Cough causes concern for parents and is a major cause of outpatient visits. It can impact on quality of life, cause anxiety and affect sleep in parents and children. Several remedies, including honey, have been used to alleviate cough symptoms.
To evaluate the effectiveness of honey for acute cough in children in ambulatory settings.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2011) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1950 to December week 4, 2011); EMBASE (1990 to January 2012); CINAHL (1981 to January 2012); Web of Science (2000 to January 2012); AMED (1985 to January 2012); LILACS (1982 to January 2012); and CAB abstracts (2009 to January 2012).
Randomised controlled trials (RCTs) comparing honey given alone, or in combination with antibiotics, versus nothing, placebo or other over-the-counter (OTC) cough medications to participants aged from two to 18 years for acute cough in ambulatory settings.
Data collection and analysis
Two review authors independently screened search results for eligible studies and extracted data on reported outcomes.
We included two RCTs of high risk of bias involving 265 children. The studies compared the effect of honey with dextromethorphan, diphenhydramine and 'no treatment' on symptomatic relief of cough using the 7-point Likert scale.
Honey was better than 'no treatment' in reducing frequency of cough (mean difference (MD) -1.07; 95% confidence interval (CI) -1.53 to -0.60; two studies; 154 participants). Moderate quality evidence suggests honey did not differ significantly from dextromethorphan in reducing cough frequency (MD -0.07; 95% CI -1.07 to 0.94; two studies; 149 participants). Low quality evidence suggests honey may be slightly better than diphenhydramine in reducing cough frequency (MD -0.57; 95% CI -0.90 to -0.24; one study; 80 participants).
Adverse events included mild reactions (nervousness, insomnia and hyperactivity) experienced by seven children (9.3%) from the honey group and two (2.7%) from the dextromethorphan group; the difference was not significant (risk ratio (RR) 2.94; 95% Cl 0.74 to 11.71; two studies; 149 participants). Three children (7.5%) in the diphenhydramine group experienced somnolence (RR 0.14; 95% Cl 0.01 to 2.68; one study; 80 participants) but there was no significant difference between honey versus dextromethorphan or honey versus diphenhydramine. No adverse event was reported in the 'no treatment' group.
Honey may be better than 'no treatment' and diphenhydramine in the symptomatic relief of cough but not better than dextromethorphan. There is no strong evidence for or against the use of honey.
Plain Language Summary
Honey for acute cough in children
Cough is a cause for concern for parents and a major cause of outpatient visits in most settings for both children and adults. Cough can impact on quality of life, cause anxiety and affect sleep for parents and children. For this reason an immediate remedy is usually sought by both the caregiver and the recipient. Cochrane reviews have assessed the effectiveness of over-the-counter (OTC) cough medications, but none have studied honey as a cough relief. A systematic review evaluating the effectiveness of honey for reducing acute cough symptoms due to upper respiratory tract infections (URTIs) in children would be useful. A review of two small randomised controlled trials (RCTs) showed that honey was moderately better than 'no treatment' for the relief of cough, reducing bothersome cough, improving quality of sleep for children and parents and reducing the severity of cough.
This review included two small trials involving 265 children, aged two to 18 years. The effects of honey and dextromethorphan on symptomatic relief of cough, bothersome cough, and quality of sleep for both child and parent did not differ. Honey may be better than diphenhydramine for symptomatic relief of cough, reducing the severity of cough, and improving sleep quality for both parent and child. Dextromethorphan and diphenhydramine are both common ingredients in cough medications. Parents of seven children given honey and two given dextromethorphan reported their children suffered mild reactions from insomnia, hyperactivity and nervousness. Parents of three children in the diphenhydramine group reported somnolence. However, as with other medications, its benefit should be considered alongside the adverse effects. The limitation of this review update is that only two small studies with high risk of bias were included.