The Top Pediatric Viewpoints of 2013
As usual, this end-of-year edition highlights the top 5 Medscape Pediatrics Viewpoints as based on US physician readership. They represent an eclectic mix. Both of the studies about bronchiolitis reviewed this year were in the top 5, as was a study about ADHD, demonstrating that despite the frequency of these 2 very common conditions seen in pediatrics, pediatricians are very interested in continuing to learn how to best treat affected children.
Will a Spoonful of Honey Make the Cough Go Away?
Effect of Honey on Nocturnal Cough and Sleep Quality: A Double-Blind, Randomized, Placebo-Controlled Study
Cohen HA, Rozen J, Kristal H, et al
Pediatrics. 2012;130:465-471
Study summary. This Israeli trial enrolled children with upper respiratory infections at 6 community clinics, randomly assigned them to 3 treatment groups or 1 placebo group, and evaluated the effects of a single nocturnal dose of the substances on overnight cough and sleep symptoms. The 300 study subjects were otherwise healthy 1- to 5-year-olds (median age, 29 months) with uncomplicated upper respiratory infections. The main outcome was a parental survey assessment of the child's cough and degree of sleep difficulty the night before and the night of the intervention. The 3 different honey treatments included eucalyptus honey, labiatae honey, and citrus honey. The placebo compound was made from dates and was also brown and sweet. Parents gave 10 g of the allocated compound 30 minutes before the children went to sleep.
The next day, study personnel contacted the family by telephone to complete the postintervention questionnaire. Parents were asked about frequency of nocturnal cough the previous night, severity of cough, how bothersome the cough was, the degree that cough affected the child's sleep, and the degree that cough affected the parents' sleep. The primary outcome was the change in the frequency of the nocturnal cough from pre- to postintervention assessments. For most of the assessment items, there were no differences among the 3 different honey extracts. Each of the honey extracts improved symptoms compared with the placebo extract. Cohen and colleagues concluded that honey given at bedtime was more effective than placebo in reducing the frequency and severity of nighttime cough. They suggest that honey could be used as a safe and effective cough suppressant for children 1 year of age and older.
Year-end viewpoint. There has been a great deal of interest in honey as a cough suppressant, given current emphasis on reducing use of cough and cold medications among young children. In 2013, the US Food and Drug Administration (FDA) issued an advisory to not administer over-the-counter (OTC) cough and cold medications to children younger than 2 years. This decision arose from concerns about lack of efficacy in clinical trials, side effects, and the potential for children to overdose if parents administer 2 or more OTC cough and cold medications simultaneously. This study had several limitations, including the fact that it employed a single dose of antitussive and relied upon parental symptom report rather than objective measures. It is possible that the findings represent little more than regression to the mean, but the degree of improvement in the treatment groups was much greater than in the placebo group. There are not many medical options available to young children, especially given that the American Academy of Pediatrics (AAP) recommends against honey in infants younger than 12 months. This study is not alone, as there has been other research that has demonstrated honey to be both safe and effective for children over the age of 2 years.