Clinical Question

Can honey decrease nighttime cough and improve sleep in children with upper respiratory tract infection?

Bottom Line

A teaspoonful of honey, given alone or with a noncaffeinated liquid before bedtime, decreases cough frequency and severity while improving the sleep of parents and the child with acute cough. Placebo also works, but not as well. Both (honey and placebo) give parents an active role in their child's well-being without exposing the child to potentially harmful medicines. (Level of Evidence = 1b)

Reference

CohenHARozenJKristalHet alEffect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study. Pediatrics.2012; 130( 3): 465– 471.

Study design: Randomized controlled trial (double-blinded)

Funding source: Industry and government

Allocation: Concealed

Setting: Outpatient (primary care)

Synopsis

There are a surprising 181 compounds in typical honey. The Israeli investigators conducting this study recruited 300 children one to five years of age (median age = 29 months) presenting to pediatric practices with nocturnal cough for less than seven days. The parents completed a questionnaire regarding their assessment of the child's cough and sleep difficulty on the previous night. Children with a severity score of at least 3 (out of a possible 7) were randomized, using concealed allocation, to receive a single dose of one of three types of honey or a sweet-tasting placebo (date extract) at bedtime.

Parents of 90 percent of the children completed a follow-up questionnaire the next day. Cough frequency, as reported by the parents, was significantly less in all four groups (including the placebo group), but the decrease was significantly more in all three honey groups. Similarly, cough severity, “bothersomeness,” children's and parents' sleep, and combined symptom scores were significantly improved with honey compared with placebo. This was only a single-dose study, and the significant improvement with placebo emphasizes the effect of parents' active role on their impression of their child's symptoms. A Cochrane review also found honey to be better than no treatment and perhaps better than diphenhydramine (Benadryl). There were significantly more dropouts among the children randomized to receive eucalyptus honey or citrus honey, which the authors speculate might be because of the strong taste (the third honey was produced from a mint-pollen honey and had a milder taste). The mechanism of action is unknown but may be a central effect caused by influence on sensory nerves that initiate cough.