I am not sure when this article was published by APhA, but the study they cite in Archives of Pediatric and Adolescent Medicine was published in 2007.
Honey more effective than honey-flavored dextromethorphan for children's coughs
Key point: A study published in Archives of Pediatric and Adolescent Medicine found that children who received a single dose of buckwheat honey 30 minutes before bedtime slept better and coughed less than those who received honey-flavored dextromethorphan or no treatment at all.
Finer points: The primary outcome measure of this partially double-blinded, randomized study was to compare parental satisfaction with a single nocturnal dose of buckwheat honey, honey-flavored dextromethorphan, or no treatment at all in children experiencing nocturnal coughing from an upper respiratory infection (URI). A total of 105 children aged 2 to 18 years with URI, nocturnal coughing, and duration of illness 7 days or less were enrolled in this study, which took place in a single, outpatient, general pediatric practice.
On the first night of the study, each child received no treatment. The next morning, parents answered five questions concerning cough frequency and severity, bothersome nature of cough, quality of child's sleep, and quality of parent's sleep. Survey responses were stratified using a seven-point Likert scale. On the second night, each child was randomized to receive a single syringe containing 2.5 mL, 5 mL, or 10 mL of buckwheat honey or honey-flavored dextromethorphan, or nothing. The syringes for all of the treatment groups were opaque and were placed in brown paper bags to ensure investigator blinding. The honey and dextromethorphan groups were blinded to patients and parents because the two products had similar consistency, texture, flavor, smell, and sweetness. Parents answered the same five questions the following morning.
Overall, parents rated honey as significantly better than dextromethorphan or no treatment for all five criteria (P < 0.001). Mild adverse events (e.g., hyperactivity, nervousness, insomnia) were significantly more common in children treated with honey than those treated with dextromethorphan or nothing (P = 0.04).
What you need to know: The recent FDA announcement that the Consumer Healthcare Products Association is voluntarily modifying the product labels of all OTC cough and cold medicines to state that the products should not be used in children under 4 years of age has left pharmacists with virtually no cough products to recommend for children in this age group. While additional research is needed to confirm the findings of this study, pharmacists should consider recommending honey as a symptomatic treatment for cough. Honey is safer than dextromethorphan in terms of abuse potential and possible serious adverse events (e.g., dystonia, anaphylaxis, psychosis, death). In addition, no published findings demonstrating the efficacy of dextromethorphan in children are available.
What your patients need to know: Tell parents that honey has been used as an alternative medicine since ancient times. Exactly why or how honey improves coughing is not known; it may be its viscosity or its antioxidant properties. Encourage parents to purchase only unfiltered, unheated, unprocessed honey and to never give honey to children under 1 year of age, because honey can contain botulism spores in its natural form.
- Paul IM et al. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161:1140–6.
Balch P, Balch J. Prescription for nutritional health, 3rd edition. New York, NY: Avery Publishing; 2000.