The parents of four children who received salbutamol and one child given honey reported rash. The parents of nine children given salbutamol, seven given honey, and six given placebo reported diarrhoea. The parents of three children in the diphenhydramine group reported that their children were often sleepy. The parents of seven children given honey and two given dextromethorphan reported side effects in their children, such as not falling asleep easily, restlessness, and becoming overexcited. Honey may be better than diphenhydramine (an antihistamine) at relieving and reducing children's cough. There may be little or no difference between the effects of honey and dextromethorphan (an ingredient in over‐the‐counter cough remedies) or honey and bromelin with honey on all cough symptoms. Honey is probably more effective at providing cough relief and reducing the impact of cough on children's sleep at night than no treatment. Honey probably reduces cough symptoms more than placebo and salbutamol (a drug that opens lung airways) when given for up to three days. We compared honey to over‐the‐counter cough preparations, bromelin (a pineapple enzyme) mixed with honey, fake treatment (placebo), and no treatment. One study did not report funding sources. Two studies were supported by pharmaceutical manufacturers one by a university research centre one by the Honey Board of Israel and non‐government agencies and one by USA National Honey Board. This update included three new trials conducted between 20 that involved 331 children. We included six small trials involving 899 children aged 12 months to 18 years conducted in Iran, Israel, the USA, Brazil, and Kenya. We searched databases to 8 February 2018 and trial registers to 12 February 2018. Honey is believed to prevent growth of germs and reduce inflammation. No adverse events were reported in the no‐treatment group.Ĭan honey reduce cough symptoms caused by bacteria and viruses in children?Ĭough causes concern for parents and is a major reason for outpatient visits. Four children who received salbutamol had rashes compared to one child in the honey group (RR 0.19, 95% CI 0.02 to 1.63 1 study 100 children moderate‐certainty evidence). When honey was compared with placebo, 34 children (12%) in the honey group and 13 (11%) in the placebo group complained of gastrointestinal symptoms (RR 1.91, 95% CI 1.12 to 3.24 I² = 0% 2 studies 402 children moderate‐certainty evidence). Three children (7.5%) in the diphenhydramine group experienced somnolence (RR 0.14, 95% Cl 0.01 to 2.68 1 study 80 children low‐certainty evidence). With a 5‐point cough scale, there was probably little or no difference between the effects of honey and bromelin mixed with honey in reducing cough frequency and severity.Īdverse events included nervousness, insomnia, and hyperactivity, experienced by seven children (9.3%) treated with honey and two children (2.7%) treated with dextromethorphan (risk ratio (RR) 2.94, 95% Cl 0.74 to 11.71 I² = 0% 2 studies 149 children low‐certainty evidence). Beyond three days honey probably had no advantage over salbutamol or placebo in reducing cough severity, bothersome cough, and impact of cough on sleep for parents and children (moderate‐certainty evidence). Giving honey for up to three days is probably more effective in relieving cough symptoms compared with placebo or salbutamol. Honey may be better than diphenhydramine in reducing cough frequency (MD ‐0.57, 95% CI ‐0.90 to ‐0.24 1 study 80 children low‐certainty evidence). Honey may have a similar effect as dextromethorphan in reducing cough frequency (MD ‐0.07, 95% CI ‐1.07 to 0.94 I² = 87% 2 studies 149 children low‐certainty evidence). Using a 7‐point Likert scale, honey probably reduces cough frequency better than no treatment or placebo (no treatment: mean difference (MD) ‐1.05, 95% confidence interval (CI) ‐1.48 to ‐0.62 I² = 0% 2 studies 154 children moderate‐certainty evidence placebo: MD ‐1.62, 95% CI ‐3.02 to ‐0.22 I² = 0% 2 studies 402 children moderate‐certainty evidence). In all studies, low score indicated better cough symptom relief. Five studies used 7‐point Likert scales to measure symptomatic relief of cough one used an unclear 5‐point scale. Studies compared honey with dextromethorphan, diphenhydramine, salbutamol, bromelin (an enzyme from the Bromeliaceae (pineapple) family), no treatment, and placebo. We assessed two studies as at high risk of performance and detection bias three studies as at unclear risk of attrition bias and three studies as at unclear risk of other bias. We included six randomised controlled trials involving 899 children we added three studies (331 children) in this update.
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