Honey for acute cough in children
- PMID: 29633783
- PMCID: PMC6513626
- DOI: 10.1002/14651858.CD007094.pub5
Honey for acute cough in children
Abstract
Background: Cough causes concern for parents and is a major cause of outpatient visits. Cough can impact quality of life, cause anxiety, and affect sleep in children and their parents. Honey has been used to alleviate cough symptoms. This is an update of reviews previously published in 2014, 2012, and 2010.
Objectives: To evaluate the effectiveness of honey for acute cough in children in ambulatory settings.
Search methods: We searched CENTRAL (2018, Issue 2), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (2014 to 8 February 2018), Embase (2014 to 8 February 2018), CINAHL (2014 to 8 February 2018), EBSCO (2014 to 8 February 2018), Web of Science (2014 to 8 February 2018), and LILACS (2014 to 8 February 2018). We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trial Registry Platform (WHO ICTRP) on 12 February 2018. The 2014 review included searches of AMED and CAB Abstracts, but these were not searched for this update due to lack of institutional access.
Selection criteria: Randomised controlled trials comparing honey alone, or in combination with antibiotics, versus no treatment, placebo, honey-based cough syrup, or other over-the-counter cough medications for children aged 12 months to 18 years for acute cough in ambulatory settings.
Data collection and analysis: We used standard methodological procedures expected by Cochrane.
Main results: We included six randomised controlled trials involving 899 children; we added three studies (331 children) in this update.We assessed two studies as at high risk of performance and detection bias; three studies as at unclear risk of attrition bias; and three studies as at unclear risk of other bias.Studies compared honey with dextromethorphan, diphenhydramine, salbutamol, bromelin (an enzyme from the Bromeliaceae (pineapple) family), no treatment, and placebo. Five studies used 7-point Likert scales to measure symptomatic relief of cough; one used an unclear 5-point scale. In all studies, low score indicated better cough symptom relief.Using a 7-point Likert scale, honey probably reduces cough frequency better than no treatment or placebo (no treatment: mean difference (MD) -1.05, 95% confidence interval (CI) -1.48 to -0.62; I² = 0%; 2 studies; 154 children; moderate-certainty evidence; placebo: MD -1.62, 95% CI -3.02 to -0.22; I² = 0%; 2 studies; 402 children; moderate-certainty evidence). Honey may have a similar effect as dextromethorphan in reducing cough frequency (MD -0.07, 95% CI -1.07 to 0.94; I² = 87%; 2 studies; 149 children; low-certainty evidence). Honey may be better than diphenhydramine in reducing cough frequency (MD -0.57, 95% CI -0.90 to -0.24; 1 study; 80 children; low-certainty evidence).Giving honey for up to three days is probably more effective in relieving cough symptoms compared with placebo or salbutamol. Beyond three days honey probably had no advantage over salbutamol or placebo in reducing cough severity, bothersome cough, and impact of cough on sleep for parents and children (moderate-certainty evidence). With a 5-point cough scale, there was probably little or no difference between the effects of honey and bromelin mixed with honey in reducing cough frequency and severity.Adverse events included nervousness, insomnia, and hyperactivity, experienced by seven children (9.3%) treated with honey and two children (2.7%) treated with dextromethorphan (risk ratio (RR) 2.94, 95% Cl 0.74 to 11.71; I² = 0%; 2 studies; 149 children; low-certainty evidence). Three children (7.5%) in the diphenhydramine group experienced somnolence (RR 0.14, 95% Cl 0.01 to 2.68; 1 study; 80 children; low-certainty evidence). When honey was compared with placebo, 34 children (12%) in the honey group and 13 (11%) in the placebo group complained of gastrointestinal symptoms (RR 1.91, 95% CI 1.12 to 3.24; I² = 0%; 2 studies; 402 children; moderate-certainty evidence). Four children who received salbutamol had rashes compared to one child in the honey group (RR 0.19, 95% CI 0.02 to 1.63; 1 study; 100 children; moderate-certainty evidence). No adverse events were reported in the no-treatment group.
Authors' conclusions: Honey probably relieves cough symptoms to a greater extent than no treatment, diphenhydramine, and placebo, but may make little or no difference compared to dextromethorphan. Honey probably reduces cough duration better than placebo and salbutamol. There was no strong evidence for or against using honey. Most of the children received treatment for one night, which is a limitation to the results of this review. There was no difference in occurrence of adverse events between the honey and control arms.
Conflict of interest statement
Olabisi Oduwole: none known. Ekong E Udoh: none known. Angela Oyo‐Ita: none known. Martin M Meremikwu: none known.
