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PURLs: A spoonful of honey helps a coughing child sleep

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Evan Ashkin at University of North Carolina at Chapel Hill
Evan Ashkin
Anne Mounsey
Anne Mounsey
Anne Mounsey
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Abstract

Finally, we have a safe and effective alternative to OTC cough and cold remedies for young children with upper respiratory infections.
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Priority Updates from the Research Literature from
the Family Physicians Inquiries Network PURLs®
Evan Ashkin, MD;
Anne Mounsey, MD
Department of Family
Medicine, University of
North Carolina at Chapel
Hill
PURLs EDITOR
James J. Stevermer, MD,
MSPH
Department of Family
Medicine, University of
Missouri-Columbia
A spoonful of honey helps
a coughing child sleep
Finally, we have a safe and eective alternative to OTC
cough and cold remedies for young children with upper
respiratory infections.
Practice changer
When a parent brings in a child (ages 1-5 years)
with cough, runny nose, and other symptoms
of a viral upper respiratory infection (URI),
recommend that honey be given at bedtime.1
STRENGTH OF RECOMMENDATION
a: Based on a well-designed, randomized
controlled trial (RCT)
Cohen HA, Rozen J, Kristal H, et al. Eect of honey on nocturnal cough
and sleep quality: a double-blind, randomized, placebo-controlled
study. Pediatrics. 2012;130:465-471.
iLLUStratiVe caSe
A mother brings in her 18-month-old son be-
cause he’s had a runny nose and low-grade fe-
ver for the past 4 days—and a cough that kept
them both up last night. You diagnose a viral
URI, and she requests a strong cough medicine
so he (and she) can get a good night’s sleep.
What can you recommend that is both safe
and effective for a child of this age?
For primary care physicians, oce visits
for coughing kids with URIs are com-
monplace. In addition to the cost of
such visits, Americans spend some $3.5 bil-
lion a year on over-the-counter (OTC) cough
and cold remedies, and often give them to
young children.
It’s not enough to tell parents
what not to do
As physicians (and parents), we understand
the desire to give a coughing child something
to ease the symptoms. We also know that OTC
cough and cold medications can lead to seri-
ous complications, and even death. Between
1983 and 2007, 118 pediatric deaths were at-
tributed to the misuse of such preparations.2
And, in a 3-year span (2005-2008), the Ameri-
can Association of Poison Control Centers
received 64,658 calls for exposures to cough
and cold remedies in children younger than
2 years of age, 28 of which resulted in a major
adverse reaction or death.3
e US Food and Drug Administration
recommends against the use of OTC cough
and cold medications in children younger
than 2 years,4 and the American Academy of
Pediatrics has issued strict warnings about
the use of OTC cough and cold preparations
in children younger than 6 years.5 But warn-
ing parents of the dangers of giving them to
young children without oering an alterna-
tive doesn’t satisfy anyone’s needs, and many
parents continue to use these medications.
What about honey?
A study published in 2007 evaluated buck-
wheat honey and found it to be superior to
no treatment and equal to honey-avored
dextromethorphan in reducing cough se-
verity and improving sleep for children and
their parents.6 Honey is known to have both
antioxidant and antimicrobial properties—a
possible scientic explanation for its eect.
Before recommending honey for kids with
URIs, however, more evidence of its ecacy
was needed.
Do you
recommend
that parents give
honey to young
children with viral
URIs?
n Yes, frequently
n Yes, provided the
child is at least
1 year old
n Only if the parent
requests a
“natural” remedy
n No, I haven’t seen
enough evidence
to support it
n Other (Please
specify) __________
INSTANT
POLL
jfponline.com
CONTINUED
145
JFPONLINE.COM VOL 62, NO 3 | MARCH 2013 | THE JOURNAL OF FAMILY PRACTICE
PURLs®
StUDY SUMMarY
Honey reduces cough frequency
and severity
Cohen et al sought to determine whether
honey, administered before bedtime, would
decrease coughing in children between the
ages of one and 5 years—and improve sleep
for both the children and their caregivers.1
ey enrolled 300 children with a nocturnal
cough of <7 days’ duration and a diagnosis of
URI in a one-night study.
Children were excluded if they had any
signs or symptoms of asthma, pneumonia,
sinusitis, allergic rhinitis, or laryngotracheo-
bronchitis, or if they had been given any
cough remedy, including honey, the night
before. Parents completed a 5-question sur-
vey, using a 7-point Likert scale to assess
the child’s cough and both the child’s and
parents’ sleep the previous night. Only chil-
dren whose parents rated their child’s cough
severity ≥3 in 2 of the 3 questions related to
cough were included in the trial.
e study had a double-blind random-
ized design, with 4 treatment arms. ree
groups received 10 g (about 1.5 tsp) of one of
3 types of honey: eucalyptus, citrus, or labia-
tae (derived from plants including sage, mint,
and thyme); the fourth group received a pla-
cebo of silan date extract, which is similar to
honey in color, texture, and taste.
