A nurse is screening an infant who is at risk for botulism infection. Which of the following cues should the nurse identify as a possible indication of botulism?

A. Loose stool: Infant botulism more commonly presents with constipation due to decreased gastrointestinal motility from neuromuscular blockade. Botulinum toxin inhibits acetylcholine release, reducing smooth muscle activity in the gut. Loose stools are not a typical early manifestation. B. Difficulty breastfeeding: Botulinum toxin causes flaccid paralysis by blocking acetylcholine at the neuromuscular junction, leading to weak suck and poor feeding. Difficulty breastfeeding is often one of the earliest signs in infants. This reflects bulbar muscle involvement and generalized hypotonia. C. Crying for long periods of time: Infant botulism is associated with a weak or diminished cry rather than excessive crying. Neuromuscular weakness limits vocal cord strength and respiratory effort. Prolonged crying is more suggestive of pain or discomfort from other causes. D. Spasms involving the whole body: Botulism produces flaccid paralysis, not spasticity or muscle spasms. Increased muscle tone and generalized spasms are more consistent with conditions such as tetanus or seizure activity. This finding does not align with the toxin’s mechanism of action.