Figures
Update of
-
Honey for acute cough in children.Cochrane Database Syst Rev. 2014 Dec 23;(12):CD007094. doi: 10.1002/14651858.CD007094.pub4. Cochrane Database Syst Rev. 2014. Update in: Cochrane Database Syst Rev. 2018 Apr 10;4:CD007094. doi: 10.1002/14651858.CD007094.pub5. PMID: 25536086 Updated. Review.
Similar articles
-
Oral antihistamine-decongestant-analgesic combinations for the common cold.Cochrane Database Syst Rev. 2022 Jan 21;1(1):CD004976. doi: 10.1002/14651858.CD004976.pub4. Cochrane Database Syst Rev. 2022. PMID: 35060618 Free PMC article. Review.
-
Honey for acute cough in children.Cochrane Database Syst Rev. 2014 Dec 23;(12):CD007094. doi: 10.1002/14651858.CD007094.pub4. Cochrane Database Syst Rev. 2014. Update in: Cochrane Database Syst Rev. 2018 Apr 10;4:CD007094. doi: 10.1002/14651858.CD007094.pub5. PMID: 25536086 Updated. Review.
-
Honey for acute cough in children.Evid Based Child Health. 2014 Jun;9(2):401-44. doi: 10.1002/ebch.1970. Evid Based Child Health. 2014. PMID: 25404607
-
Honey for acute cough in children.Cochrane Database Syst Rev. 2012 Mar 14;(3):CD007094. doi: 10.1002/14651858.CD007094.pub3. Cochrane Database Syst Rev. 2012. Update in: Cochrane Database Syst Rev. 2014 Dec 23;(12):CD007094. doi: 10.1002/14651858.CD007094.pub4. PMID: 22419319 Updated. Review.
-
Honey for acute cough in children.Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007094. doi: 10.1002/14651858.CD007094.pub2. Cochrane Database Syst Rev. 2010. Update in: Cochrane Database Syst Rev. 2012 Mar 14;(3):CD007094. doi: 10.1002/14651858.CD007094.pub3. PMID: 20091616 Updated. Review.
Cited by
-
Traditional medical practices for children in five islands from the Society archipelago (French Polynesia).J Ethnobiol Ethnomed. 2023 Oct 18;19(1):44. doi: 10.1186/s13002-023-00617-0. J Ethnobiol Ethnomed. 2023. PMID: 37853377 Free PMC article. Review.
-
Honey for acute cough in children - a systematic review.Eur J Pediatr. 2023 Sep;182(9):3949-3956. doi: 10.1007/s00431-023-05066-1. Epub 2023 Jun 25. Eur J Pediatr. 2023. PMID: 37355498 Free PMC article.
-
Serotonin, melatonin and their precursors and metabolites and vitamin D3 derivatives in honey.Melatonin Res. 2022 Oct 3;5(3):374-380. doi: 10.32794/mr112500137. Epub 2022 Sep 30. Melatonin Res. 2022. PMID: 37007214 Free PMC article.
-
Use of Herbal Tea/Herbal Preparations for Children with Symptoms of Viral Upper Respiratory Infections.Turk J Pharm Sci. 2023 Mar 2;20(1):8-15. doi: 10.4274/tjps.galenos.2022.65475. Turk J Pharm Sci. 2023. PMID: 36862009 Free PMC article.
-
Therapeutic principles and unmet needs in the treatment of cough in pediatric patients: review and expert survey.BMC Pediatr. 2023 Jan 21;23(1):34. doi: 10.1186/s12887-022-03814-0. BMC Pediatr. 2023. PMID: 36670372 Free PMC article.
References
References to studies included in this review
Ahmadi 2013 {published data only}
-
- Ahmadi M, Moosavi SM, Zakeri S. Comparison of the effect of honey and diphenhydramine on cough alleviation in 2‐5 year‐old children with viral upper respiratory tract infection. Journal of Gorgan University of Medical Science 2013;15(2):8‐13.
