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Honey decreases Nocturnal Cough in Children with uncomplicated URI

Question

  • In US children with URI and cough is honey an effective treatment in comparison to no treatment to decrease cough?

Clinical Bottom Lines
1. A single dose of honey before bed is effective at decreasing cough severity, improving sleep, and decreasing the bothersome nature of cough in children with uncomplicated URIs.
2. Dextromethorphan (DM) was as ineffective as no treatment for alleviating cough symptoms. Describe clinical actions to be taken based on the results of your critical appraisal


Summary of Key Evidence
1. One hundred and five 2-18 year old children with uncomplicated URI and cough of < 7 days duration randomly assigned to receive honey, honey flavored DM, or no treatment.
2. Partially double-blind randomized trial.
3. Honey or DM was administered 30 minutes prior to bedtime and dosed based on age. Survey was administered at baseline and the next day via telephone.
4. Those receiving treatments had greater reduction in cough symptoms than those in the no treatment group, and honey was slightly better than DM and significantly better than no treatment for cough frequency, combined symptom score, child sleep, and bothersome nature of the cough. DM was as ineffective as no treatment.
5. Honey (5 children) and DM (2 children) groups showed side effects of hyperactivity, insomnia, and nervousness with none of those in the no treatment group.

Additional Comments

  • Potential for unblinding occurred when parents talked to surveyors the next day.
    • No treatment group has a potential for bias on their surveys based on the fact that they were not blinded to their treatment group.
    • Ethnicity was not included in analysis and is another potential for bias, however the groups were randomized and there should be equal bias across groups.
    • Difficult to determine if there was a clinically significant outcome (significant difference was determined by 1 point difference on survey).
    • Questionnaire was an imprecise measurement of symptoms but has been validated by other groups.
    • Honey may be acting as a demulcent to mucous membranes and has been thought to have some anti-microbial and antioxidant effects.
    • Honey is inexpensive and effective method for reducing cough and increasing sleep in children 2-18 years of age. The risk profile is low when used in children >1 year old and has a potential to significantly improve symptoms from cough.
    • Unfortunately, buckwheat honey is not readily available and it is unknown if other types of honey are equally effective.

Citation

  1. 1. Ian M. Paul; Jessica Beiler; Amyee McMonagle; Michele L. Shaffer; Laura Duda; Cheston M. Berlin, Jr. 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(12):1140-1146.
CAT Author: Andrea Morrison, MD

CAT Appraisers: Amanda Dempsey, MD

Date appraised: <November 26, 2008

Last updated June 15, 2009
Department of Pediatrics and Communicable Diseases
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