It's the time of year for coughs and colds and sleepless night for children and parents. Recent concerns about the safety of some medication ingredients have parents searching for a way to provide their children with some effective relief that is also safe. A study published in the Archives of Pediatrics and Adolescent Medicine offers a solution for upper respiratory infection associated cough that is palatable to adults and children — honey.

[T]he World Health Organization cites honey as a potential treatment for cough...since it contains antioxidants, it may have some effect against germs.

The investigators in this 2007 study compared three treatments: a single dose of honey, honey- flavored-dextromethorphan and no treatment. They looked for improvement in cough severity, and most importantly sleep quality of the children and their parents. Their results are well worth reviewing.

The researchers noted that although the American Academy of Pediatrics discouraged the use of dextromethorphan, it remained a common component of multisymptom over the counter purchases by parents event though prior research had shown that neither dextromethorphan nor diphenhydramine (an antihistamine) was any better than placebo in improving cough symptoms.

This study assessed 105 children whose acute care visits were for URIs (upper respiratory infections) with bothersome coughs that had been present for a week or less. They divided the patients into three study groups and compared the cough the night before the acute care visit, to the night after the visit. The parents rated the cough frequency and quality, and the effect of the cough on sleep on the evening preceding the doctor visit using a standardized questionnaire. The patients were then given a single dose of either honey or dextromethorphan flavored with honey, or instructions for no treatment for use that night. The treatment was to be given 30 minutes before sleep, with a non-carbonated beverage if desired. The next day parents were given a telephone interview and asked how effective the treatment had been.

Results of this one night test showed that honey alone provided the greatest relief compared to children with dextromethorphan/honey combination or no treatment. Specifically, honey was shown to offer the most improvement in child and parental sleep. The study also showed that dextromethorphan was not significantly better than no treatment at all. This was consistent with the 2004 study that found no improvement in cough when dextromethorphan and placebo were compared.

Although objective scientific evidence is lacking, the World Health Organization cites honey as a potential treatment for cough. They postulate that it has both a demulcent (soothing) effect and, since it contains antioxidant's, it may have some effect against germs. Dark honey has higher amounts of compounds that have antioxidant properties that are known to fight some infections. According to the study's authors, it is believed that sweet substances, such as honey, stimulate salivation and increase airway secretions that may sooth the mouth and throat. These extra secretions also acted as an expectorant to help clear the airway. These mechanisms would be particularly helpful in dry, non-productive coughs.

Dextromethorphan is known to have a variety of potentially dangerous side effects and abuse potential. It is important to know that honey is not considered safe for children less than one year of age. However, the only side effects that occurred from honey in the study group were hyperactivity, nervousness, and insomnia in a few of the children.

It is known that URIs improve over time, and the change from night one to night two of the study may reflect this natural occurrence. A physician did not reevaluate the children in the study group after the initial encounter. Data for efficacy of treatment was gathered by parental report via phone interview the morning after the treatment. Nevertheless, the researchers feel that this study, along with others, supports the use of honey as an alternative to over the counter cough and cold preparations for treatment of nighttime cough.

Parents may wish to discuss this option, which has been cited in the American Academy of Pediatrics literature including AAP Grand Rounds 2008 and AAP news 2008, with their children's doctors. It is important to remember that the study group was comprised of children with simple upper respiratory infections and cough. If a child's cough has a barking quality, is associated with wheezing, difficulty breathing, chest pain, blue color in lips or finger, or clearly more complex illness than a simple cold, a visit to the doctor, not a teaspoon of honey is in order.