Children in all 4 groups received the
preparation 30 minutes before bedtime.
Neither the parents nor the physicians or
study coordinators knew which preparation
the children received. e following day, re-
search assistants telephoned the parent who
had completed the initial survey and asked
the same 5 questions. e primary outcome
measure was the change in cough frequency
from the night before to the night after treat-
ment. Secondary measures included cough
severity and the eect on sleep for both the
child and the parent.
Of the 300 children initially enrolled,
270 (90%) completed the trial, with an even
distribution among the groups. While there
were improvements across all outcomes for
both the treatment and placebo groups, the
changes were statistically signicant only in
the treatment groups. ere were no signi-
cant dierences in ecacy noted among the
3 types of honey. Adverse eects of stom-
achache, nausea, or vomiting were noted by
4 parents in the treatment groups and one in
the placebo group, a dierence that was not
statistically signicant.
What’S neW?
We have more evidence
of honey’s efcacy
For children older than one year with a viral
URI, we can now recommend 1.5 tsp honey to
be given prior to bedtime as a cough remedy.
is may reduce the use of potentially harm-
ful and often ineective OTC cough and cold
remedies.
caVeatS
Honey is unsafe
for the youngest children
An obvious limitation of this study was its
brevity. Although one night of improved
cough and sleep is important, a study that
showed honey’s sustained benet as a cough
suppressant would be more convincing.
What’s more, there are safety concerns that
are age-related.
Honey is considered unsafe for children
younger than one year because of the risk of
botulism. And honey has the potential to in-
crease dental caries if it is given nightly for a
prolonged period of time.
We do not know whether all varieties of
honey will have the same benet, and the
source of store-bought honey is not always
identied. e authors of this study received
funding from the Honey Board of Israel.
chaLLengeS tO iMPLeMentatiOn
Parents may be reluctant
to abandon OTCs
Changing the behavior of parents and other
caregivers who are accustomed to treating
children with OTC cough and cold remedies
is likely to be an uphill battle. Because honey
is readily available, however—often as close
as the pantry—and perceived to be safe and
nutritious, a recommendation from a trust-
ed physician could go a long way toward its
implementation. JFP
Giving children
honey may
reduce the
use of
potentially
harmful and
often ineffective
OTC cough and
cold remedies.
146 THE JOURNAL OF FAMILY PRACTICE | MARCH 2013 | VOL 62, NO 3
hOneY fOr cOUgh
147
JFPONLINE.COM VOL 62, NO 3 | MARCH 2013 | THE JOURNAL OF FAMILY PRACTICE
ACKNOWLEDGEMENT
The PURLs Surveillance System was supported in part by Grant
Number UL1RR024999 from the National Center for Research
Resources, a Clinical Translational Science Award to the Uni-
versity of Chicago. The content is solely the responsibility of
the authors and does not necessarily represent the ofcial
views of the National Center for Research Resources or the
National Institutes of Health.
Copyright © 2013. The Family Physicians Inquiries Network.
1. Cohen HA, Rozen J, Kristal H, et al. Eect of honey on nocturnal
cough and sleep quality: a double-blind, randomized, placebo-
controlled study. Pediatrics. 2012;130:465-471.
2. Dart RC, Paul IM, Bond GR, et al. Pediatric fatalities associated
with over the counter (nonprescription) cough and cold medica-
tions. Ann Emerg Med. 2009;53:411-417.
3. Srinivasan A, Budnitz D, Shehab N, et al. Infant deaths associ-
ated with cough and cold medications—two states, 2005. JAMA.
2007;297:800-801.
4. US Food and Drug Administration. Public Health Advisory:
FDA recommends that over-the-counter (OTC) cough and cold
products not be used for Infants and children under 2 years
of age. Available at: http://www.fda.gov/Drugs/DrugSafety/
PostmarketDrugSafetyInformationforPatientsandProviders/
DrugSafetyInformationforHeathcareProfessionals/
PublicHealthAdvisories/ucm051137.htm. Accessed February 14,
2013.
5. American Academy of Pediatrics. Withdrawal of cold medi-
cines: addressing parent concerns. Available at: http://www.
aap.org/en-us/professional-resources/practice-support/Pages/
Withdrawal-of-Cold-Medicines-Addressing-Parent-Concerns.
aspx. Accessed February 14, 2013.