Cohen 2012 {published data only}
Paul 2007 {published and unpublished data}
-
- Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM Jr. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Archives of Pediatrics and Adolescent Medicine 2007;161(12):1140‐6. - PubMed
Peixoto 2016 {published data only}
-
- Peixoto DM, Rizzo JA, Schor D, Silva AR, Cavalcanti de Oliveira D, Solé D, et al. Use of honey associated with Ananas comosus (Bromelin) in the treatment of acute irritative cough [Uso do mel de abelha associado ao Ananas comosus (Bromelin) no tratamentoda tosse irritativa aguda]. Revista Paulista de Pediatria 2016;34(4):412‐7. - PMC - PubMed
Shadkam 2010 {published data only}
-
- Shadkam MN, Mozaffari‐Khosravi H, Mozayan MR. A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents. Journal of Alternative and Complementary Medicine (New York, NY) 2010;16(7):787‐93. [DOI: 10.1089/acm.2009.0311] - DOI - PubMed
Waris 2014 {published data only}
-
- Waris A, Macharia WM, Njeru EK, Essajee F. Randomised double blind study to compare effectiveness of honey, salbutamol and placebo in treatment of cough in children with common cold. East African Medical Journal 2014;91(2):50‐6. - PubMed
References to studies excluded from this review
Ahmed 2013a {published data only}
Ayazi 2017 {published data only}
-
- Ayazi P, Mahyar A, Yousef‐Zanjani M, Allami A, Esmailzadehha N, Beyhaghi T. Comparison of the effect of two kinds of Iranian honey and diphenhydramine on nocturnal cough and the sleep quality in coughing children and their parents. PLoS ONE 2017;12(1):e0170277. [DOI: 10.1371/journal.pone.0170277] - DOI - PMC - PubMed
Baker 2016 {published data only}
Cohen 2017 {published data only}
-
- Cohen HA, Hoshen M, Gur S, Bahir A, Laks Y, Blau H. Efficacy and tolerability of a polysaccharide‐resin‐honey based cough syrup as compared to carbocysteine syrup for children with colds: a randomized, single‐blinded, multicenter study. World Journal of Pediatrics 2017;13(1):27‐33. [DOI: 10.1007/s12519-016-0048-4] - DOI - PubMed
Gilbert 2008 {published data only}
-
- Gilbert G. Single dose of honey effective for cough in kids. Journal of the National Medical Association 2008;100(4):459.
Miceli Sopo 2014 {published data only}
-
- Miceli Sopo S, Greco M, Monaco S, Varrasi G, Lorenzo G, Simeone G, Milk Honey Study Group. Effect of multiple honey doses on non‐specific acute cough in children. An open randomised study and literature review. Allergologia et Immunopathologia 2014;43(5):449‐55. - PubMed
Warren 2007 {published data only}
-
- Warren MD, Pont SJ, Barkin SL, Callahan ST, Caples TL, Carroll KN, et al. The effect of honey on nocturnal cough and sleep quality for children and their parents. Archives of Pediatrics and Adolescent Medicine 2007;161(12):1149‐53. - PubMed
References to studies awaiting assessment
IRCT2014090819037N1 {published data only}
-
- IRCT2014090819037N1. Comparison of the effect of two kinds of Iranian honey and diphenhydramine on nocturnal cough and sleep quality in coughing children and their parents. apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT2014090819037N1 (first received 23 September 2013).
References to ongoing studies
NCT03218696 {unpublished data only}
-
- NCT03218696. Comparison of a protective cough syrup against placebo on night cough in children 1‐5 years coughing since 1‐2 days due to common cold. clinicaltrials.gov/ct2/show/NCT03218696 (first received 14 July 2017).
UMIN000020651 {unpublished data only}
-
- UMIN000020651. Effectiveness of honey and expectorant for nocturnal cough in children with acute upper respiratory infection: a prospective interventional study. rctportal.niph.go.jp/en/detail?trial_id=UMIN000020651 (first received 25 January 2016).
Additional references
Abramson 1999 [Computer program]
-
- Abramson JH, Gahlinger PM. Computer Programs for Epidemiologists: PEPI version 3. Llanidloes: Brixton Books, 1999.
Adeleye 2003
-
- Adeleye IA, Opiah L. Antimicrobial activities of local cough mixtures on upper respiratory tract bacterial pathogens. West Indian Medical Journal 2003;52(3):188‐90. - PubMed
Agbaje 2006
-
- Agbaje EO, Ogunsanya T, Aiwerioba OR. Conventional use of honey as antibacterial agent. Annals of African Medicine 2006;5(2):78‐81.
