WHAT’S NEW?
We have more evidence of honey’s efficacy
For children older than 1 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 1 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 clinician could go a long way toward aiding the implementation of its use as an alternative symptom-reliever for kids with cough.
REFERENCES
1. Cohen HA, Rozen J, Kristal H, et al. Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study. Pediatrics. 2012;130:465-471.
2. Dart RC, Paul IM, Bond GR, et al. Pediatric fatalities associated with over the counter (nonprescription) cough and cold medications. Ann Emerg Med. 2009;53:411-417.
3. Srinivasan A, Budnitz D, Shehab N, et al. Infant deaths associated with cough and cold medications—two states, 2005. JAMA. 2007;297:800-801.
4. FDA. Public health advisory: FDA recommends that over-the-counter (OTC) cough and cold products not be used for Infants and children under 2 years of age. www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm051137.htm. Accessed May 30, 2013.
5. American Academy of Pediatrics. Withdrawal of cold medicines: addressing parent concerns. www.aap.org/en-us/professional-resources/practice-support/Pages/Withdrawal-of-Cold-Medicines-Addressing-Parent-Concerns.aspx. Accessed May 30, 2013.
6. Paul IM, Beiler J, McMonagle A, et al. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161:1140-1146.
Acknowledgement
The PURLs Surveillance System was developed with support from 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.
Copyright © 2013. The Family Physicians Inquiries Network. All rights reserved.
Reprinted with permission from the Family Physicians Inquiries Network and The Journal of Family Practice. 2013;62(3):145-147.