Will a sweet treat make cough retreat? In children presenting with acute cough due to upper respiratory tract infection, does honey treatment reduce cough severity?
Date First Published:
May 23, 2026
Last Updated:
May 23, 2026
Report by:
Dr Joseph Williams, Specialty Training Year 4 in Emergency Medicine (Wythenshawe Hospital, Manchester, United Kingdom)
Search checked by:
Dr Anne Fitzgibbon-Cadiou, Specialty Training Year 4 in Emergency Medicine
Three-Part Question:
In [children presenting with acute cough due to upper respiratory tract infection], does [the administration of honey] reduce [severity and frequency of cough symptoms]?
Clinical Scenario:
A three-year old child presents with a two day history of cough and coryza. Their observations are normal, and they appear clinically well. Their parents are distressed by the cough and ask if there are any treatments that can be used to reduce its severity. They ask if the traditional treatment of honey is of any use; you wonder whether the evidence supports the use of honey to treat acute cough in children.
Search Strategy:
EMBASE (1980-2025) and MEDLINE (1946-2025) databases were searched using the Ovid interface and the following keyword / Medical Subject Headings (MeSH) strategy:
1. Cough$.mp
2. Honey.mp
Inclusion Criteria:
• Children (1-18 years) presenting to ambulatory or emergency services with acute (≤7 days) of cough judged to be secondary to upper respiratory tract infection.
• Treatment with oral honey (can be mixed with a drink or other food item), compared to no treatment, placebo, or over the counter cough remedy.
• Interventional or observational study, reporting cough symptoms as primary or secondary outcome.
Exclusion Criteria:
• Non-empirical study.
• Prescribed honey-based pharmaceutical treatment such as inhaler.
• Cough secondary to other causes such as asthma, allergy, or lower respiratory tract infection.
1. Cough$.mp
2. Honey.mp
Inclusion Criteria:
• Children (1-18 years) presenting to ambulatory or emergency services with acute (≤7 days) of cough judged to be secondary to upper respiratory tract infection.
• Treatment with oral honey (can be mixed with a drink or other food item), compared to no treatment, placebo, or over the counter cough remedy.
• Interventional or observational study, reporting cough symptoms as primary or secondary outcome.
Exclusion Criteria:
• Non-empirical study.
• Prescribed honey-based pharmaceutical treatment such as inhaler.
• Cough secondary to other causes such as asthma, allergy, or lower respiratory tract infection.
Search Details:
Conference abstracts, case reports, and literature review articles were excluded. English language publications, or papers with a published English language translation, were included. Relevant papers had their reference lists screened for further suitable studies. The Google Scholar ‘cited by’ toolset was also used to find studies that had referenced the papers we considered relevant.
Outcome:
149 studies were initially identified by our search strategy. Of these, 83 were excluded on title review. 58 papers were excluded after abstract or full text review. Papers were primarily excluded due to being non-empirical studies, not evaluating paediatric patients, or not assessing honey. 8 papers were included in the final analysis; these were composed of 8 randomised control trials. All trials evaluated paediatric patients presenting with acute cough secondary to presumed viral upper respiratory tract infection. All studies used the same 7 point validated cough severity questionnaire (Ref 1).
