Honey I Suppressed the Kids

(written 2013)

You may have been hearing a lot the past few years about the wonderful effects honey can have on coughs.   Media, nutritionists, social networking and various other sources have been very effective in spreading the news that was issued in a 2007 press release by Penn State University (PSU) and the Journal of the American Medical Association (JAMA).  This study was funded by an unrestricted grant from the National Honey Board, an industry-funded agency of the United States Department of Agriculture. Unfortunately, as the Hip Hop group Public Enemy has said, “Don’t Believe the Hype.”

The press release from PSU (http://news.psu.edu/story/192001/2007/12/03/honey-proves-better-option-childhood-cough-otcs ) states that:
“The study found that a small dose of buckwheat honey given before bedtime provided better relief of nighttime cough and sleep difficulty in children than no treatment or dextromethorphan (DM), a cough suppressant found in many over-the-counter cold medications.”

While this statement is not untrue, it is a little misleading once one reads the published study. (http://archpedi.jamanetwork.com/article.aspx?articleid=571638).  In the study it states:
“Notably, however, direct comparison between honey and DM yielded no statistically significant differences.” and “much of the improvement can also be attributed to the natural history of URIs (Upper Respiratory Infection), which generally improve with time and supportive care.”

Well this is getting a little confusing.  Where did the PSU get the idea about honey being better?   Well, it also states in the study:
“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. “

OK, so now we know where the supportive information came from.   But wait a minute!   Do you see it?  If honey is significantly better than no treatment, and DM is no better than no treatment, then how can the comparison between honey and DM show no significant differences?  So what’s going on here?

Looking at the First Night and Second Night comparison scores (figure 2 in the JAMA study), you can see honey does fare better overall compared to DM and no treatment.  Upon closer examination, you will notice though, that the advantage it has is less than 1 point.  Most seem to show just a .5 difference between No Treatment and Honey with DM in between those two.   So really, it shows no significance and is suggesting that a child having no treatment will experience pretty much the same relief as those taking a cough suppressant with DM or honey.

The authors suggest that the cause for the slight increase in effectiveness of honey may be due to some of its antimicrobial and antioxidant effects.  They also suggest that sweetened liquids may cause salivation and airway mucus to be secreted and thus provide a soothing demulcent effect.   Although, taken with a grain of sugar, when you again compare the relatively unimpressive results of honey over DM and no treatment with these explanations, it’s not really saying much.

Ideally, I would say that this study really shows that attentive and supportive care and time is the most important medicine in helping a child with a cough, which the authors also support by saying:
“much of the improvement can also be attributed to the natural history of URIs, which generally improve with time and supportive care. “

So just make sure that you show your child love and care for them.  If your child’s cough persists, see your doctor immediately.