Review question

Can honey reduce cough symptoms caused by bacteria and viruses in children?

Background

Cough causes concern for parents and is a major reason for outpatient visits. Honey is believed to prevent growth of germs and reduce inflammation.

Search date

We searched databases to 8 February 2018 and trial registers to 12 February 2018.

Study characteristics

We included six small trials involving 899 children aged 12 months to 18 years conducted in Iran, Israel, the USA, Brazil, and Kenya. This update included three new trials conducted between 2007 and 2016 that involved 331 children.

Study funding sources

Two studies were supported by pharmaceutical manufacturers; one by a university research centre; one by the Honey Board of Israel and non-government agencies; and one by USA National Honey Board. One study did not report funding sources.

Key results

We compared honey to over-the-counter cough preparations, bromelin (a pineapple enzyme) mixed with honey, fake treatment (placebo), and no treatment.

Honey probably reduces cough symptoms more than placebo and salbutamol (a drug that opens lung airways) when given for up to three days. Honey is probably more effective at providing cough relief and reducing the impact of cough on children's sleep at night than no treatment.

There may be little or no difference between the effects of honey and dextromethorphan (an ingredient in over-the-counter cough remedies) or honey and bromelin with honey on all cough symptoms. Honey may be better than diphenhydramine (an antihistamine) at relieving and reducing children's cough.

The parents of seven children given honey and two given dextromethorphan reported side effects in their children, such as not falling asleep easily, restlessness, and becoming overexcited. The parents of three children in the diphenhydramine group reported that their children were often sleepy. The parents of nine children given salbutamol, seven given honey, and six given placebo reported diarrhoea. The parents of four children who received salbutamol and one child given honey reported rash.

We found no evidence for or against the use of honey to relieve cough in children. Using honey for infants aged up to 12 months is not advised because of poor immunity against bacteria that may be present, which can cause paralysis. Most of the children received honey for just one night, which is a limitation to the results of this review.

Quality of the evidence

Overall, evidence quality was low to moderate. Some studies did not blind participants.