6. Paul IM, Beiler J, McMonagle A , et al. Eect of honey, dextro-
methorphan, and no treatment on nocturnal cough and sleep
quality for coughing children and their parents. Arch Pediatr
Adolesc Med. 2007;161:1140-1146.
References
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... For instance, in the case of honey, the purchase is based on a range of tastes and benefits established in the minds of consumers who either reject or accept specific types of honey (Ahmed et al., 2013). The benefits associated with honey include but are not limited to its benefits for adults and children; such as serving as a sweetener (Ashkin & Mounsey, 2013;Bardy, Slevin, Mais, & Molassiotis, 2008), as a source of antioxidants (Bogdanov, Jurendic, Sieber, & Gallmann, 2008;Lianda, Sant' Ana, Echevarria, & Castro, 2012), as a cough suppressant (Ashkin & Mounsey, 2013), as an antibacterial effect (Molan, 1997), as treatment for cardiovascular diseases (Farooqui & Farooqui, 2011), and as an energy booster with relevant health benefits for children (Ashkin & Mounsey, 2013;Bardy et al., 2008). ...
... For instance, in the case of honey, the purchase is based on a range of tastes and benefits established in the minds of consumers who either reject or accept specific types of honey (Ahmed et al., 2013). The benefits associated with honey include but are not limited to its benefits for adults and children; such as serving as a sweetener (Ashkin & Mounsey, 2013;Bardy, Slevin, Mais, & Molassiotis, 2008), as a source of antioxidants (Bogdanov, Jurendic, Sieber, & Gallmann, 2008;Lianda, Sant' Ana, Echevarria, & Castro, 2012), as a cough suppressant (Ashkin & Mounsey, 2013), as an antibacterial effect (Molan, 1997), as treatment for cardiovascular diseases (Farooqui & Farooqui, 2011), and as an energy booster with relevant health benefits for children (Ashkin & Mounsey, 2013;Bardy et al., 2008). ...
... For instance, in the case of honey, the purchase is based on a range of tastes and benefits established in the minds of consumers who either reject or accept specific types of honey (Ahmed et al., 2013). The benefits associated with honey include but are not limited to its benefits for adults and children; such as serving as a sweetener (Ashkin & Mounsey, 2013;Bardy, Slevin, Mais, & Molassiotis, 2008), as a source of antioxidants (Bogdanov, Jurendic, Sieber, & Gallmann, 2008;Lianda, Sant' Ana, Echevarria, & Castro, 2012), as a cough suppressant (Ashkin & Mounsey, 2013), as an antibacterial effect (Molan, 1997), as treatment for cardiovascular diseases (Farooqui & Farooqui, 2011), and as an energy booster with relevant health benefits for children (Ashkin & Mounsey, 2013;Bardy et al., 2008). ...
Direct, indirect and mediation effects of consumer ethnocentrism on the willingness to pay premium price for locally produced honey
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  • Mar 2024
The study investigated the factors influencing the preference for locally produced honey in Ghana and the direct and indirect effects of consumer ethnocentrism on the willingness to pay premium price. The study results indicated that consumer ethnocentrism, trust, and purchase from the local or farmers’ market positively influenced the preference for locally produced honey; meanwhile, monthly consumption and packaging negatively influenced the preference for locally produced honey. Evidence from the structural equation model suggested that consumer ethnocentrism had a direct and positive effect on consumers’ willingness to pay for locally produced honey at premium price. Also, monthly consumption negatively mediates the consumer ethnocentrism and readiness to pay for locally produced honey at premium price. Further, education had a direct and negative effect on consumers’ willingness to pay for locally produced honey at premium price, but education through consumer ethnocentrism had no significant effect
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... However, several reports from trials conducted in children have concluded that there are no significant benefits of using the syrups over placebo. On the contrary, this may predispose the children to serious adverse effects, especially those less than two years of age [32][33][34][35][36]. To this extent, the regulatory authority in America in January 2008 withdrew some of the OTC cough products, or restricted their use in children, especially those under the age of 2 years due to serious and life threatening adverse effects [9,35]. ...
... The Canadian Paediatric Society also holds the same views, according to a report released in November 2011, and both have provided other options for parents and caregivers for the management of cold symptoms including use of saline water, fluid intake, humidified air (vaporizer), honey and acetaminophen if accompanied by fever [37,38]. The current view based on recently conducted studies in several other centres is that the use of cough syrups should be restricted in children owing to concerns on both efficacy and safety, and that other safer remedies such as honey should instead be used [32,[39][40][41][42][43]. Authors from a study conducted recently in Kenya arrived at the same conclusions [43,44]. ...
