Honey vs cough medicine for a child's night cough

The best summary of the honey evidence is the 2018 Cochrane review of honey for acute cough in children. It included six randomized trials in 899 children aged 12 months to 18 years, seen as outpatients with an ordinary short-lived cough. The trials compared honey with no treatment, placebo, dextromethorphan, diphenhydramine (an antihistamine), salbutamol and a pineapple enzyme Oduwole 2018.

• Against no treatment or placebo, honey probably reduced cough frequency, on moderate-certainty evidence Oduwole 2018.
• Against dextromethorphan, honey may have a similar effect on cough frequency, but the two trials (149 children) disagreed with each other and the certainty was low Oduwole 2018.
• Against diphenhydramine, honey may be better, from one trial of 80 childrenOduwole 2018.

The most quoted single trial, from Penn State, gave 105 children aged 2 to 18 one dose of buckwheat honey, honey-flavored dextromethorphan or nothing, 30 minutes before bed. Parents rated honey best for night cough and sleep. Honey beat no treatment for cough frequency, dextromethorphan did not beat no treatment on any measure, and honey versus dextromethorphan showed no significant difference Paul 2007.

The weakness of the honey evidence is short follow-up. Most children in the Cochrane trials were given honey for one night only, and the reviewers concluded there was no strong evidence for or against itOduwole 2018. That is why the honey side is graded moderate rather than strong.

Cough medicines have been studied too, and they come out no better. A Cochrane review of OTC medicines for acute cough included 29 placebo-controlled trials in 4,835 people, 1,036 of them children. In the children's trials, antitussives (the cough-suppressant group that includes dextromethorphan), antihistamines and antihistamine-decongestant combinations were no more effective than placebo. The reviewers found no good evidence for or against OTC cough medicines, and noted more side effects with products containing antihistamines and dextromethorphan Smith 2014.

FDA puts it plainly for parents: most children get better on their own, and cough or cold medicine will not change the natural course of a cold or make it go away faster FDA. A cough also does a job, helping clear mucus from the airway.

We do not give cough medicine a grade on this page because it is a drug, not a food, and our grades cover kitchen remedies. The comparison card above shows only honey's grade for that reason.

For medicines, FDA does not recommend OTC cough and cold products for children younger than 2, because they can cause serious and potentially life-threatening side effects, and manufacturers voluntarily label them "Do not use in children under 4 years of age" FDA. MedlinePlus says the same for products containing dextromethorphan: do not give them under age 4, and use caution and follow the package directions for ages 4 to 11 MedlinePlus.

Put together, the ages sort the choice for you:

• Under 12 months: neither. Ask your pediatrician, and use the non-drug steps below.
• 1 to 3 years: honey is an option; OTC cough and cold medicine is not.
• 4 and up: both are options, and the trials give no reason to think the medicine does better.

In the honey trials, nervousness, poor sleep and hyperactivity were reported by 7 children (9.3%) given honey and 2 children (2.7%) given dextromethorphan, a difference that was not statistically clear. Against placebo, stomach complaints were a little more common with honey (12% versus 11%) Oduwole 2018. Honey is mostly sugar, so brush teeth after a bedtime spoonful.

Dextromethorphan's listed side effects include dizziness, lightheadedness, drowsiness, nervousness, restlessness, nausea and vomiting. It should not be combined with an MAO inhibitor antidepressant, or used within two weeks of stopping one MedlinePlus. The larger hazard with children is dosing: FDA warns that OTC products can harm children who get more than the recommended dose or who are given two products containing the same drug, and asks parents to use the measuring device that comes with the medicine rather than a kitchen spoon FDA.

FDA's non-drug suggestions for children with colds are fluids (warm drinks soothe the throat), a cool-mist humidifier rather than a warm one, saline nose drops or spray, and a bulb syringe for babies. Acetaminophen or ibuprofen can be used for fever and aches, at the dose on the label FDA. A warm mug of ginger tea with a spoon of honey stirred in suits an older child or an adult; more on what works for adults is on the colds page.

FDA lists these as reasons to call a doctor: a fever of 100.4°F or higher in a baby 2 months or younger, a fever of 102°F or higher at any age, blue lips, labored or fast breathing, wheezing, ribs showing with each breath, a severe headache, not drinking or signs of dehydration, unusual crankiness or sleepiness, ongoing ear pain, or a child who is getting worse FDA.

Any honey works in the trials; the Penn State study used dark buckwheat honey Paul 2007. A supermarket jar is fine. If you want a particular kind, iHerb lists raw and buckwheat honeys.