A Rare Diagnosis, A Remarkable Recovery

Inside Baby Bryson’s Botulism Case

When Renee Siemak and Jesse Obrand brought their 5½-month-old son, Bryson, to the pediatrician, they weren’t expecting anything more than a quick checkup and some reassurance. He had stopped feeding, was lethargic, and was fussy—but the suggestion was that it might be a mild vaccine reaction. A little Tylenol, then try nursing, and things would turn around.

Except they didn’t.

“He actually seemed to be getting worse.  His eyes were droopy, his cry was weak, his head flopped back when I held him, and he just wasn’t bouncing back,” Renee recalls. “I knew something was wrong.”

She trusted her gut and returned to the pediatrician—this time insisting they go deeper and without hesitation, the pediatrician saw his very ill-demeanor and sent them to the emergency room. That decision likely saved Bryson’s life.

It would be determined that baby Bryson had infant botulism, an extremely rare illness that impacts roughly 200 children a year in the US. Infant botulism is caused by bacterial spores that colonize an infant’s intestine and produce a paralyzing toxin. If left untreated, the condition can be life-threatening.

A Rare Diagnosis in Real Time

Tyler Leppek, MD, had just arrived for his shift in the Torrance Memorial Emergency Department when a nurse pulled him aside. A baby was admitted appearing severely ill. Bryson’s blood sugar was dangerously low, and he was limp, dehydrated, and lethargic.

“At first, botulism wasn’t even on the radar,” says Dr. Leppek. “You start with the more common things. We cast a wide net and started IV fluids.”

The labs came back reassuring—but Bryson wasn’t improving the way he should have.

“He was alert, looking around—but he couldn’t latch to breastfeed or even swallow,” Dr. Leppek explains. “When his mom let go of his head, it just flopped back. That’s when I started thinking about infant botulism.”

Though extremely rare, the condition fit. Bryson had the classic signs: weak cry, poor feeding, loss of muscle tone.

Trying to hydrate Bryson in the Torrance Memorial Emergency Department. Photos courtesy of Renee Siemak.

The Teamwork That Made the Difference

“Botulism is something many ED doctors will never see in their entire career,” Dr. Leppek notes. “But thanks to my training—including a rotation at Miller Children’s Hospital where I once saw a botulism case—I had a framework to pull from.”

He consulted with pediatric intensive care at Miller and arranged an immediate transfer. There, Bryson would get the advanced care he needed, including a life-saving treatment called BabyBIG, a human-derived antitoxin.

“You can’t test for botulism in the ED, and lab results take over a week,” he says. “But with teamwork and clinical instinct, we were able to act fast.”

Dr. Leppek credits the Torrance Memorial ED team for identifying the urgency early.

“Our nurses, techs, respiratory therapists—everyone had eyes on this child. That kind of support gives you confidence in critical moments. This is why I love working here.”

Renee describes those first days as terrifying and surreal.

“You don’t think your child has one of the rarest illnesses in the country. I mean, only around 200 cases a year—and 25% of them are in California? I was terrified.”

Renee never fed Bryson honey, the most well-known cause of infant botulism. But the more she learned, the more the Hermosa Beach mother of three realized how environmental exposure plays a role.

“It could have come from multiple places.  We had recently traveled to the Santa Ynez Valley where there was a nearby wildfire. We were Easter egg hunting on a greenbelt in Hermosa Beach. There was even construction on our street where we live. It could’ve been dust, soil from any of those places… we’ll never know. That uncertainty is hard to deal with.”

Bryson and his two sisters, Sierra (left) and Makenzie (right), who are happy Bryson is home from his two-week stay at the hospital. 

A Public Health View: Why California?

According to Jennifer Read, MD, Chief of the Infant Botulism Treatment and Prevention Program at the California Department of Public Health, California consistently sees more infant botulism cases than any other state and has one of the highest incidences of infant botulism in the U.S., especially along the Central Coast.

“It’s likely related to soil type,” she explains. “Spores of Clostridium botulinum are naturally present in the environment, and the incidence of infant botulism is associated with certain soil types.”

Could climate change and wildfires be making things worse?

 “We can’t definitively link increased cases to climate events, but it’s reasonable to explore the possibility that environmental changes could play a role,” Dr. Read says.

Why BabyBIG® Matters

Treatment of botulism generally relies on equine-derived antitoxins which have a short half-life and treated patients may have allergic reactions.  Infant botulism is a different type of botulism for which a medication called BabyBIG (antitoxins derived from humans) is available. 

“BabyBIG has a long half-life,” says Dr. Read. “BabyBIG reduces the duration of hospital stay, intensive care stay, mechanical ventilation, and tube or intravenous feeding.  It’s a game-changer.”

Still, it's a precious resource.

Dr. Read added: “Our on-call pediatricians receive requests for consultation from treating physicians 24/7 and only authorize release of the anti-toxin if the clinical presentation warrants it.  BabyBIG is released as soon as possible after clinical suspicion of infant botulism.  Treatment should not be delayed pending confirmatory laboratory testing.”

Back to Baseline

After two weeks in the hospital—including several days in the ICU—Bryson returned home. He’s now thriving.

“With therapy, he’s almost back to where he should be developmentally,” Renee says. “His strength, his energy, his smile—he’s amazing. We’re so grateful.”

Dr. Leppek still remembers checking in for updates through Angela Shvartsman, RN, the lead ED nurse who had cared for the family before.

“It was so great to hear he was doing well,” he says. “That’s why we do this work—to make a difference in moments like that.”

Bryson with his mom Renee, dad Jesse, and sisters during a much-needed trip to Catalina Island following his hospital stay.

What Parents Should Know

Dr. Leppek states: Parents don’t need to panic. But awareness matters.

Watch for Symptoms Like:

• Poor feeding
• Weak cry
• Poor head control
• Muscle weakness
• Lethargy
• Constipation

Preventive Tips:

• Avoid feeding honey or homemade canned foods to babies under 12 months
• Seek prompt medical care if you notice concerning symptoms

A Message of Gratitude

“Torrance Memorial saved my son’s life,” Renee says. “From the ER to the transfer, to the follow-ups—it was fast, coordinated, and compassionate. A quick diagnosis was so important and I’ll never forget the care we received.”