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Honey: not for infants
Honey should never be given
to children under 12 months old because of the
risk of infant botulism. Parents need to be warned
about this, because it certainly isn't written
on most honey jars.
Dr Paul's study included children
as young as two, but he would willingly give honey
to those of 12 to 24 months, he said, at the same
dose as the two to five age group, half a teaspoon.
He recommends one teaspoon in the six to 11 age
group, and two thereafter.
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Child cough and cold medicines
are very much in the doghouse right now after being
panned by the regulators and pediatric associations
of both Canada and the US in October. Yet with winter
upon us, parents and pediatricians alike could use an
alternative to the clinically sound but unpopular alternative
of offering no treatment at all for childhood upper
respiratory infections.
A genuinely appealing alternative
is suggested in December's issue of the Archives
of Pediatrics and Adolescent Medicine: try a bit
of honey.
Numerous studies have attested
to honey's antioxidant and wound healing properties.
Honey, the new research suggests, is not merely a useful
stand-in: it's actually more effective than the commonest
over-the-counter cough medicine, dextromethorphan.
SOOTHING
NECTAR
Researchers from Penn State University College of Medicine,
led by Dr Ian Paul, compared three treatments for nighttime
cough in 105 patients aged two to 18 years old. One
group received dextromethorphan in a honey-flavoured
artificial syrup typical of over-the-counter formulations.
Another received buckwheat honey (darker honeys are
thought to have more antioxidant properties) and a third
group went untreated.
The parents then rated symptoms
such as cough frequency, severity and sleep quality.
For all outcomes, the no treatment group saw the smallest
improvement, closely followed by dextromethorphan, while
honey emerged the clear winner.
That latter finding not only seems
to vindicate the judgement of the pediatric societies,
it also came as no great surprise to Dr Paul, whose
previous research had already shown dextromethorphan
to be in no way superior to a sweet liquid placebo.
That squares with a current theory that the sweetness
of liquid preparations is responsible for a large part
of their treatment effect. Sweet liquids cause reflex
salivation that can help protect the pharynx and larynx,
and trigger production of endogenous opioids.
"It's quite notable, and quite
odd," Dr Paul told NRM, "that even adult formulations
containing dextromethorphan so often come in a sweet
liquid, when most adult drugs come in pills." The only
evidence that the drug has a real treatment effect even
in adults, he says, is some rather unconvincing data
from a single proprietary study.
SWEET
DREAMS
The honey group had more side effects than the dextromethorphan
group, consisting of what parents would call a sugar
rush. Despite this, the honey group as a whole still
reported the best sleep. In the study, the honey was
administered within half an hour of bedtime. Pushing
that forward a bit might help get the sugar rush out
of the way, suggests Dr Paul. "Though we didn't test
it as a daytime cough medicine, honey might be quite
useful in that role too."
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