A Review of the Ingredients Contained in Over the Counter (OTC) Cough Syrup Formulations in Kenya. Are They Harmful to Infants?
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Cough syrups are widely used in the developing world, but safety of their use in infants and children less than two years has not been well documented. Some syrups contain multiple combinations of such drugs as promethazine, diphenhydramine and ephedrine; which are individually now contraindicated in children less than two years. Despite this, the syrups are available as over the counter drugs and may be dispensed to mothers who are unaware of the potentially hazardous effects to their infants. A descriptive cross-sectional study was used to investigate suitability of cough syrups sold within Eldoret municipality for use in children less than two years of age based on their formulations and available literature.Two semi-structured questionnaires were administered to pharmacy attendants and mothers attending sick child clinic at a referral hospital to establish whether cough syrups containing more than one active ingredient of compounds, now contraindicated in children are administered to infants, and awareness of potential serious adverse effects. Data from labeled contents of cough syrups from retail pharmacies was recorded and corroborated with information from literature to determine those deemed to contain the ingredients. The second questionnaire was administered to mothers with children less than two years to ascertain whether they had used the identified syrups. A total of 260 mothers and 55 pharmacy attendants were interviewed.There was widespread use of the syrups in children, including infants, with 192 (74%) of the respondents having used identified syrups and over 90% of these on children less than 2 years including those less than three months.146 (76%) mothers had administered the syrup at double the recommended dose.The regulatory authorities should make concerted efforts to discourage use of cough syrups containing ingredients that pose adverse events to infants, including campaigns to educate pharmacy workers and mothers.
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... Antibiotics have no effect on viral inflammations of the respiratory tract and there is limited evidence for the effectiveness of antibiotics and antitussives on asthma (22). As the specter of the treatment for these problems is reduced, it would be useful to consider apitherapy which, according to studies, reduces cough frequency and severity (23). ...
Honey Bee Pollen in Allergic Rhinitis Healing
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  • Jan 2020
The most common atopic disease of the upper respiratory tract is allergic rhinitis. It is defined as a chronic inflammatory condition of nasal mucosa due to the effects of one or more allergens and is usually a long-term problem. Under those conditions, it is desirable to avoid excessive and irrational application of chemical drugs and to consider the use of supplemental medicaments. The purpose of our study was to test the efficiency of apitherapy in allergic rhinitis healing by the application of honey bee pollen. Apitherapy is a branch of alternative medicine that uses honey bee products. Honey bee pollen can act as an allergen and cause new allergy attacks for those who suffer from allergic rhinitis. Conversely, we hoped to prove that smaller ingestion of honey bee pollen on a daily basis would desensitize participants to pollen and thus reduce the severity of allergic rhinitis. We conducted this research with 46 individuals between 22 and 47 years old, treated for allergic rhinitis. The patients filled in a questionnaire, with a visual analogous scale linked with the individual feeling of sneezing and other symptoms of rhinitis before and after the therapy. There was a significant difference (p = .000; α = .05) between symptoms of users before and after therapy conducted using honey bee pollen. After the pollen application, we recorded reduced symptoms with all participants and therefore the results support the main hypothesis. According to our research, the application of the honey bee pollen as therapy for allergic rhinitis is efficient and justified. Also, pollen therapy resulted in positive responses with participants suffering from other health issues.
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... Similarly study suggested that honey enhanced symptoms and reduced cough frequency compared with no treatment. In addition, it should encourage a rethinking of the management of common childhood illness and the role parents participated.The current view based on recently conducted studies in several other centres is that the use of cough syrups should be restricted in children owing to concerns on both efficacy and safety, and that other safer remedies such as honey should be used instead 16 . This is in harmony with conducted a systematic review to identify studies relating to the use of products to treat symptoms of the common cold, influenza or allergic rhinitis, and relating to poisoning or toxicity from unintentional ingestion or overdose in children (<12 years). ...
Cough Syrup Misuse in Children
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  • Dec 2017
The aim of the present study was to determine the epidemiology of cough syrup misuse and assess cough and cold medications (CCM) related adverse events (AEs) among children.8162 electronic questionnaires were completed by parents of using cough syrup on their children in Hail. Data analysis with SPSS version 22. In the present study we found that there was misuse of cough medicine and our study showed that approximately 88.6% of the parents used cough medicines for their children , 11.4% were not sure about their use. Regarding to the uses of the last year 5 times or less was 57.4% , those who not sure how many times they used was 18.3% , those used it from 5 to 10 times was18.1% and those used it more than 10 times were 6.1%. About the knowledge of the side effects of cough medicines 44.7% know and 55.3% do not know about the side effects of cough medicines.38.9% had dizziness and sleep, 3.6% had difficulty in breathing and 1.7% had shiver. This study highlights the fact that using of cough syrups without a proper medical consultation is an important health related mistakes in our local community in Hail city.
