By Todd Neale, Senior Staff Writer, MedPage Today

Published: August 06, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Parents of young children who have a cough that keeps them up at night may want to try giving their little ones honey for some relief, a randomized trial showed.

Compared with placebo, single doses of three different types of honey resulted in significantly greater gains on a number of subjective outcomes, including cough frequency, in children with a median age of 2.4 years, according to Herman Avner Cohen, MD, of Tel Aviv University in Israel, and colleagues.

There were few adverse events, the researchers reported online ahead of the September issue of Pediatrics.

"Honey may be a preferable treatment of cough and sleep difficulties associated with childhood upper respiratory tract infections," they wrote, noting that honey should not be used in infants because of the risk of infantile botulism.

Parents have limited options when it comes to treating cough and cold symptoms, as most over-the-counter medications sold in the U.S. state that they should not be used in children younger than 4. In Canada, use is restricted to children 6 and older.

Many home and herbal remedies have been used to treat a nagging cough, including honey, which the World Health Organization lists as a potential treatment.

However, evidence supporting that use for honey is limited. Of two studies showing a benefit for honey, one tested only buckwheat honey and the other was not blinded.

To further explore the issue, Cohen and colleagues conducted a double-blind, randomized, controlled trial involving 300 children, ages 1 to 5, who had upper respiratory tract infections, a nocturnal cough, and an illness duration of less than a week. The participants were enrolled from six general pediatric community clinics.

The placebo in the study was a silan date extract, chosen because its structure, color, and taste are similar to those of honey. The three types of honey evaluated were eucalyptus, citrus, and labiatae.

The patients were randomized to receive a single 10-gram dose of placebo or one of the honey products within 30 minutes of bedtime.

Parents completed a survey the day before the intervention and the day after. It contained five questions covering the frequency and severity of the child's cough, how bothered the child was by the cough, and how the cough affected both the child's and the parents' sleep. Each measure was rated on a seven-point Likert scale.

Placebo and all three types of honey were associated with improvements from 1 day to the next, which could be indicative of the natural course of upper respiratory tract infections. However, the gains were larger in the honey groups for all of the outcomes.

Cough frequency, for example, improved by 1.77 to 1.95 points in the honey groups compared with 1.00 point in the placebo group (P<0.001).

When all of the outcomes were combined together, the improvements were 9.88 points with eucalyptus honey, 10.10 points for citrus honey, and 9.51 points for labiatae honey. All of those gains were significantly larger than the 5.82-point improvement with the date extract (P<0.001).

Adverse events included stomach ache, nausea, and vomiting. There were two cases in the citrus honey group and one each in the other two honey groups and the placebo group.

The researchers noted that it is unclear what characteristic of honey is responsible for the improvements, adding, however, that honey has been found to have both antioxidant and antimicrobial properties.

It also was not likely that the date extract worsened cough and cold symptoms because those patients did show some improvement. In addition, "there is also no reason to believe silan caused allergic symptoms or bronchospasm because dates are not a common food allergen in the Israeli population," they said.

Another possible factor to explain at least part of the effect of honey could involve the central nervous system; there is a close anatomic relationship between the sensory nerve fibers involved in coughing and the gustatory nerve fibers involved in tasting sweetness.

"This theory may explain some of the observed effect in patients treated with silan date extract because this is also a sweet substance," the authors wrote.

They acknowledged some limitations of their study, including the use of a single dose of honey, subjective assessments of outcomes, and the inability to ensure compliance with honey and placebo administration. They also pointed out that the dropout rate was higher for children receiving citrus and eucalyptus honey, possibly because both of those substances are more aromatic, which the children may not have liked.

The study was supported in part by a research grant from the Israel Ambulatory Pediatric Association, Materna Infant Nutrition Research Institute, and the Honey Board of Israel.

The authors reported no conflicts of interest.

Primary source: Pediatrics
Source reference:
Cohen H, et al "Effect of honey on nocturnal cough and sleep quality: A double-blind, randomized, placebo-controlled study" Pediatr 2012; DOI: 10.1542/peds.2011-3075.