Ahmed 2013b
-
- Ahmed M, Djebli N, Aissat S, Khiati B, Meslem A, Bacha S. In vitro activity of natural honey alone and in combination with curcuma starch against Rhodotorula mucilaginosa in correlation with bioactive compounds and diastase activity. Asian Pacific Journal of Tropical Biomedicine 2013;3(10):816‐21. - PMC - PubMed
Atkins 2004
Banderali 1995
-
- Banderali G, Riva E, Fiocchi A, Cordaro CI, Giovannini M. Efficacy and tolerability of levodropropizine and dropropizine in children with non‐productive cough. Journal of International Medical Research 1995;23(3):175‐83. - PubMed
Braman 2006
-
- Braman SS. Postinfectious cough: ACCP evidence‐based clinical guidelines. Chest 2006;129(Suppl 1):138‐46. - PubMed
Butler 2005
-
- Butler CC, Hood K, Kinnersley P, Robling M, Prout H, Houston H. Predicting the clinical course of suspected acute viral upper respiratory tract infection in children. Family Practice 2005;22(1):92‐5. - PubMed
CDC 2007
-
- Centers for Disease Control and Prevention. Infant death associated with cough and cold medications ‐ two states, 2005. MMWR. Morbidity and Mortality Weekly Report 2007;56(1):1‐4. - PubMed
Chang 2005
Chang 2014
Covidence [Computer program]
-
- Veritas Health Innovation. Covidence. Version accessed prior to 16 August 2017. Melbourne, Australia: Veritas Health Innovation.
Cuestas 2017
-
- Cuestas G, Rodríguez V, Doormann F, Bellia Munzón P, Bellia Munzón G. Foreign body in the esophagus as a cause of respiratory symptoms in children. Clinical cases [Cuerpo extraño en el esófago como causa de síntomas respiratorios en el niño. Casos clínicos]. Archivos Argentinos de Pediatria 2017;115(2):e126‐30. [DOI: 10.5546/aap.2017.e126] - DOI - PubMed
Derebery 2013
Dicpinigaitis 2011
El‐Gindy 2005
-
- El‐Gindy A, Emara S, Mesbah MK, Hadad GM. Liquid chromatography and chemometric‐assisted spectrophotometric methods for the analysis of two multicomponent mixtures containing cough suppressant drugs. Journal of AOAC International 2005;88(4):1069‐80. - PubMed
Freestone 1997
-
- Freestone C, Eccles R. Assessment of the antitussive efficacy of codeine in cough associated with common cold. Journal of Pharmacy and Pharmacology 1997;49(10):1045‐9. - PubMed
French 2002
-
- French CT, Irwin RS, Fletcher KE, Adam TM. Evaluation of a cough‐specific quality‐of‐life‐questionnaire. Chest 2002;121(4):1123‐31. - PubMed
Golob 2005
-
- Golob T, Dobersek U, Kump P, Necemer M. Determination of trace and minor elements in Slovenian honey by total reflection x‐ray fluorescence spectroscopy. Food Chemistry 2005;91(4):593‐600.
GRADEpro GDT 2015 [Computer program]
-
- GRADE Working Group, McMaster University. GRADEpro GDT. Version accessed prior to 16 August 2017. Hamilton (ON): GRADE Working Group, McMaster University, 2015.
Gunn 2001
-
- Gunn VL, Taha SH, Liebelt EL, Serwint JR. Toxicity of over‐the‐counter cough and cold medications. Pediatrics 2001;108(3):e52. - PubMed
Hay 2003
-
- Hay AD, Wilson A, Fahey T, Peters TJ. The duration of acute cough in pre‐school children presenting to primary care: a prospective cohort study. Family Practice 2003;20(6):696‐705. - PubMed
Hermosin 2003
-
- Hermosin I, Chicon RM, Cabezudo MD. Free amino acid composition and botanical origin of honey. Food Chemistry 2003;83(2):263‐8.
Hernández 2005
-
- Hernández OM, Fraga JMG, Jiménez AI, Jiménez F, Arias JJ. Characterization of honey from the Canary Islands: determination of the mineral content by atomic absorption spectrophotometry. Food Chemistry 2005;93(3):449‐58.
Higgins 2011
-
- Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Irish 2006
Katrina 2014
Kelly 2004
-
- Kelly LF. Pediatric cough and cold preparations. Pediatrics in Review 2004;25(4):115‐23. - PubMed
Khalil 2010
-
- Khalil MI, Sulaiman SA, Boukraa L. Antioxidant properties of honey and its role in preventing health disorder. Open Nutraceuticals Journal 2010;3:6‐16.