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... [23] Interestingly, we found 61.5% of pharmacist recommend use of honey in children with cough because honey is very useful in relieving cough frequency and severity in children; since it has antioxidant and antimicrobial properties also improve the sleep when administer before the bedtime as well as reduce the use of ineffective OTC cough drugs. [24] The assessment of pharmacists' practice showed fair practice as more than half (56.6%) of participants, while only 11.4% have a good practice. This may be due to lack of knowledge, lack of professional training with qualified staff also ignorance, and unawareness of parents who insist on taking specific drugs regardless of the opinion of the pharmacist. ...
Knowledge and practice of community pharmacists toward dispensing of cough medications for children Khartoum State: A cross-sectional study
Article
Full-text available
  • Apr 2020
INTRODUCTION: Cough is one of the common symptoms that alert patients to seek medical attention from physicians, which may lead to an increase in the cost of health‑care services. The pharmacist is one of the medical professionals to whom parents can go for consultation and request cough medications for their children. The study aimed to assess the knowledge and practice of community pharmacists toward dispensing of cough medication for children. MATERIALS AND METHODS: A cross‑sectional study was carried out among 325 community pharmacists using a pretested, standardized questionnaire. A stratifid random sampling method was used to select the participants. The knowledge and practice were assessed, and then the associations between knowledge and practice with different demographic variables were assessed using Chi‑square test and analyzed using the Statistical Package for the Social Sciences. RESULTS: Of 325 participants, the majority of them were females (74.2%) with B. Pharm (73.5%) and experienced <5 years (68.6%). About 53.8% of pharmacists were showed to have moderate knowledge, whereas 35.7% and 10.5% of them had a high and low level of knowledge, respectively. Regarding practice, 56.6% was found to show a fair level of practice, whereas 11.4% and 32% showed a good and poor level of practice, respectively. The majority of pharmacists still dispense cough medications for children <2 years despite the lack of effiacy and safety. Antibiotics were dispensed by pharmacists to children with cough without prescription, in the presence of fever and cough for a long period. CONCLUSION: More than half of the participants showed moderate knowledge and practice toward dispensing of cough medication in children, no signifiant association between knowledge and demographic variables, but practice showed a signifiant association with participants’ qualifiations.
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... 1 Other studies had also reported similar results. 11,12,[14][15][16][17][18][19][20][21] In spite of the significant improvement in nocturnal cough severity and frequency among the studied sample, parents and caregivers reported less satisfaction rates (p=0.025), and fewer intentions to re-use it in future attacks (p=0.025). ...
Effect of honey on nocturnal cough among children in Taif city
Article
Full-text available
  • Jan 2018
Background: Nocturnal cough is a common disturbing symptom that affects children during upper respiratory tract infections and can have a major negative impact on child and parents’ sleep quality. Many pharmaceutical medications, herbal regimens, and non-pharmaceutical advice are prescribed to reduce nocturnal cough. The aim of this research was to study the impact of honey on nocturnal cough in children.Methods: A descriptive study was conducted on 226 children in Taif city, KSA using a pre-prepared questionnaire to assess the cough severity and response to honey in comparison to other treatment modalities. Data collected were then analyzed using SPSS software.Results: The study was conducted on 226 children (51.77% were females). Children who used honey were significantly older (mean age 7.64±3.8 years) than those who used medications (mean age 6.98±60) (p=0.025). Children who used honey had a higher prevalence of headache (p=0.001) and malaise (p<0.001) than children who did not receive honey. The use of honey was also significantly associated with high cough severity scores. The use of honey seemed to significantly reduce both the cough severity score and combined severity scores, with odd’s ratios of 0.46 and 0.19, respectively (p=0.020 and <0.001). However, it was associated with fewer satisfaction rates and fewer intentions to re-use in next attacks (p=0.025).Conclusions: Honey has a beneficial effect on treating nocturnal cough in children. It decreases the severity of cough as well as the frequency of cough. It is commonly used among older Saudi children who have cough associated with malaise and fever. However, it is not satisfactory for patient and parental relief in Taif city because it doesn’t improve the sleep quality of patients or parents.
