The Effect of Honey on Nocturnal Cough and Sleep Quality for Children and Their Parents

OUGH IS A COMMON SYMPTOM IN PEDIATric practice and can be particularly troubling to children and their parents, resulting in discomfort, loss of sleep, and missed schooldays and workdays.Caregivers frequently administer over-the-counter (OTC) medications to their children in an attempt to treat cough.Apart from the costs associated with such medications, some OTC medications have unwelcome and potentially dangerous adverse effects.Dextromethorphan, an opiate-derived antitussive commonly found in OTC cough and cold preparations, is generally safe but on rare occasions can be associated with adverse effects such as dystonia, ataxia, lethargy, and even death. 1,2Furthermore, several studies 3,4 have shown that dextromethorphan is not more effective than placebo at reducing cough symptoms.The American Academy of Pediatrics policy statement on the use of codeine-and dextromethorphancontaining cough remedies in children states that indications for the use of narcotics or dextromethorphan as antitussives in children have not been established given the lack of data for efficacy and the potential for adverse effects. 5The American Academy of Pediatrics recommends that physicians talk with parents about the risk associated with these drugs as well as the lack of data on the efficacy of codeine and dextromethorphan as antitussives.In addition to OTC preparations, a variety of home remedies and herbal medications, such as licorice, clove, lemon, and honey, are used by some caregivers to treat the symptoms associated with upper respiratory tract infections (URIs). 6,7The World Health Organization 7 notes that many such preparations are inexpensive and encourages the use of safe antitussives such as lemon juice and honey for the treatment of cough if treatment is desired by the patient and family.In the randomized, partially double-blinded study by Paul et al 8 in this issue of the Archives, administration of honey is compared with administration of dextromethorphan and with no treatment for the reduction of nocturnal cough and sleep difficulty in children with URIs.This study enrolled 105 children aged 2 to 18 years from an acute care clinic in Pennsylvania.Children were randomized to receive honey, dextromethorphan, or no treatment at bedtime.Follow-up assessments were made by telephone the following day.Compared with children who received dextromethorphan or no treatment, children who