RECALLED BABY FORMULA

Federal agencies are investigating a multistate outbreak of infant botulism linked to infant formula. Infant botulism happens when a baby swallows Clostridium botulinum spores that grow in the gut and make toxin. Infant botulism often starts with constipation but is usually first noticed as difficulty feeding (sucking and swallowing), a weak and altered cry, and lack of head control.

On November 11, 2025, ByHeart Inc. recalled all infant formula products due to contamination with a bacteria that causes infant botulism. ByHeart Whole Nutrition Infant Formula is available for sale online and at major retailers nationwide. Parents and caregivers are urged to stop using any ByHeart Whole Nutrition infant formula immediately. This includes: 

• All lot numbers
• All sizes of cans and single serve packets

For more information:

• Infant Botulism Outbreak Linked to Infant Formula, November 2025 | Botulism | CDC
• Outbreak Investigation of Infant Botulism: Infant Formula (November 2025) | FDA

The California Department of Public Health has a public hotline to support caregivers with concerns about this outbreak and infant botulism. They are available 7 days a week from 7am to 8pm PST at 1-833-398-2022. This hotline serves the entire United States.

Exclusion Guidelines REMINDER

As we head into the winter months, now is a good time to review your child care’s exclusion policy for ill children. When do you require children with symptoms of illness to stay home from care? When can they return? Review the child care licensing regulations and make sure that your policy meets these requirements. You can always be more strict than this, but it must be written into your policies so that parents are clear about what to expect.

(4) An ill child must be sent home or reasonably separated from other children if:  (a) The illness or condition prevents the child from participating in normal activities; (b) The illness or condition requires more care and attention than the early learning provider can give; (c) The required amount of care for the ill child compromises or places at risk the health and safety of other children in care; or (d) There is a risk that the child's illness or condition will spread to other children or individuals.

(5) Unless covered by an individual care plan or protected by the ADA, an ill child, staff member, or other individual must be sent home or isolated from children in care if the ill individual has: (a) A fever 101 degrees Fahrenheit for children over two months (or 100.4 degrees Fahrenheit for an infant younger than two months) by any method, and behavior change or other signs and symptoms of illness (including sore throat, earache, headache, rash, vomiting, diarrhea); (b) Vomiting two or more times in the previous twenty-four hours; (c) Diarrhea where stool frequency exceeds two stools above normal per twenty-four hours for that child or whose stool contains more than a drop of blood or mucus; (d) A rash not associated with heat, diapering, or an allergic reaction; (e) Open sores or wounds discharging bodily fluids that cannot be adequately covered with a waterproof dressing or mouth sores with drooling; (f) Lice, ringworm, or scabies. Individuals with head lice, ringworm, or scabies must be excluded from the child care premises beginning from the end of the day the head lice, ringworm, or scabies was discovered. The provider may allow an individual with head lice, ringworm, or scabies to return to the premises after receiving the first treatment; or (g) A child who appears severely ill, which may include lethargy, persistent crying, difficulty breathing, or a significant change in behavior or activity level indicative of illness.

(8) An early learning provider may readmit a child, staff member, volunteer or household member into the early learning program area with written permission of a health care provider or health jurisdiction stating the individual may safely return after being diagnosed with a contagious disease pursuant to WAC 246-110-010 (3), as now and hereafter amended.

Take the time now to remind families about your policies. Share your policy reminders in a newsletter, post on a parent board, or send out through your program’s preferred messaging app. Emphasize that everyone needs to play their part to keep germs out of the child care space.

Here are a few additional resources that you may find helpful:

• Keep Me Home If Poster – this resource helps families understand when children need to stay at home. It is also available in a variety of languages.
• Hand Foot and Mouth Disease (HFMD) Guidance – We are still seeing HFMD popping up in child cares. Refer to the information in our September 2025 newsletter for helpful tips.
• Respiratory Illness Guidance – This handout from the Washington State Department of Health provides guidance for when to stay home when there are symptoms of respiratory illness, such as COVID, influenza, or RSV. It is also available in other languages.
• Respiratory Illness Dashboard – This webpage can give you an idea of the level of illness spreading in the community.

Contact us for assistance. Remember that if you have questions about illness symptoms or exclusions from child care, our staff are ready and available to assist you. Please contact us at childcarehealth@co.snohomish.wa.us or call 425-252-5415 (you will be asked to leave a message, but rest assured one of our staff will return your call).