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... Naučnici mu pripisuju antibakterijska, antiseptička i antioksidaciona svojstva. Postoje brojne kliničke studije u kojima je ispitivano dejstvo meda na kašalj i u kojima je pokazano da je podjednako efikasan sa najčešće korišćenim antitusicima [20]. ...
Herbal medicine for cough therapy in children
Article
  • Jan 2015
Introduction: In pediatric population, the largest number of respiratory episodes accompanied by coughing are of viral origin. In such situations it is necessary to adjust therapy to avoid excessive and irrational use of antibiotics and evaluate the use of herbal medicines. The intensive development of pharmaceutical industries have developed methods, which have revealed the presence of a large number of ingredients in plants. Our working-hypothesis was to test the efficacy of multicomponent herbal medication during a prolonged cough in children. Methodology: The study was conducted in 109-children, 2.5 to 17 years of age who were treated for prolonged coughing. Patients and parents answered the questionnaires before and after the therapy, completed a visual analog scale (VAS) related to the subjective perception of coughing. Results: Significant statistical difference was obtained in the assessment of cough in children before and after herbal preparations defined as add on drug therapy. The apparent effectiveness of dietary supplementation is shown on the basis of numerical score system for measuring cough, evaluated by the parents. Positive evaluation of the herbal preparation is evident in all patients, even in children with atopic component, asthma and/or allergic rhinitis. Conclusions: According to our research, the use of herbal medicines in the treatment of mixed prolonged cough in children is effective and justified, without any adverse effects, and it can produce a strongly positive response in children with asthma and/or allergic rhinitis.
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... Ashkin et al. 18 highlighted that parents and caregivers may be reluctant to abandon OTCs. Trying to change their behaviour is likely to be an uphill battle but honey can be the keystone. ...
Effect of multiple honey doses on non-specific acute cough in children. An open randomised study and literature review
Article
  • Sep 2014
  • ALLERGOL IMMUNOPATH
Background Honey is recommended for non-specific acute paediatric cough by the Australian guidelines. Current available randomised clinical trials evaluated the effects of a single evening dose of honey, but multiple doses outcomes have never been studied. Objectives To evaluate the effects of wildflower honey, given for three subsequent evenings, on non-specific acute paediatric cough, compared to dextromethorphan (DM) and levodropropizine (LDP), which are the most prescribed over-the-counter (OTC) antitussives in Italy. Methods 134 children suffering from non-specific acute cough were randomised to receive for three subsequent evenings a mixture of milk (90 ml) and wildflower honey (10 ml) or a dose of DM or LDP adjusted for the specific age. The effectiveness was evaluated by a cough questionnaire answered by parents. Primary end-point efficacy was therapeutic success. The latter was defined as a decrease in cough questionnaire score greater than 50% after treatment compared with baseline values. Results Three children were excluded from the study, as their parents did not complete the questionnaire. Therapeutic success was achieved by 80% in the honey and milk group and 87% in OTC medication group (p = 0.25). Conclusions Milk and honey mixture seems to be at least as effective as DM or LDP in non-specific acute cough in children. These results are in line with previous studies, which reported the health effects of honey on paediatric cough, even if placebo effect cannot be totally excluded.
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Full-text available
  • Aug 2018
ABSTRAKBalita pneumonia mengalami batuk, napas cepat, dan ronkhi. Madu memiliki efek antimikroba dan antibodi yang dapat menghambat pertumbuhan agen mikroba penyebab pneumonia. Tujuan penelitian: mengetahui pengaruh pemberian madu terhadap frekuensi batuk, frekuensi napas, dan ronkhi balita pneumonia. Metode: Desain penelitian quasi-experimental: pre-test-post-test, non-equivalent control group. Jumlah sampel 34 balita berdasarkan rumus besar sampel kategorik berpasangan. Kelompok intervensi sejumlah 17 orang, diberikan madu murni 2,5 cc 30 menit sebelum anak tidur malam (± pukul 18.00) selama 3 hari. Kelompok kontrol sejumlah 17 orang diberikan air putih 2,5 cc 30 menit sebelum anak tidur malam (± pukul 18.00) selama 3 hari. Pengukuran hasil penelitian dilakukan pada hari pertama sebelum perlakuan dan hari keempat setelah perlakuan. Instrumen yang digunakan ialah timer, stetoskop, lembar observasi, dan kuesioner. Analisis data bivariat