Honey for Cough

Honey for CoughCough is a very common symptom in children. Certainly, we need to consider that an ominous cause may be lurking (Asthma, Occult Aspirated Foreign Body, Croup, Sinusitis, Pneumonia, Acute Chest Syndrome, etc.). Most often, though, the cough is due to a viral illness, but remember viral illnesses can become complicated (see, Myocarditis, Guillaine-Barre). So, take care not to be dismissive. Additionally, while you are doing your best to avoid the phrase “just a virus,” prepare yourself to address the parent’s next question: “What can be used to make the cough better?”  Unfortunately, there are not many medications that are safe to use in young children… but this may be an opportunity to “prescribe” Winnie the Pooh’s favorite: Honey for Cough.

 

Honey: Not for < 1 year of age

Before we get carried away by Winnie’s obsession… don’t overlook a real danger… Infantile Botulism

  • Infantile botulism is the most common form of botulism in the USA. [Brown, 2012]
  • Due to ingested Clostridium botulinum spores
    • Spores colonize the GI tract and the produce toxin.
    • Toxin prevents release of acetylcholine from the presynapse.
  • Presents with vague symptoms, but can be deadly (yup… your job is difficult).
    • Poor feeding
    • Constipation
    • Weakness (ex, weak cry, can’t hold head up) – Descending Weakness.
    • Hypotonia
    • Cranial Nerve palsies (ex, ptosis, poor suck, sluggish pupillary reflexes)
    • Respiratory Depression
      • ~50% of all infantile botulism cases require mechanical ventilation. [Brown, 2012]
    • May initially be first managed as if sepsis/serious bacterial infection is present, but child is afebrile and has negative cultures.
  • Honey consumption is the classically associated with infantile botulism, but as with many cases of “classical” medical associations, this is not the full story.
    • 85% of cases have no known honey exposure.
    • Botulinum spores are ubiquitous.
    • Honey should still be avoiding in children < 1 year of age… and don’t overlook honey being used as oral pacifier. [Benjamins, 2013]

 

Honey for Cough

Ok, now that we are clear that Honey should not be recommended for a child < 1 year of age, let’s get back to how it may help your older child with a cough!

  • Cough Medications from Over the Counter (OTC) [Paul, 2012]
  • Honey for Cough
    • Honey has been reported to have many health benefits (because the Bee Lobby is very active).
      • Antimicrobial activity
      • Wound Care
      • Post-Tonsillectomy Pain Management [Mohebbi, 2014; Boroumand, 2013; Ozlugedik, 2006]
    • Several small studies have shown the honey can compare favorably to the OTC cough preparations. [Cohen, 2016; Paul, 2012; Cohen 2012; Paul 2007]
    • Honey may:
      • Decrease cough frequency and severity
      • Improve child and parent sleep quality 
    • The literature may still have inadequacies [Allan, 2011], but honey is generally deemed safe with good side-effect profile.

 

Moral of the Morsel

  • Once again, don’t say “it’s just a virus.”
  • Be vigilant and think about ominous causes of cough… and think out loud.
  • Appreciate the persistent coughing, even if merely due to a viral infection, disturbs the entire household. Do not be dismissive of this.
  • Anticipate the question about what “medication” can be used to help.
  • Weigh the risks and benefits and know that the scales tip toward avoiding OTC cough/cold medications in the young.
  • The risk:benefit scales may not slant dramatically toward use of Honey, but as long as the child is > 1 year of age, it is safe so even some minor benefit may be worth it.  Plus… honey is delicious!

 

References

Cohen HA1,2, Hoshen M3, Gur S4,5, Bahir A4,6, Laks Y4,7, Blau H4,8. 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 J Pediatr. 2016 Jul 23. PMID: 27457790. [PubMed] [Read by QxMD]

Mohebbi S1, Nia FH2, Kelantari F2, Nejad SE2, Hamedi Y3, Abd R4. Efficacy of honey in reduction of post tonsillectomy pain, randomized clinical trial. Int J Pediatr Otorhinolaryngol. 2014 Nov;78(11):1886-9. PMID: 25193590. [PubMed] [Read by QxMD]

Benjamins LJ1, Gourishankar A, Yataco-Marquez V, Cardona EH, de Ybarrondo L. Honey pacifier use among an indigent pediatric population. Pediatrics. 2013 Jun;131(6):e1838-41. PMID: 23650307. [PubMed] [Read by QxMD]

Boroumand P1, Zamani MM, Saeedi M, Rouhbakhshfar O, Hosseini Motlagh SR, Aarabi Moghaddam F. Post tonsillectomy pain: can honey reduce the analgesic requirements? Anesth Pain Med. 2013 Summer;3(1):198-202. PMID: 24223362. [PubMed] [Read by QxMD]

Paul IM1. Therapeutic options for acute cough due to upper respiratory infections in children. Lung. 2012 Feb;190(1):41-4. PMID: 21892785. [PubMed] [Read by QxMD]

Cohen HA1, Rozen J, Kristal H, Laks Y, Berkovitch M, Uziel Y, Kozer E, Pomeranz A, Efrat H. Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study. Pediatrics. 2012 Sep;130(3):465-71. PMID: 22869830. [PubMed] [Read by QxMD]

Allan GM1, Korownyk C, Kolber M. Do cough suppressants or honey help pediatric cough? Can Fam Physician. 2011 Apr;57(4):435. PMID: 21490355. [PubMed] [Read by QxMD]
Ozlugedik S1, Genc S, Unal A, Elhan AH, Tezer M, Titiz A. Can postoperative pains following tonsillectomy be relieved by honey? A prospective, randomized, placebo controlled preliminary study. Int J Pediatr Otorhinolaryngol. 2006 Nov;70(11):1929-34. PMID: 16914210. [PubMed] [Read by QxMD]

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

You may also like...

Leave a Reply