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Effect of Honey on Cough Symptoms in Children with Upper Respiratory Tract Infection: A Randomised Controlled Trial Anibasa et al. 2022 Nigeria | Age 2-12, n = 84 Mean age – 3.6y 56% male, 44% female Comparison of honey to diphenhydramine (DPH) over 3 doses | Randomised control trial, single centre, single-blinded. Level II. | Primary: Cough severity and frequency. | Cough severity significantly improved in honey vs DPH (difference 3.0, p<0.001) | Authors were not blinded to the study groups, which may have influenced their analysis. Febrile children were excluded from the study, which limits its generalisability to clinical practice. |
| Secondary: sleep quality in child and adult, caregiver burden score. | Cough frequency significantly improved in honey vs DPH (difference 3.0, p<0.001) | ||||
| Caregiver burden score significantly lower in honey group (5.0 vs 11.0, p<0.001) | |||||
| Multicentre, randomised study found that honey had no pharmacological effect on nocturnal coughs and sleep quality at 1–5 years of age. Nishimura et al. 2022 Japan | Age 1-5, n = 161 Median age 2.7y 55% male, 45% female Comparison of honey and placebo syrup over 2 doses | Randomised control trial, multicentre (n = 13), placebo-controlled, double-blind. Level II. |
Primary: individual cough score measures. | No significant difference in individual cough scores between honey and placebo. | Exclusion of COVID-19 patients limits generalisability of treatment in children with upper respiratory signs. |
| Secondary: combined cough score. | No significant differences in combined cough score between honey and placebo. | ||||
| Comparison of the effect of two kinds of Iranian honey and diphenhydramine on nocturnal cough and the sleep quality in coughing children and their parents. Ayazi et al. 2017 Iran | Age 1-12, n = 92 Mean age 3. 52.9% female, 47.1% male Comparison of two types of honey and diphenhydramine for two doses | Randomised control trial, single centre, unblinded, age stratified. 3 arms. Level III | Primary: individual cough score measures. | Cough severity, bothersomeness, and parental sleep quality were significantly improved in honey groups compared to DPH. | Parents, patients and authors were not blinded, which may have led to bias in parental answers. to the questionnaires, and to the authors’ analysis. Randomisation method at risk of selection bias. Worse starting cough scores in the honey groups likely exaggerated the effect size. Not intention-to-treat analysis. |
| Combined cough score improvement: 9.1 in Honey 1, 10.2 in Honey 2, 4.2 in diphenhydramine (p=0.011) | |||||
| Effect of multiple honey doses on non-specific acute cough in children. An open randomised study and literature review. Sopo et al. 2015 Italy | Age 1-14, n = 134 Sex and ages not stated Comparison of milk and honey mixture with dextromethorphan (DMP) and levodropropizine (LDP) for 3 doses | Randomised control trial, unblinded, multicentre (n = 18). 4 arms. Level II. | Primary: | No significant difference in combined cough scores or treatment success between honey and dextromethorphan or levodropropizine. | Parents, patients and authors were not blinded, which may have led to bias in parental answers to the questionnaires, and to the authors’ analysis. Enrolment method vulnerable to selection bias. |
| ‘Treatment success’ (designated as a 50% reduction in cough score.) | |||||
| Combined cough score | |||||
| Randomised double blind study to compare effectiveness of honey, salbutamol and placebo in treatment of cough in children with common cold. Waris et al. 2014 Kenya | Age 1-12, n = 133 Age average not stated 51% male, 49% female Comparison of honey with placebo or oral salbutamol three times daily for 5 days | Randomised control trial, double-blinded, single centre, 3 arms. Level II. | Difference in cough score between d0 and d5 | Significant reduction in cough score for honey (12.68), compared to salbutamol (11.37) or placebo (8.69), p=0.003. | Trial materials provided by HoneyCare Africa Ltd, which may have influenced the findings. Not intention-to-treat analysis, which may lead to under-reporting of side effects. |
| Days to reduction of cough score to zero. | |||||
| Honey associated with a lower number of days (4.46) to cough clearance compared to placebo (5.18) or salbutamol (5.0), p=0.019. | |||||
| Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study. Cohen et al. 2012 Israel | Age 1-5, n = 270 Median age 2.4 59% male, 41% female Comparison of 3 types of honey to placebo syrup for one dose | Randomised control trial, double blinded, multicentre (n = 6), 4 arms. Level II. | Primary: cough frequency. | Cough frequency significantly improved in all 3 honey groups (1.77, 1.95, 1.82 point improvement) compared to placebo (1.0 point), p<0.01. | Not intention-to-treat analysis, which may lead to under-reporting of side effects. Higher drop-out rates in eucalyptus and citrus honey groups support the possible under-reporting of side effects. |
