Honey for cough in children: can it help?

Honey for cough? Is it a helpful treatment for acute cough in children? How does it compare with other treatments? Cochrane UK’s Senior Fellow in General Practice, Lynda Ware, looks into honey and at the latest evidence.

No-one knows for sure how long honey has existed but fossils of bees have been found dating back 150 million years. A cave painting in Valencia, Spain, which is over 8000 years old, depicts men collecting honey from a wild bee nest. The earliest record of beekeeping using hives was found in Cairo and dates from 2400 BC.

Honey was used by the ancient Egyptians, the Greeks and the Romans in offerings to their gods. In the Old Testament, Israel was refered to as the ‘land flowing of milk and honey’. Honey was also, of course, used as a sweetener, but was replaced in the seventeenth century by sugar. 

Since ancient times it has been considered to have medicinal properties. Much more recently honey has been demonstrated to have antibacterial, antiviral, antifungal and anti-inflammatory activities. It has been used in traditional medicine to treat coughs and today can be found in several over-the-counter (OTC) cough remedies. It is also used in modern medical practice to treat wounds. 

Gathering honey. Tomb of Rekhmire.

What is honey exactly?

Bees collect nectar from flowers. They use some of this nectar to provide the energy they need to fly and the rest is stored in the hive as honey for when other food sources are scarce The bees ingest and regurgitate the nectar many times until it is partially digested and then place it in honeycomb cells. Once sufficient water has evaporated from the honey, helped by the bees fluttering their wings to circulate the air, the cells are sealed with wax.

The sweetness of honey comes from the sugars fructose and sucrose. Amazingly, once sealed, honey does not spoil and jars of still edible honey have been found which are centuries old.

Honey for cough 

Honey is thought to be helpful in relieving cough because of its various antimicrobial and anti-inflammatory properties. It has also been suggested that due to its viscous nature it coats the throat causing a soothing effect.

The ‘home remedy’ of hot lemon and honey is promoted in advice from both the British Thoracic Society and NHS Choices. However, honey is not recommended for children under 12 months of age and care must be exercised with hot liquids.

How does honey stand up to scrutiny in helping relieve cough symptoms?

Cochrane Review was published in April this year, which updated previous reviews from 2010, 2012 and 2014. It included six randomised controlled trials involving 899 children. The studies compared honey to placebo (a dummy treatment), to no treatment and to various cough remedies. The authors looked to see how well honey improved cough frequency, cough severity and the impact of cough on the sleep of the child and parents. They also looked at any adverse effects that occurred. 

Good news! Honey is probably more effective than doing nothing for relieving cough symptoms and may be as good or better than some commercial cough products.

The review concluded that honey is probably more effective than no treatment at all for providing cough relief and reducing the impact of cough on children’s sleep.

Honey is also probably better than placebo or salbutamol (a drug used in asthma to open the airways) at reducing cough symptoms when given for up to three days.

It may be better than diphenhydramine (an antihistamine drug) and may have a similar effect to dextromethorphan (this is found in OTC preparations such as some Benylin, Night Nurse, Covonia and Boots cough remedies) in reducing cough frequency.

There were no serious adverse events. Unwanted effects included rash (4 children who received salbutamol and 1 with honey), diarrhoea (9 children who received salbutamol, 7 with honey and 6 with placebo), sleepiness (3 children who received diphenhydramine) and restlessness/difficulty falling asleep/overexcitability (7 children who received honey and 2 given dextromethorphan).

The trials were small and in most of them the children only received honey for one night, which limited the results of the review. The trials took place in Iran, Israel, USA, Brazil and Kenya. Two studies were supported by pharmaceutical manufacturers, one by a university research centre, one by the Honey Board of Isreal and non-government agencies, and one by USA National Honey Board. One study did not report on its funding sources.

Overall the authors concluded that there was no strong evidence for or against using honey to relieve cough in children.  

Where does this leave us? 

Although cough is a normal protective mechanism whereby we clear secretions and foreign bodies from our airways, it can cause considerable distress and anxiety, alongside days lost from school and work, as well as taking up doctors’ appointments. Simple, safe remedies which do not need a prescription can be helpful. This review shows that honey is probably effective in relieving cough symptoms and may be at least as effective as some OTC preparations.

And, what’s more, it’s delicious!

Join in the conversation on Twitter with @CochraneUK or leave a comment on the blog.

Lynda Ware has nothing to disclose.

ReferenceOduwole O, Udoh EE, Oyo-Ita A, Meremikwu MM. Honey for acute cough in children. Cochrane Database of Systematic Reviews 2018, Issue 4. Art. No.: CD007094. DOI: 10.1002/14651858.CD007094.pub5.

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Lynda Ware

About Lynda Ware

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Lynda is a Senior Fellow in General Practice with Cochrane UK. Her background is in primary care and she was a GP partner in rural Oxfordshire for over thirty years with particular clinical interests in psychiatry and women's health. Since joining Cochrane UK in 2014, she has visited many village halls and community centres around Oxford talking to non-medical audiences about Evidence-Based Medicine and its relevance to everyday life. With a colleague, Lynda now visits schools to meet students from Years 10 to 13 to teach about EBM and to encourage critical thinking, particularly around health care claims made in the media. She blogs about Cochrane Reviews for the Evidently Cochrane website.

1 Comments on this post

  1. When I was a child my parents treated a cough or sore throat with glycerol / glycerin and a squeeze of jiff lemon (concentrated lemon juice in a plastic lemon container) mixed with hot water. It seemed to work a treat and tasted nice. Today – even though we know honey is not much different nutritionally from sugar – my family use honey and lemon mixed with hot water to treat coughs and sore throats. It does have a soothing effect and so seems to be of more use than not. Just as the Cochrane review revealed.

    Mike Sutton / Reply

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