Infantile botulism is the most common form of botulism in the modern era. Most likely infants are more susceptible to the colonization of the gastrointestinal tract by Clostridium botulinum because normal bowel flora has not fully developed. Some studies have shown honey exposure may increase the risk of colonization. Clinical manifestations are typically descending paralysis with cranial nerve involvement and mydriasis. The presence of mydriasis is a helpful clue that is not seen in congenital myasthenia or spinal muscular atrophy, both of which do not have such a rapid onset. Some variants of Guillan Barre can have pupillary changes but those are exceptionally uncommon in infants. Treatment is largely supportive but there are anti-toxins available that significantly improve recovery. Common findings on head imaging consistent with non-accidental trauma (NAT) include focal brain contusions, subdural hematomas, and skull fractures. Examination findings of NAT include immersion burns and retinal hemorrhages.