Children in all 4 groups received the preparation 30 minutes before bedtime. Neither the parents nor the physicians or study coordinators knew which preparation the children received. The following day, research assistants telephoned the parent who had completed the initial survey and asked the same 5 questions. The primary outcome measure was the change in cough frequency from the night before to the night after treatment. Secondary measures included cough severity and the effect on sleep for both the child and the parent.
Of the 300 children initially enrolled, 270 (90%) completed the trial, with an even distribution among the groups. While there were improvements across all outcomes for both the treatment and placebo groups, the changes were statistically significant only in the treatment groups. There were no significant differences in efficacy noted among the 3 types of honey. Adverse effects of stomachache, nausea, or vomiting were noted by 4 parents in the treatment groups and one in the placebo group, a difference that was not statistically significant.
WHAT’S NEW?: We have more evidence of honey’s efficacy
For children older than one year with a viral URI, we can now recommend 1.5 tsp honey to be given prior to bedtime as a cough remedy. This may reduce the use of potentially harmful and often ineffective OTC cough and cold remedies.
CAVEATS: Honey is unsafe for the youngest children
An obvious limitation of this study was its brevity. Although one night of improved cough and sleep is important, a study that showed honey’s sustained benefit as a cough suppressant would be more convincing. What’s more, there are safety concerns that are age-related.
Honey is considered unsafe for children younger than one year because of the risk of botulism. And honey has the potential to increase dental caries if it is given nightly for a prolonged period of time.
We do not know whether all varieties of honey will have the same benefit, and the source of store-bought honey is not always identified. The authors of this study received funding from the Honey Board of Israel.
CHALLENGES TO IMPLEMENTATION: Parents may be reluctant to abandon OTCs
Changing the behavior of parents and other caregivers who are accustomed to treating children with OTC cough and cold remedies is likely to be an uphill battle. Because honey is readily available, however—often as close as the pantry—and perceived to be safe and nutritious, a recommendation from a trusted physician could go a long way toward its implementation.
Acknowledgement
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
