Honey improves nocturnal cough in children

General

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 both parents and the child with acute cough. Placebo also works, but not as well. Both (honey or placebo) give parents an active role in their child's well-being while not exposing the child to potentially harmful medicines. (LOE = 1b)

Reference:
Cohen HA, Rozen J, Kristal H, et al. Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study. Pediatrics 2012;130(3):465-471.  [PMID:22869830]

Study Design:
Randomized controlled trial (double-blinded)

Funding:
Industry + govt

Allocation:
Concealed

Setting:
Outpatient (primary care)

Synopsis:
There are 181 compounds in typical honey (who knew?). The Israeli investigators conducting this study recruited 300 children 1 year to 5 years of age (median age = 29 months) presenting to pediatric practices with nocturnal cough for less than 7 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 a receive a single dose of 1 of 3 types of honey or a sweet-tasting placebo (date extract) at bedtime. Parents of 90% of the children completed a follow-up questionnaire the next day. Cough frequency, as reported by the parents, was significantly less in all 4 groups (including the placebo group). But the decrease was significantly more in all 3 honey groups. Similarly, cough severity, "bothersomeness," children's and parents' sleep, and combined symptom scores were significantly improved with honey as compared with placebo. This was only a single-dose study and the significant improvement with placebo emphasizes the effect of a parent's 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 in the children randomized to receive eucalyptus honey or citrus honey, which the authors speculate might be due to the stong 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 due to influence on sensory nerves that initiate cough.

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