berpasangan menggunakan marginal homogenity, pair t test, dan Mc Nemar. Analisis data bivariat tidak berpasangan menggunakan Kolmogorov Smirnov, Fisher exact, dan independent t test. Hasil: Hasil penelitian menemukan adanya pengaruh yang bermakna pada pemberian madu terhadap frekuensi batuk (p=0,001), frekuensi napas (p=0,0001), dan ronkhi (p=0,012) antara kelompok kontrol dan kelompok intervensi. Kesimpulan: Rekomendasi penelitian ialah perlu menerapkan pemberian madu pada balita pneumonia untuk menurunkan batuk, frekuensi napas, dan ronkhi.Kata Kunci: balita pneumonia, frekuensi batuk, frekuensi napas, madu, ronkhi.EFFECT OF HONEY ON FREQUENCY OF COUGH, RESPIRATION AND RHONCHI IN UNDER-FIVE CHILDREN WITH PNEUMONIAABSTRACTUnder-five children with pneumonia experience cough, rapid breathing, and rhonchi. Honey has antimicrobial and antibody effects which can inhibit the growth of pneumonia-causing microbial agents. Objective: To identify the effect of honey on frequency of cough, respiration, and rhonchi in under-five children with pneumonia. Methods: This study employed quasi- experimental research with pretest-posttest, non-equivalent control group. The number of samples of 34 under-five children based on the formula of categorical paired samples. The intervention group numbering 17 people was given 2.5 cc ofpure honey 30 minutes before the child slept at night (± 06:00pm) for 3 days. The control group numbering 17people was given 2.5 cc ofwater 30 minutes before the child slept at night (± 06:00pm) for 3 days. The study results were measured on the first day before treatment and the fourth day after treatment. The instruments used were timer, stethoscope, observation sheet, and questionnaire. Paired bivariate data were analyzed using marginal homogeneity, pair t test, and Mc Nemar. Unpaired bivariate data were analyzed of using Kolmogorov-Smirnov, Fisher’s exact, and independent t-test. Results: The study results found a significant effect of giving honey on frequency of cough (p=0.001), frequency of respiration (p=0.0001), and rhonchi (p=0.012) between the control group and the intervention group. Conclusion: This study recommends to give honey to under-five children with pneumonia to decrease cough, frequency of respiration, and rhonchi.Keywords: under-five children with pneumonia, frequency of cough, frequency of respiration, honey, rhonchi.
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Acute cough and honey
Article
  • Jan 2014
Recent Australian guidelines on cough in children recommend the use of honey as cough suppressant. Conversely, the same guidelines, just like other documents previously published, advise against the use of drugs like antitussives, such as codeine and dextrometrophan, because of the lack of demonstration of their efficacy and because of their possible serious side effects. Moreover, even for honey, available revisions on its use in acute nonspecific cough are not so much in favour. So, it becomes necessary for the paediatrician to review the scientific evidence in order to come up with his own informed opinion and be able to express it. The solution is not as clear as many people would like to, but eventually, it will probably make it possible for the paediatrician to take a definite position.
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Effect of Honey on Nocturnal Cough and Sleep Quality: A Double-blind, Randomized, Placebo-Controlled Study
Article
Full-text available
To compare the effects of a single nocturnal dose of 3 honey products (eucalyptus honey, citrus honey, or labiatae honey) to placebo (silan date extract) on nocturnal cough and difficulty sleeping associated with childhood upper respiratory tract infections (URIs). A survey was administered to parents on 2 consecutive days, first on the day of presentation, when no medication had been given the previous evening, and the following day, when the study preparation was given before bedtime, based on a double-blind randomization plan. Participants included 300 children aged 1 to 5 years with URIs, nocturnal cough, and illness duration of ≤ 7 days from 6 general pediatric community clinics. Eligible children received a single dose of 10 g of eucalyptus honey, citrus honey, labiatae honey, or placebo administered 30 minutes before bedtime. Main outcome measures were cough frequency, cough severity, bothersome nature of cough, and child and parent sleep quality. In all 3 honey products and the placebo group, there was a significant improvement from the night before treatment to the night of treatment. However, the improvement was greater in the honey groups for all the Parents rated the honey products higher than the silan date extract for symptomatic relief of their children's nocturnal cough and sleep difficulty due to URI. Honey may be a preferable treatment for cough and sleep difficulty associated with childhood URI.
