PHILADELPHIA — Kevin and Julie McMonagle’s nearly 3-month-old daughter was behaving oddly. Colleen wasn’t finishing her bottles, her pacifier kept falling out of her mouth, and her cry was as quiet as a kitten’s.

As the parents of four children, they rarely worried about sniffles and stomach bugs. Still, they took the baby to the emergency department at Children’s Hospital of Philadelphia’s King of Prussia hospital in an abundance of caution. Julie told the older kids she’d be home by dinner.

But the McMonagles ended up staying at the hospital for two weeks, as their baby girl fought off an illness they knew nothing about. Colleen had infant botulism, a rare, potentially deadly infection that affects the nervous system and can lead to paralysis. She was admitted to the pediatric intensive care unit and put on a ventilator when she started struggling to breathe.

The Philadelphia area, and in particular Montgomery County where the McMonagles live, is a hot spot for infant botulism. Pennsylvania has the second highest rate of infant botulism cases in the country, following California. The state health department reported 17 cases in 2019, representing 11% of the 152 cases reported nationally that year, according to the most recent available data from the Centers for Disease Control and Prevention.

“Pediatricians in other areas of the country may see one case in their entire career,” said Laura McGarry, a neurologist at CHOP. “In the first two years of residency, I had seen 10 to 12.”

There’s little families can do to avoid the risk of this uncommon ailment, so doctors say it’s important for parents here to know the signs of an infection.

Parents are often warned against giving infants honey because it is a known source of the bacteria spores that cause botulism. But the bacteria more commonly comes from microscopic specks of dirt inhaled while driving with the windows open, playing at a park, or strolling past neighborhood construction.

“We don’t want parents to feel they did something to cause this,” McGarry said. “It’s just something for people who live in this area to be mindful of.”

What is infant botulism?

Infant botulism is caused when babies ingest C botulinum, a type of bacteria. The bacteria’s spores colonize in the large intestine and release a toxin that affects the nervous system.

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