Does Honey Relieve Cough in Children?

William T. Basco, Jr., MD, FAAP


May 08, 2008

Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents

Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM
Arch Pediatr Adolesc Med. 2007;161:1140-1146

This study was a blinded comparison of 3 approaches to treating nocturnal cough associated with upper respiratory tract infections. The treatment groups received either a single dose of honey, a single dose of honey-flavored dextromethorphan (DM), or no treatment. Outcomes were conducted through parental assessment by diary of subject's nighttime cough and sleep difficulty.

The study enrolled patients 2-18 years old over a 1.5-year period. All subjects had rhinorrhea and cough for no more than 7 days. Subjects were not included if they required antibiotics or had a history of chronic lung condition, including asthma. When potential subjects presented for medical care, study personnel obtained an assessment of how the child's previous night's sleep had been affected by cough; only subjects with significant sleep effects were continued in the intervention component of the study.

The intervention occurred for only 1 night, and subjects were randomized to 1 of the 3 groups after stratification into 3 age groupings. DM dosing varied by age stratum, with 2-5 year olds receiving 8.5 mg; children 6-11 years old receiving 17 mg; and children 12-18 years old receiving 34 mg.

The outcomes of interest were parent responses to telephone interview the day after the intervention. The questions included assessment of subject cough, subject sleep, and the impact of those on parental sleep.

One hundred five subjects completed the study, with 35 in the honey group, 33 in the DM group, and 37 receiving no treatment. The groups were similar in symptom severity before randomization, and they had been ill for an average of 4.6 days prior to study enrollment. While all 3 groups improved from pre-enrollment, the honey group experienced the greatest degree of improvement, followed by the DM group.

On a 6-point scale, subjects who received honey reported an average improvement of 1.89 points in cough frequency, compared with 1.39 points for DM subjects and 0.92 points for "no treatment" subjects. Parental assessment of the child's sleep improved by 2.49 points for honey patients, by 1.79 points for DM patients, and by 1.57 points for no treatment patients.

When the authors compared groups pair wise, honey subjects did significantly better than no treatment subjects. However, the difference in improvement between honey and DM subjects was not statistically significant. The difference between DM and no treatment subjects also did not reach statistical significance.

The authors concluded that honey provided symptomatic relief for nocturnal cough and represents an inexpensive and safe treatment for cough in patients older than 2 years old.

The paper's discussion reviews many of the theories as to why honey or other sweet substances may serve to improve cough, and that section is very interesting to read. In any case, the authors note that both parents and providers often want to help cough; their findings provide an alternative that should be both helpful and acceptable to parents and providers alike.



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