Honey Dosing for Cough in Children 1-2 Years Old
For children between 1 and 2 years old with acute cough, give 2.5 mL (approximately half a teaspoon) of honey as a single dose before bedtime, which can be repeated for up to three consecutive nights.
Recommended Dosing Protocol
The evidence supports honey as first-line therapy for cough in this age group, with the following approach:
- Single evening dose: 2.5 mL (half teaspoon) of honey given before bedtime 1, 2
- Duration: Can be administered for 2-3 consecutive nights 3
- Administration method: Honey can be mixed with warm milk (10 mL honey in 90 mL milk) to improve palatability and ease of administration 3
Why Honey is the Preferred Treatment
Honey provides superior symptom relief compared to over-the-counter medications and placebo in children over 1 year of age 1, 2:
- The American Academy of Pediatrics recommends honey as first-line treatment for cough in children over 1 year old 1
- The American College of Chest Physicians endorses honey as first-line therapy, showing better efficacy than no treatment, placebo, or diphenhydramine 2
- Research demonstrates that honey significantly reduces cough frequency, severity, and improves sleep quality for both children and parents by day 3 of treatment 4, 5
Critical Safety Consideration
Never give honey to infants under 12 months of age due to the risk of infant botulism 1, 2, 6. This is an absolute contraindication.
What to Avoid
Over-the-counter cough and cold medications should NOT be used in children under 4 years:
- The FDA and American Academy of Pediatrics recommend against OTC cold medications in children under 4 years due to potential toxicity and lack of proven efficacy 7
- Between 1969-2006, there were 54 deaths associated with decongestants and 69 deaths associated with antihistamines in children under 6 years 7
- Codeine-containing medications must be avoided due to risk of respiratory distress 1, 2
- Dextromethorphan is no more effective than placebo in this age group 1
When to Re-evaluate
- Review the child if symptoms worsen or fail to improve after 48 hours 1
- Re-evaluate if cough persists beyond 2-4 weeks to assess for specific underlying causes requiring different management 1, 2
- Seek immediate evaluation if the child develops difficulty breathing, persistent high fever, changes in mental status, or refuses to eat or drink 2
Common Pitfall to Avoid
Do not prescribe OTC cough medications due to parental pressure—these medications carry risks without proven benefit in young children 1, 7. Instead, educate parents that honey is both safer and more effective than pharmaceutical alternatives for symptomatic cough relief in this age group 4, 5, 8.