Kigen 2015
Kousalya 2010
Kuncic 2012
-
- Kuncic MK, Jaklic D, Lapanje A, Gunde‐Cimerman N. Antibacterial and antimycotic activities of Slovenian honeys. British Journal of Biomedical Science 2012;69(4):154‐8. [PUBMED: 23304790] - PubMed
Kurth 1978
-
- Kurth W. Secure therapeutic effectiveness of the traditional antitussive agent Mintetten in a double‐blind study [Gesicherte therapeutische wirksamkeit des traditionellen antitussivums mintetten im doppelblindversuch]. Medizinische Welt 1978;29(48):1906‐9. - PubMed
Kusel 2007
-
- Kusel MM, Klerk N, Holt PG, Landau Ll, Sly PD. Occurrence and management of acute respiratory illnesses in early childhood. Pediatric Infectious Disease Journal 2007;43(3):139‐46. - PubMed
Küplülü 2006
-
- Küplülü O, Göncüoglu M, Özdemir H, Koluman A. Incidence of Clostridium botulinum spores in honey in Turkey. Food Control 2006;17(3):222‐4.
Landau 2006
-
- Landau LI. Acute and chronic cough. Paediatric Respiratory Reviews 2006;7(1):64‐7. - PubMed
Lefebvre 2011
-
- Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Likert 1932
-
- Likert R. A technique for measurement of attitude. Archives of Psychology 1932;140:1‐55.
Lusby 2005
-
- Lusby PE, Coombes AL, Wilkinson JM. Bactericidal activity of different honeys against pathogenic bacteria. Archives of Medical Research 2005;36(5):464‐7. - PubMed
Ma 2017
Microsoft 2007 [Computer program]
-
- Microsoft. Microsoft Excel. 2007.
Molan 2006
-
- Molan PC. The evidence supporting the use of honey as a wound dressing. International Journal of Lower Extremity Wounds 2006;5(1):40‐54. - PubMed
Morice 1998
-
- Morice A, Abdul‐Manap R. Drug treatments for coughs and colds. Prescriber 1998;17(9):74‐9.
Mulholland 2011
Mullai 2007
-
- Mullai V, Menon T. Bactericidal activity of different types of honey against clinical and environmental isolates of Pseudomonas aeruginosa. Journal of Alternative and Complementary Medicine 2007;13(4):439‐41. - PubMed
Nagai 2006
-
- Nagai T, Inoue R, Kanamori N, Suzuki N, Nagashima T. Characterization of honey from different floral sources. Its functional properties and effect of honey species on storage meat. Food Chemistry 2006;97(2):256‐62.
Nanda 2003
-
- Nanda V, Sarkar BC, Sharma HK, Bawa AS. Physico‐chemical properties and estimation of mineral content in honey produced from different plants in Northern India. Journal of Food Composition and Analysis 2003;16(5):613‐9.
Nevas 2002
-
- Nevas M, Heilm S, Lindström M, Horn H, Koivulehto K, Korkeala H. High prevalence of Clostridium botulinum types A and B in honey samples detected by polymerase chain reaction. International Journal of Food Microbiology 2002;72(1‐2):45‐52. - PubMed
Nitsche 2016
Review Manager 2014 [Computer program]
-
- Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Sanz 2004
-
- Sanz ML, Gonzalez M, Lorenzo C, Sanz J, Matinez‐Castro I. Carbohydrate composition and physico chemical properties of artisanal honeys from Madrid (Spain): occurrence of Echium sp honey. Journal of the Science of Food and Agriculture 2004;84(12):1577‐84.
Shahzad 2012
Smith 2014
Smith 2016
Suárez‐Luque 2002
-
- Suárez‐Luque S, Mato I, Huidobro JF, Simal‐Lozano J, Sancho MT. Rapid determination of minority organic acids in honey by high‐performance liquid chromatography. Journal of Chromatography 2002;955(2):207‐14. - PubMed
Tonks 2003
-
- Tonks AJ, Cooper RA, Jones KP, Blair S, Parton J, Tonks A. Honey stimulates inflammatory cytokine production from monocytes. Cytokine 2003;21(5):242‐7. - PubMed
Tuzen 2007
-
- Tuzen M, Silici S, Mendil D, Soylak M. Trace element levels in honeys from different regions of Turkey. Food Chemistry 2007;103(2):325‐30.
Watanabe 2014
Yao 2003
-
- Yao L, Datta N, Tomas‐Barberan FA, Ferreres F, Martos I, Singanusong R. Flavonoids, phenolic acids and abscisic acid in Australian and New Zealand leptospermum honeys. Food Chemistry 2003;81(2):159‐68.
Zeina 1996
-
- Zeina B, Othman O, Al‐Assad S. Effects of honey versus thyme on rubella virus survival in vitro. Journal of Alternative and Complementary Medicine 1996;2(3):345‐8. - PubMed
References to other published versions of this review
Oduwole 2008
Oduwole 2010
Oduwole 2012
Oduwole 2014a
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical