Honey as Cough Treatment
Honey is recommended as a first-line treatment for acute cough in children over 1 year of age and can be used as a simple, cost-effective home remedy for adults with acute viral cough. 1, 2, 3
For Pediatric Patients (Children Over 1 Year)
Honey should be your first choice for treating acute cough in children over 12 months old. 2, 3
Evidence Supporting Honey Use
- Honey provides more relief for cough symptoms than no treatment, diphenhydramine, or placebo in children. 2, 4
- Honey reduces cough frequency (mean difference -1.05 on a 7-point scale compared to no treatment, and -1.62 compared to placebo). 4
- Honey performs similarly to dextromethorphan in reducing cough frequency, but dextromethorphan should still be avoided due to lack of proven efficacy and potential adverse effects. 2, 4
- Multiple evening doses of honey (given for three consecutive nights) achieve therapeutic success in 80% of children with non-specific acute cough. 5
- Honey significantly reduces cough severity, improves sleep patterns for both children and caregivers, and decreases caregiver stress burden. 6
Dosing Approach
- Give honey at bedtime to reduce nocturnal cough and improve sleep quality. 4, 5
- A typical dose is 10 mL of honey mixed with 90 mL of milk, given for up to three consecutive evenings. 5
- Honey can be given alone or mixed with lemon as a simple home remedy. 1
Critical Safety Warning
Never give honey to infants under 12 months of age due to the risk of infant botulism. 2, 3
What NOT to Use in Children
- Avoid over-the-counter cough and cold medicines - they have not been shown to make cough less severe or resolve sooner and are associated with significant morbidity and mortality. 3
- Avoid codeine-containing medications - they can cause serious side effects including respiratory distress and death. 2, 3
- Avoid dextromethorphan - it is no different than placebo in reducing nocturnal cough or sleep disturbance in children. 3
- Avoid antihistamines - they have minimal to no efficacy for cough relief and are associated with adverse events. 3
For Adult Patients
For adults with acute viral cough, honey and lemon is recommended as the simplest and cheapest first-line home remedy. 1
Rationale for Adults
- Acute viral cough is almost invariably benign and self-limiting. 1
- Patients report benefit from honey-based home remedies, likely through central modulation of the cough reflex. 1
- Honey provides symptomatic relief without the adverse side effect profile of opiate antitussives. 1
Alternative Options for Adults
If honey alone is insufficient, consider:
- Dextromethorphan at 60 mg (higher than typical over-the-counter doses) for maximum cough reflex suppression. 1
- Menthol by inhalation for acute, short-lived cough suppression. 1
- Sedative antihistamines specifically for nocturnal cough (though they cause drowsiness). 1
When to Re-Evaluate
- In children: Re-evaluate if cough persists beyond 2-4 weeks for emergence of specific etiological pointers. 2, 3
- In adults: Seek medical attention if cough persists for more than three weeks, or if accompanied by hemoptysis, breathlessness, prolonged fever, or underlying chronic conditions. 1
Common Pitfalls to Avoid
- Do not use adult cough management approaches in pediatric patients - children require pediatric-specific protocols. 3
- Do not prescribe OTC medications due to parental pressure despite lack of efficacy in children. 3
- Do not give honey to infants under 12 months - this is an absolute contraindication. 2, 3
- Do not use opiate antitussives (codeine, pholcodine) in any age group - they have no greater efficacy than other options but carry significant adverse effects. 1
Adverse Events
Honey is generally well-tolerated with minimal side effects: