Honey for cough: it works, but never before age 1

A cough that keeps a child awake, and the parents with them, is one of the great miseries of fall. Cough syrups are not recommended for little ones, and we look for something simple that might help. Honey, the classic home remedy, has in fact been studied closely.

The good news: it is one of the few kitchen remedies with evidence behind it. The bad news for the very young: it is off-limits before age 1, no exceptions. This article is part of our guide to herbal remedies for colds and flu.

This article is for information only and does not replace the advice of a health professional.

What the Cochrane review says

Cochrane is an international network that gathers all the quality studies on a question and draws an overall conclusion. Its review on honey for acute cough in children, by Oduwole and colleagues, was updated in 2018. It brings together 6 trials and 899 children aged 1 to 18 who were coughing because of a respiratory tract infection.

The authors conclude that honey probably relieves cough more than no treatment, diphenhydramine and placebo, and makes little or no difference compared with dextromethorphan. They also state that there is no strong evidence for or against its use: most children were treated for only one night, and the studies are small.

As for adverse effects, the authors found no overall difference between children given honey and the others. Some children were more agitated or had more trouble sleeping after honey, but with low certainty.

The study that started it all

The best-known trial on the subject was led by pediatrician Ian Paul, of Penn State University, and published in 2007 in the Archives of Pediatrics and Adolescent Medicine. It involved 105 children aged 2 to 18 who were coughing because of an upper respiratory tract infection.

The children received, 30 minutes before bedtime, a single dose of buckwheat honey, a dose of honey-flavoured dextromethorphan, or nothing at all. The amounts depended on age:

• from 2 to 5 years: ½ teaspoon;
• from 6 to 11 years: 1 teaspoon;
• from 12 to 18 years: 2 teaspoons.

According to the parents, honey gave the greatest improvement on every measure: frequency and severity of nighttime cough, and the sleep of both child and parents. Honey did significantly better than no treatment, while dextromethorphan did no better than nothing at all. A few children had mild side effects with honey, such as hyperactivity.

These amounts are the study's, not an official dosage. Still, they give a good idea of the scale: a small spoonful, not a jar.

Never before age 1: infant botulism

This is the rule with no exceptions. According to Health Canada, honey can contain spores of Clostridium botulinum, the bacteria that causes infant botulism. In babies, the good bacteria that protect the gut against these spores are not yet established. After age 1, they are, and the risk becomes very low.

Three important points from Health Canada:

• Pasteurization does not remove the spores from honey.
• Cooking does not easily destroy them either. A cookie, cake or cereal that contains honey should therefore also be avoided before age 1.
• Honey is the only food linked to infant botulism in Canada.

Symptoms to watch for in a baby: constipation, weakness to the point of not crying or feeding normally, a neck too weak to hold up the head, a lack of facial expression, floppy arms and legs, trouble breathing or swallowing. If your baby shows any of these signs, Health Canada says to contact a doctor immediately.

So before age 1: no honey, no pacifier dipped in honey, no herbal tea sweetened with honey, and no "natural" cough product that contains it. Read labels carefully.

What about cough syrups?

This is exactly where honey becomes interesting. Health Canada says over-the-counter cough and cold medicines should never be given to children under 6. Since 2009, it has asked manufacturers to state on the label that these products are contraindicated before that age: there is little evidence they work in young children, and cases of misuse, overdose and serious side effects have been reported.

Between ages 1 and 6, honey is therefore one of the few simple options. The National Center for Complementary and Integrative Health (NCCIH), a U.S. public agency, also notes that buckwheat honey does better than placebo for cough frequency and severity, and for sleep, in children with colds, while reminding parents to avoid it before age 1.

And in adults?

Most studies involve children, but honey is also recommended for adults. In the United Kingdom, the National Institute for Health and Care Excellence (NICE), which writes guidelines for the public health system, lists honey among treatments with limited evidence of some benefit for relieving acute cough, in people over 1 year old. NICE also notes that an acute cough usually gets better on its own within 3 to 4 weeks, without antibiotics.

In other words, honey does not shorten a cold. It can make the cough a little less unpleasant, especially at night, while it runs its course.

Using it well

• At night: in the studies, honey was given about 30 minutes before bedtime, when the cough is most disruptive.
• Plain or diluted: a small spoonful as is, or in a cup of hot water or cooled herbal tea. For the tea, we have a few ideas, like our rose hip tea.
• The type of honey: the 2007 trial used buckwheat honey, a dark honey. Other studies in the Cochrane review used other honeys. There is no evidence that one particular honey is better.
• Teeth: honey is a sugar. After the evening spoonful, brushing teeth is a good idea.
• Diabetes: if your child or you have diabetes, talk to a health professional before making it a daily remedy.

When to see a doctor

Honey relieves, it does not cure. Most coughs from colds go away on their own, but some situations call for a doctor. According to the Institut national de santé publique du Québec (INSPQ), see a doctor if:

• a baby under 3 months coughs a lot;
• the child coughs to the point of choking or vomiting;
• the cough has lasted more than 10 days.

Seek care quickly if the child has trouble breathing, if their chest pulls in when they breathe, if they wheeze or breathe fast, if you suspect they swallowed an object, or if their general condition worries you. In an emergency, call 911. If in doubt, Info-Santé answers at 811 at any time.

In short

A small spoonful of honey at night is a simple, inexpensive remedy, backed by studies, for relieving the cough of a child with a cold who is over 1 year old, and even of an adult. It is not a miracle: the effect is modest and the studies are small. But before age 1, the rule is absolute: no honey, raw, pasteurized or cooked.

For other cold remedies, from elderberry to echinacea, see our guide to what has evidence, and what does not.

Sources

• Honey for acute cough in children, O. Oduwole, E. E. Udoh, A. Oyo-Ita and M. M. Meremikwu, Cochrane, 2018.
• Summary of the trial by I. Paul et al. on honey and cough (2007), American Family Physician, 2008.
• Honey proves better option for childhood cough than OTCs, Penn State, 2007.
• Infant botulism, Health Canada.
• Concerns about children's medication, Health Canada.
• The Common Cold and Complementary Health Approaches, National Center for Complementary and Integrative Health, 2020.
• Cough (acute): antimicrobial prescribing (NG120), National Institute for Health and Care Excellence, 2019.
• Toux chez l'enfant (in French), Institut national de santé publique du Québec, 2026.