Paediatr Child Health Vol 21 No 4 May 2016 ©2016 Canadian Paediatric Society. All rights reserved 199
Evidence for Clinicians
(a common OTC cough medicine) (6). Previous studies, however, Of note, these studies have all been performed examining only
have shown that dextromethorphan itself is no better than pla- one night of treatment. Acute cough in children can last up to
cebo (7-9). Ultimately, the positive effects of honey are likely three weeks, with 50% resolved at 10 days and 90% at 25 days
fairly small. In this review, honey was found to reduce cough fre- (11). The bigger question should be does honey lead to improve-
quency and severity over a single night by an average of 1.97 from ments that exceed that expected as part of the natural history of a
the night before using a seven-point Likert scale (6). This may cough/cold? Further study is required. In the meantime, if parents
mean symptoms going from ‘extremely’ to ‘a lot’ or ‘very much’ to want/need to give something, why not honey?
‘to some extent’ or even ‘a little bit’ to ‘not at all’. The patients
who received no treatment or placebo demonstrated smaller References
1. Smith SM, Schroeder K, Fahey T. Over-the-counter medications for
improvements. Although the differences between these groups acute cough in children and adults in ambulatory settings.
were statistically significant, they may or may not be clinically Cochrane Database Syst Rev 2008;(1):CD001831.
significant. The studies reviewed also had limitations including 2. Schaefer MK, Shehab N, Cohen AL, Budnitz DS.Adverse events
small size, lack of blinding in two of the three and short duration from cough and cold medications in children. Pediatrics
(a single night). The overall conclusion was that there is no strong 2008;121:783-7.
3. Centers for Disease Control and Prevention (CDC). Infant deaths
evidence for or against the use of honey. This is the same conclu- associated with cough and cold medications – two states, 2005.
sion as that reached in the 2010 review (10). MMWR Morb Mortal Wkly Rep 2007;56:1-4.
According to current evidence, there isn’t really anything 4. Dart RC, Paul IM, Bond GR, et al. Pediatric fatalities associated
available that does much good for acute cough. We must remind with over the counter (nonprescription) cough and cold
families that coughing isn’t all bad; it helps clear mucus from the medications. Ann Emerg Med 2009;53:411-7.
5. Health Canada. Health Canada’s decision on cough and cold
airways. If a child is otherwise healthy there is usually no reason to medicines. <http://healthycanadians.gc.ca/recall-alert-rappel-avis/
suppress a cough. The best treatment for a cold remains plenty of hc-sc/2008/13267a-eng.php#al> (Accecssed July 17, 2015).
rest, liquids and tincture of time. Cough and cold medications are 6. Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE. Honey for
potentially harmful and are not effective and, therefore, should acute cough in children. Cochrane Database Syst Rev 2014,
not be given. Issue 12.
7. Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC)
Nonetheless, parents appear to want to give their children medications for acute cough in children and adults in ambulatory
‘something’. As opposed to antibiotics and cough and cold medica- settings. Cochrane Database Syst Rev 2012;(8):CD001831
tions, honey actually is a fairly reasonable option as long as the 8. Paul IM, Yoder KE, Crowell KR, et al. Effect of dextromethorphan,
child is older than one year of age (due to the risk of botulism in diphenhydramine, and placebo on nocturnal cough and sleep
infants). This review demonstrates that honey can safely be used quality for coughing children and their parents. Pediatrics
2004;114:e85-90.
in children older than one year of age. It has few side effects, with 9. Yoder KE, Shaffer ML, La Tournous SJ, Paul IM. Assessment of
only mild reactions reported that were not statistically significant, dextromethorphan, diphenhydramine and placebo for nocturnal cough
mostly gastrointestinal symptoms, insomnia and hyperactivity. due to upper respiratory infection. Clin Pediatr 2007:45:633-40.
Honey may have potential benefits, although based on this review, 10. Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE. Honey for
these are likely small. It is ‘natural’ and it tastes good. I will admit acute cough in children. Cochrane Database Syst Rev
2010;(1):CD007094.
that I have recommended it to families as a potential therapy. The 11. Hay AD, Wilson A, Fahey T, Peters TJ. The duration of acute
doses used in studies appear to be in the range of one-half to two cough in preschool children presenting to primary care:
teaspoons at bedtime; however, the optimal dose is not known. A prospective cohort study. Fam Pract 2003;20:696-705.