| Secondary: other cough severity markers and combined cough score. | Combined cough score lower in all honey groups compared to placebo (p<0.01). | ||||
| A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents. Shadkam et al. 2010 Iran | Age 2-5y, n = 139 Mean age 37.8 months 48.9% male, 51.1% female Comparison of honey to DMP and diphenhydramine for one dose | Randomised control trial, unblinded, centres not mentioned. Level II. | Primary: cough frequency, severity, effect on child’s sleep, effect on parent’s sleep. | Cough frequency was significantly less in the honey group (1.93) at study end-point compared to DMP (2.47), diphenhydramine (2.50) or control (3.11) groups. Cough severity, and effect on both child’s and parental sleep also signfiicantly less in honey group. P<0.01 in all measures. | Failed to reach recruitment to power study sufficiently. Not intention-to-treat analysis, which may lead to under-reporting of side effects. |
| Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Paul et al. 2007 United States of America | Age 2-18, n = 105 Median age 5.2 47% male, 53% female Comparison of honey, DMP, and no treatment for one dose | Randomised control trial, partially blinded, single centre. Level II. | Primary: cough frequency. | Cough frequency was significantly improved in honey (1.89) compared to no treatment (0.92), but not compared to dextromethorphan (1.39). | The no treatment group was not blinded, which may have led to bias in their symptom severity reporting. Collaborated with National Honey Board (USA). |
| Secondary: other cough scores and combined cough score. | Combined cough score significantly improved in honey (-10.71) vs DMP (-8.39) or no treatment (-6.41), p<0.01. |
Author Commentary:
Our key results are summarised in Table 1. We found a high volume of randomised controlled trials to investigate this question. Overall, these studies suggest that honey may be associated with an improvement in cough severity and frequency in children with acute cough secondary to viral upper respiratory infection. Honey is non-inferior to over-the-counter preparations such as levodropropizine, oral salbutamol and dextromethorphan, but is associated with an improvement in cough scores compared to diphenhydramine.
These results should be interpreted with caution. The majority of the trials which favoured honey were not intention-to-treat analyses, with two trials showing higher drop-out rates in honey groups. The higher drop-out rates in honey groups may reflect under-reporting of its side effects; several of the trials noted gastrointestinal side effects in honey groups, but these did not reach statistical significance in their analyses. As well, several of the trials which showed positive results for honey had involvement with honey-based business interests, though they declared no involvement in the trial structure or analysis. Honey remains unsuitable for children below the age of one, due to a possible risk of botulism, though this was not assessed in this review.
These results should be interpreted with caution. The majority of the trials which favoured honey were not intention-to-treat analyses, with two trials showing higher drop-out rates in honey groups. The higher drop-out rates in honey groups may reflect under-reporting of its side effects; several of the trials noted gastrointestinal side effects in honey groups, but these did not reach statistical significance in their analyses. As well, several of the trials which showed positive results for honey had involvement with honey-based business interests, though they declared no involvement in the trial structure or analysis. Honey remains unsuitable for children below the age of one, due to a possible risk of botulism, though this was not assessed in this review.
Bottom Line:
Honey is associated with an improvement in cough severity in children with acute cough. It is cheap and ready available, and appears to be at least as effective as over-the-counter cough medications, for lower cost. In light of the potential side effects of these medications, honey can be used as a similarly effective and cheaper alternative. Parents should be counselled around the possible side-effects of honey including gastrointestinal effects, due to potential under-reporting in these trials. For the symptomatic management of acute paediatric cough, secondary to viral upper respiratory infections, honey should be considered as a routine treatment option.
References:
1. Haver, K., et al. "Validation of a pediatric cough questionnaire." Poster presented at: American Thoracic Society 2006 International Conference. 2006.
2. Anibasa, F. O. "ORIGINAL: Effect of Honey on Cough Symptoms in Children with Upper Respiratory Tract Infection: A Randomised Controlled Trial: West Afr J Med. 2022 Sep 16; 39 (9): 928-934." West Africa Journal of Medicine 39.9 (2022): 928-934.
