Honey: An effective cough remedy for kids?

*Cough* Cough*

That sound is not music to any parent’s ears. Having a cough is not fun for kids, and can be a source of concern for parents. Coughing is linked to increased anxiety, can impact the sleep of the entire family, and is a major source of outpatient visits (Oduwole, Meremikwu, Oyo-Ita, & Udoh, 2014). In fact, acute cough linked to upper respiratory tract infection (URTIs) is one of the most common symptoms encountered by general practitioners.

Given the prevalence of cough and its impact on quality of life, it is not surprising that both caregivers and children want a quick and easy fix. The most common approach to soothing a cough is the self-prescription of widely available over-the-counter (OTC) cough medications. Despite their convenient accessibility, OTC cough medications have no conclusive evidence supporting their use, and can even be dangerous for young children (Oduwole, Meremikwu, Oyo-Ita, & Udoh, 2014). The Canadian Pediatric Society heavily cautions against the use of OTC cough and cold medications, particularly in children under the age of two, due to the prevalence of unintentional overdose (Goldman & Hazardous Substances Committee, 2011). Nonetheless, OTC cough medications continue to be used as a first line of treatment by many physicians.

Identifying effective and ineffective treatments for cough is important for both health care consumers and providers. Although today is Innovation Day, we are going to talk about a natural product that has been used for its possible health benefits since ancient times – honey.

The evidence

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Source: Wikimedia Commons

Although most of us just consider honey to be a sweet treat, it is also said to possess antibacterial and anti-inflammatory utility (Oduwole, Meremikwu, Oyo-Ita, & Udoh, 2014). A recently updated Cochrane review, containing three randomized controlled trials and 568 participants, evaluated the effectiveness of honey for acute cough in children. Here is what the review found:

  • Honey may be better than ‘no treatment’, placebo, and diphenhydramine for
    symptomatic relief of cough.
  • Honey may also be better than ‘no treatment’ and diphenhydramine, but not placebo, for improving sleep quality for both the parents and child.
  • Honey was not more effective than dextromethorphan for symptomatic relief of cough, resolving bothersome cough, or improving sleep quality.

Implications for care

The findings from this review show that there is no strong evidence either for or against the use of honey, but suggest that honey may be better than ‘no treatment’ or diphenhydramine for symptomatic relief of cough and improving sleep of both the parents and child. The Canadian Pediatric Society suggests honey as an acceptable alternative to OTC cough medications:

“Pasteurized honey can be safely used in children older than one year of age. It is inexpensive, has an excellent safety profile, a good demulcent effect and antioxidant properties, and it increases cytokine release, which may result in antimicrobial effects.”

However, the authors of the review highlight limitations to this review, and the need for more high quality RCTs:

“These findings are from three small studies, two of which are at ‘high risk of bias’ with moderate to low quality evidence and may not be generalizable. None of the included studies assessed the effect of honey on ‘cough duration’ because the intervention and follow-up were for one night only… There is a need for more high quality randomized controlled trials on the use of honey in the treatment of cough in children.”

For more evidence on OTC medications, check out Evidently Cochrane’s post, “Over-the-counter treatments: do we know what works?” and our earlier post, “Will over-the-counter cough and cold medications help our kids feel better this cold season?”

References:

Goldman, R. D., & Hazardous Substances Committee. (2011). Treating cough and cold: guidance for caregivers of children and youth. Paediatrics & child health16(9), 564.

Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE. Honey for acute cough in children. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD007094. DOI: 10.1002/14651858.CD007094.pub4.

Cochrane Summary

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