatrician’s office.In the UK, call NHS 111 or use 111 online.Call your doctor or your local health advice line.