3. Nishimura, Tatsuo, et al. "Multicentre, randomised study found that honey had no pharmacological effect on nocturnal coughs and sleep quality at 1–5 years of age." Acta Paediatrica 111.11 (2022): 2157-2164.
4. Ayazi, Parviz, et al. "Comparison of the effect of two kinds of Iranian honey and diphenhydramine on nocturnal cough and the sleep quality in coughing children and their parents." Plos one 12.1 (2017): e0170277.
5. Sopo, S. Miceli, et al. "Effect of multiple honey doses on non-specific acute cough in children. An open randomised study and literature review." Allergologia et immunopathologia 43.5 (2015): 449-455.
6. Waris, Adil, et al. "Randomised double blind study to compare effectiveness of honey, salbutamol and placebo in treatment of cough in children with common cold." East African medical journal 91.2 (2014): 50-56.
7. Cohen, Herman Avner, et al. "Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study." Pediatrics 130.3 (2012): 465-471.
8. Shadkam, Mahmood Noori, Hassan Mozaffari-Khosravi, and Mohammad Reza Mozayan. "A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents." The Journal of Alternative and Complementary Medicine: Paradigm, Practice, and Policy Advancing Integrative Health 16.7 (2010): 787-793.
9. Paul, Ian M., et al. "Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents." Archives of pediatrics & adolescent medicine 161.12 (2007): 1140-1146.
References:
1. Haver, K., et al. "Validation of a pediatric cough questionnaire." Poster presented at: American Thoracic Society 2006 International Conference. 2006.
2. Anibasa, F. O. "ORIGINAL: Effect of Honey on Cough Symptoms in Children with Upper Respiratory Tract Infection: A Randomised Controlled Trial: West Afr J Med. 2022 Sep 16; 39 (9): 928-934." West Africa Journal of Medicine 39.9 (2022): 928-934.
3. Nishimura, Tatsuo, et al. "Multicentre, randomised study found that honey had no pharmacological effect on nocturnal coughs and sleep quality at 1–5 years of age." Acta Paediatrica 111.11 (2022): 2157-2164.
4. Ayazi, Parviz, et al. "Comparison of the effect of two kinds of Iranian honey and diphenhydramine on nocturnal cough and the sleep quality in coughing children and their parents." Plos one 12.1 (2017): e0170277.
5. Sopo, S. Miceli, et al. "Effect of multiple honey doses on non-specific acute cough in children. An open randomised study and literature review." Allergologia et immunopathologia 43.5 (2015): 449-455.
6. Waris, Adil, et al. "Randomised double blind study to compare effectiveness of honey, salbutamol and placebo in treatment of cough in children with common cold." East African medical journal 91.2 (2014): 50-56.
7. Cohen, Herman Avner, et al. "Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study." Pediatrics 130.3 (2012): 465-471.
8. Shadkam, Mahmood Noori, Hassan Mozaffari-Khosravi, and Mohammad Reza Mozayan. "A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents." The Journal of Alternative and Complementary Medicine: Paradigm, Practice, and Policy Advancing Integrative Health 16.7 (2010): 787-793.
9. Paul, Ian M., et al. "Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents." Archives of pediatrics & adolescent medicine 161.12 (2007): 1140-1146.
Level of Evidence:
Level 2: Studies considered were neither 1 or 3
References:
- Anibasa et al.. Effect of Honey on Cough Symptoms in Children with Upper Respiratory Tract Infection: A Randomised Controlled Trial
- Nishimura et al.. Multicentre, randomised study found that honey had no pharmacological effect on nocturnal coughs and sleep quality at 1–5 years of age.
- Ayazi et al.. Comparison of the effect of two kinds of Iranian honey and diphenhydramine on nocturnal cough and the sleep quality in coughing children and their parents.
- Sopo et al.. Effect of multiple honey doses on non-specific acute cough in children. An open randomised study and literature review.
- Waris et al.. Randomised double blind study to compare effectiveness of honey, salbutamol and placebo in treatment of cough in children with common cold.
- Cohen et al.. Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study.
- Shadkam et al.. A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents.
- Paul et al.. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents.