What is the evidence for using honey to treat Upper Respiratory Tract Infections (URTI) in children?

Evidence for Honey in Treating Upper Respiratory Tract Infections in Children

Honey is effective for symptomatic relief of cough in children with upper respiratory tract infections (URTIs) and should be considered as a first-line therapy for children over 1 year of age with acute cough. 1, 2

Efficacy of Honey for URTI Symptoms

• Honey probably reduces cough frequency better than no treatment or placebo (moderate-certainty evidence) 2
• Honey may be more effective than diphenhydramine in reducing cough frequency (low-certainty evidence) 2, 3
• Honey may have similar effects to dextromethorphan in reducing cough symptoms (low-certainty evidence) 2
• Honey improves combined symptom scores compared to usual care in URTIs 4
• Night-time honey doses given to children with cough from URTI significantly reduces symptoms and improves sleep for both children and caregivers 3

Duration of Effect

• Honey is most effective when given for up to three days for relieving cough symptoms compared with placebo or salbutamol 2
• Beyond three days, honey probably has no advantage over salbutamol or placebo in reducing cough severity, bothersome cough, and impact on sleep for parents and children (moderate-certainty evidence) 2

Safety Considerations

• Never give honey to infants under 12 months of age due to the risk of infant botulism 1, 5
• Adverse events associated with honey may include gastrointestinal symptoms (reported in about 12% of children in clinical trials) 2
• Honey has fewer adverse effects compared to diphenhydramine and dextromethorphan 3, 2
• Honey is safer than codeine-containing medications, which should be avoided due to potential serious side effects including respiratory distress 1

Comparison with Other Treatments

• Over-the-counter cough and cold medicines have little to no benefit in children and carry risk of adverse events 1
• The American College of Chest Physicians recommends honey as a first-line therapy for children over 1 year of age with acute cough 1
• Honey provides a widely available and cheap alternative to antibiotics for symptomatic relief of URTIs 4

Clinical Application

• Honey can be administered as a single dose before bedtime to help reduce nighttime cough and improve sleep quality for both children and caregivers 3, 2
• For children with persistent cough beyond 2-4 weeks, medical re-evaluation is recommended to identify potential specific etiologies 1
• Consider medical evaluation if cough is accompanied by difficulty breathing, persistent fever, changes in mental status, or refusal to eat/drink 1

Limitations of Evidence

• Most studies evaluated treatment for only one night, which limits the generalizability of results for longer treatment periods 2
• While evidence supports honey's effectiveness for acute cough, its applicability to chronic cough remains unknown 5
• The European Position Paper on Rhinosinusitis and Nasal Polyps (2020) noted that studies evaluating honey in nasal saline irrigation for rhinosinusitis did not find relevant differences between honey-treated groups and placebo groups 6

Honey represents a safe, effective, and accessible option for symptomatic management of cough in children with URTIs, provided they are over 12 months of age.