Honey improves cough in children compared to no treatment

Article Outline

• Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med 2007;161:1140-6
  • Question
  • Design
  • Setting
  • Participants
  • Intervention
  • Outcomes
  • Main results
  • Conclusions
  • Comment
• Copyright

Back to Article Outline

Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med 2007;161:1140-6 

Question 

Among children with nocturnal cough and sleep difficulty associated with upper respiratory tract infections, does a single nocturnal dose of buckwheat honey or honey-flavored dextromethorphan (DM) decrease cough and improve sleep compared with no treatment?

Design 

Randomized, partially double-blinded clinical trial.

Setting 

A single, outpatient, general pediatric practice in Hershey, Pennsylvania.

Participants 

105 children, ages 2 to 18 years, with upper respiratory tract infections, nocturnal symptoms, and illness duration of fewer than 8 days.

Intervention 

A single dose of buckwheat honey, honey-flavored DM, or no treatment administered 30 minutes before bedtime.

Outcomes 

Cough frequency, cough severity, bothersome nature of cough, and child and parent sleep quality.

Main results 

Significant differences in symptom improvement were detected between treatment groups, with honey consistently scoring the best and no treatment scoring the worst. In paired comparisons, honey was significantly superior to no treatment for cough frequency (P = .01) and the combined symptom score (P = .04), but DM was not better than no treatment for any outcome. Comparison of honey with DM revealed no significant differences.

Conclusions 

Parents rated honey most favorably for symptomatic relief of their child's nocturnal cough and sleep difficulty caused by upper respiratory tract infection.

Comment 

In this well-designed and valid study, Paul et al were able to show that honey was significantly superior to no treatment for improvement in cough severity (47.3% reduction vs 24.7%) and an overall symptom score (53.7% reduction vs 33.4%). The findings of this study suggest that honey is better than no treatment for reducing cough frequency and improving combined symptom scores. A key strength of this study is that the investigators were particularly thorough in their attempts to maintain blinding and were diligent in treating groups in a similar fashion aside from the interventions. However, one limitation is the lack of information on the validity and reliability of the cough questionnaire. Despite this, the study offers an interesting alternative to traditional over-the-counter remedies for cough in children. Further randomized controlled trials could explore whether improvement is seen with varieties of honey other than buckwheat and whether consumption of other sweet liquids results in the same improvement as that seen after administration of honey. Many pediatricians are reluctant to prescribe remedies such as dextromethorphan, given the lack of evidence for its efficacy and the potential for adverse effects. Some may now view honey as a possible alternative for the treatment of cough for children over 1 year of age. Other clinicians may not prescribe any therapy for the treatment of symptoms of upper respiratory tract infections; for those clinicians, the results of this article may be less applicable.