Cochrane for Clinicians
Putting Evidence into Practice
Honey for Acute Cough in Children
Am Fam Physician. 2016 Jul 1;94(1):20-21.
Author disclosure: No relevant financial affiliations.
Is honey an effective treatment for acute cough in children?
For patients one to 18 years of age, providing honey for cough symptoms can reduce the frequency and severity of cough, as well as improve sleep for patients and parents, when compared with placebo or no treatment. Honey is no better than dextromethorphan for symptom control. (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)
Acute cough in children is a common reason for primary care visits. It is a source of anxiety for patients and parents, and may impact quality of life during the course of illness. From 1999 to 2006, approximately one child in 10 took an over-the-counter (OTC) cold medication in any given week.1 However, there is a lack of evidence demonstrating the effectiveness of OTC or prescription medications for cough in patients younger than four years. These treatments often include dextromethorphan and diphenhydramine, which have potential adverse effects such as respiratory depression, hallucinations, dry mouth, and tachycardia. The authors of this review set out to determine whether honey is a safe and effective treatment for acute cough in children.
This Cochrane review included three small, randomized controlled trials with 568 children one to 18 years of age. Studies compared the mean difference (MD) of caregiver symptom scores for acute cough before and after treatment with honey, diphenhydramine, dextromethorphan, placebo, or no treatment on a scale from 0 to 6 (with lower scores signifying better symptoms). Cough frequency was reduced with honey vs. no treatment (MD = −1.05; 95% confidence interval [CI], −1.48 to −0.62; n = 154) and placebo (MD = −1.85; 95% CI, −3.36 to −0.33; n = 300). There was no difference when honey was compared with dextromethorphan for cough frequency, although honey was slightly better than diphenhydramine (MD = −0.57; 95% CI, −0.9 to −0.24; n = 80). Overall, honey was no better than any of the other interventions for bothersome cough, although one study indicated that it may be better than placebo (MD = −2.08; 95% CI, −3.97 to −0.19; n = 300). The groups were not stratified by age, making it difficult to establish effectiveness among different ages of children. Cough duration was not included in the analysis because the studies examined only one night of symptoms for participants.
Use of honey was associated with some adverse effects, such as nervousness, insomnia, and hyperactivity, although these occurrences were not statistically significant. Because of a lack of immunity against Clostridium botulinum, infants younger than one year should not be given honey.
In 2006, the American College of Chest Physicians recommended that children, especially those younger than two years, should not receive OTC cough medication because there were no clear benefits and definite potential harms.2 This was later supported by the U.S. Food and Drug Administration and the American Academy of Pediatrics, both of whom recommended raising the minimum safe age for cough medications to four years.3,4 The findings in this study support honey as an alternative to the standard cough medications.
SOURCE: Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE. Honey for acute cough in children. Cochrane Database Syst Rev. 2014;(12):CD007094.
The practice recommendations in this activity are available at http://summaries.cochrane.org/CD007094.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Defense.
REFERENCESshow all references
1. Vernacchio L, Kelly JP, Kaufman DW, Mitchell AA. Cough and cold medication use by US children, 1999–2006: results from the Slone Survey. Pediatrics. 2008;122(2):e323–e329....
2. Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 suppl):1S–23S.
3. U.S. Food and Drug Administration. Using over-the-counter cough and cold products in children. 2008. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048515.htm. Accessed August 10, 2015.
4. Choosing Wisely Campaign. American Academy of Pediatrics. Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children under four years of age. 2013. http://www.choosingwisely.org/clinician-lists/american-academy-pediatrics-cough-and-cold-medicines-for-children-under-four. Accessed August 10, 2015.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.
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