Thursday, January 24, 2013

Honey as a Cough Suppressant in Children: Does It Work?

Effect of Honey on Nocturnal Cough and Sleep Quality: A Double-Blind, Randomized, Placebo-Controlled Study

Cohen HA, Rozen J, Kristal H, et al

Pediatrics. 2012;130:465-471

Honey as a Cough Suppressant

The use of over-the-counter (OTC) cough and cold medications is discouraged by professional societies and the US Food and Drug Administration. Home remedies, such as honey, are inexpensive and could be safe alternatives for the treatment of cough. Cohen and colleagues conducted a trial in Israel, enrolling children at 6 community clinics during 2009. The goal of this study was to compare the effects of a single nocturnal dose of 1 of 3 different honey products, with placebo, on overnight cough and sleep symptoms for children with upper respiratory infections.

Study Summary

The children in the study were 1-5 years old and had what was believed to be an uncomplicated upper respiratory infection. Children with asthma, pneumonia, sinusitis, or allergic rhinitis were excluded from the study. Outcomes were measured with pre- and postintervention questionnaires containing 5 items that assessed the child's cough and degree of sleep difficulty the night before and the night of the intervention. Children were enrolled if their scores on the preintervention questionnaire were of sufficient severity.
The 3 different honey treatments included eucalyptus honey, labiatae honey, and citrus honey. The placebo compound was made from dates, and it was also brown and sweet. On the night of the intervention, parents gave 10 g of the allocated compound 30 minutes before the children went to sleep. On the next day, study personnel contacted the family by telephone to complete the postintervention questionnaire. Parents were asked about the following:
  • Frequency of nocturnal cough the previous night;
  • Severity of the cough;
  • How bothersome the cough was;
  • The degree to which the cough affected the child's sleep; and
  • The degree to which the cough affected the parents' sleep.
The primary outcome was the change in the frequency of the nocturnal cough from pre- to postintervention assessments. The study enrolled 300 children with upper respiratory infections, and 89.7% completed the protocol. The median age of the children was 29 months, and 54% were boys. For most of the assessment items, there were no differences among the 3 different honey extracts. Each of the honey extracts improved symptoms compared with the placebo extract. Cohen and colleagues concluded that honey given at bedtime was more effective than placebo in reducing the frequency and severity of nighttime cough. They suggest that honey could be used as a safe and effective cough suppressant for children 1 year of age and older.


Honey has many potential medicinal benefits, including antioxidant activity. Histograms created by the investigators show that the postintervention scores were lower for every group, suggesting a potential benefit of just being in the study, or a temporal improvement of symptoms. However, improvement was universally much greater for the honey extracts, by as much as 20%, compared with the placebo extract. The American Academy of Pediatrics (AAP) does not recommend honey for patients younger than 1 year of age because of the potential risk for botulism. The AAP has produced a handout that can be shared with families, and that details several safe alternatives for alleviating cold symptoms in children, including honey. When considering the relatively low cost of honey (compared with OTC cough and cold medications) and concerns over the vasoactive agents in OTC cough and cold preparations, honey sure seems to be an attractive option.

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