Level 2: Mid-level evidence

The use of honey to alleviate nocturnal cough was evaluated in a randomized trial of 130 children aged 2-17 years with untreated rhinorrhea and cough for seven days or less (Arch Pediatr Adolesc Med. 2007;161:1140-1146). The children were randomized to buckwheat honey vs. artificial honey-flavored dextromethorphan vs. nothing in a 10-mL syringe that was to be used 30 minutes before sleep for one night. The dose was 0.5 teaspoons for children aged 2-5 years, one teaspoon for children aged 6-11 years, and two teaspoons for children aged 12-18 years. Symptoms were rated by parents on a scale from 0 to 6.

Comparing honey vs. dextromethorphan vs. control after one night of treatment, cough frequency improved by 1.89 points vs. 1.39 points vs. 0.92 points (P<.001). Severity of cough improved by 1.8 points vs. 1.3 points vs. 1.11 points (P<.001), and sleep improved by 2.49 points vs. 1.79 points vs. 1.57 points (P<.001).

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The results may be limited by the trial’s methodologic problems, including lack of intention-to-treat analysis, a relatively low 81% follow-up rate, and the evaluation of only a single dose of therapy. Honey should be avoided until after age 1 year because it is a dietary reservoir of Clostridium botulinum spores definitively linked to infant botulism in laboratory and epidemiologic studies.