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Pediatric Fatalities Associated With Over the Counter (Nonprescription) Cough and Cold Medications
Article
Full-text available
  • Apr 2009
The use of nonprescription cough and cold medicines is widespread, but their use has been sporadically associated with severe toxicity and death. We evaluate the role of these medications in pediatric fatalities and identified factors that contributed to the death. Fatalities that involved a child younger than 12 years and mentioned a cough and cold ingredient were obtained from 5 sources. An independent panel of 8 experts (pediatrics, pediatric critical care, pediatric toxicology, clinical toxicology, forensic toxicology, forensic pathology) used explicit definitions to assess the causal relationship between medication ingestion and death. Contributing factors were identified. Of 189 cases included, 118 were judged possibly, likely, or definitely related to a cough and cold ingredient. Of these 118 cases, 103 involved a nonprescription drug, whereas 15 cases involved a prescription medication alone. Of 103 cases associated with nonprescription drugs, the evidence indicated that 88 involved an overdosage. A dosage could not be assessed in the remaining 15 cases. Several contributing factors were identified: age younger than 2 years, use of the medication for sedation, use in a daycare setting, use of 2 medicines with the same ingredient, failure to use a measuring device, product misidentification, and use of a nonprescription product intended for adult use. All cases that occurred in a daycare setting involved a child younger than 2 years. In our sample, pediatric fatalities caused by nonprescription cough and cold medications were uncommon, involved overdose, and primarily affected children younger than 2 years. The intent of caregivers appears to be therapeutic to relieve symptoms in some cases and nontherapeutic to induce sedation or to facilitate child maltreatment in other cases.
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Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents
Article
Full-text available
  • Jan 2008
To compare the effects of a single nocturnal dose of buckwheat honey or honey-flavored dextromethorphan (DM) with no treatment on nocturnal cough and sleep difficulty associated with childhood upper respiratory tract infections. A survey was administered to parents on 2 consecutive days, first on the day of presentation when no medication had been given the prior evening and then the next day when honey, honey-flavored DM, or no treatment had been given prior to bedtime according to a partially double-blinded randomization scheme. A single, outpatient, general pediatric practice. One hundred five children aged 2 to 18 years with upper respiratory tract infections, nocturnal symptoms, and illness duration of 7 days or less. A single dose of buckwheat honey, honey-flavored DM, or no treatment administered 30 minutes prior to bedtime. Cough frequency, cough severity, bothersome nature of cough, and child and parent sleep quality. Significant differences in symptom improvement were detected between treatment groups, with honey consistently scoring the best and no treatment scoring the worst. In paired comparisons, honey was significantly superior to no treatment for cough frequency and the combined score, but DM was not better than no treatment for any outcome. Comparison of honey with DM revealed no significant differences. In a comparison of honey, DM, and no treatment, parents rated honey most favorably for symptomatic relief of their child's nocturnal cough and sleep difficulty due to upper respiratory tract infection. Honey may be a preferable treatment for the cough and sleep difficulty associated with childhood upper respiratory tract infection. clinicaltrials.gov Identifier: NCT00127686.
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Public Health Advisory: FDA recommends that over-the-counter (OTC) cough and cold products not be used for Infants and children under 2 years of age Available at: http://www.fda.gov
  • Mar 2013
  • Us
  • Drug Food
  • Administration
US Food and Drug Administration. Public Health Advisory: FDA recommends that over-the-counter (OTC) cough and cold products not be used for Infants and children under 2 years of age. Available at: http://www.fda.gov/Drugs/DrugSafety/ PostmarketDrugSafetyInformationforPatientsandProviders/ D r u g S a f e t y I n f o r m a t i o n f o r H e a t h c a re P ro f e s s i o n a l s / PublicHealthAdvisories/ucm051137.htm. Accessed February 14, 2013.
Withdrawal of cold medi-cines: addressing parent concerns Available at: http://www. aap.org/en-us/professional-resources/practice-support/Pages/ Withdrawal-of-Cold-Medicines-Addressing-Parent-Concerns. aspx
  • Mar 2013
  • American Academy
American Academy of Pediatrics. Withdrawal of cold medi-cines: addressing parent concerns. Available at: http://www. aap.org/en-us/professional-resources/practice-support/Pages/ Withdrawal-of-Cold-Medicines-Addressing-Parent-Concerns. aspx. Accessed February 14, 2013.
Infant deaths associ-ated with cough and cold medications—two states
  • Jan 2005
  • 800-801
  • A Srinivasan
  • D Budnitz
  • N Shehab
Srinivasan A, Budnitz D, Shehab N, et al. Infant deaths associ-ated with cough and cold medications—two states, 2005. JAMA. 2007;297:800-801.
Withdrawal of cold medicines: addressing parent concerns
  • Feb 2013
American Academy of Pediatrics. Withdrawal of cold medicines: addressing parent concerns. Available at: http://www. aap.org/en-us/professional-resources/practice-support/Pages/ Withdrawal-of-Cold-Medicines-Addressing-Parent-Concerns. aspx. Accessed February 14, 2013.