A Sweet Thought for Night Time Cough

Editor’s note: Wellness Word is an informational column which is not meant to replace a health care professional’s diagnosis, treatment or medication.


By Hari Dass Khalsa, DC


Cough is the reason for nearly 20,000,000 outpatient visits in the United States per year, and it most commonly occurs in conjunction with an upper respiratory tract infection. At night, it is particularly bothersome, because it disrupts sleep.

Despite the common occurrence of upper respiratory tract infections and cough, there appears to be confusion among consumers about the most effective therapy for this annoying symptom.

The use of dextromethorphan (DM), the most common over-the-counter (OTC) medicine for the treatment of cough in children, is not supported by the American Academy of Pediatrics or the American College of Chest Physicians. Nonetheless, consumers spend billions of dollars per year on OTC medications for cough.

Research has shown that neither DM nor diphenhydramine is superior to placebo for outcomes related to cough and sleep quality.  In fact, the Center for Disease Control (CDC) is estimating that each year, cough and cold medicines send about 7,000 children to hospital emergency rooms.

Standard doses of DM are associated with numerous serious adverse events described in the medical literature, such as dystonia (sustained muscle contractions) and anaphylaxis (severe hypersensitivity allergic reaction); and higher doses are associated with dependence, psychosis, mania hallucinations, insulin-dependent diabetes mellitus, peripheral neuropathy and death. Further, DM is increasingly being abused as a recreational drug, particularly by adolescents.

In contrast to DM, honey is generally recognized as safe, with the exception of the risk of infantile botulism for children younger than 1 year.

Recently, researchers from Pennsylvania State University performed a blinded randomized clinical trial that compared the effects of the following treatments on nocturnal cough and sleep difficulty associated with childhood upper respiratory tract infections: a single nocturnal dose of buckwheat honey, a dose of honey-flavored dextromethorphan (DM), and no treatment. One hundred five children aged 2 to 18 years with upper respiratory tract infections, nocturnal symptoms, and illness duration of 7 days or less participated. A single dose (10 ml = 2 teaspoons) of buckwheat honey, honey-flavored DM, or no treatment were administered 30 minutes prior to bedtime.

Differences in symptom improvement were detected between treatment groups, with honey consistently scoring the best and no treatment scoring the worst. In paired comparisons, honey was superior to no treatment. DM was not better than no treatment for any outcome.

Considering the risks and benefits, honey provides the most favorable symptomatic relief for a child’s nocturnal cough and sleep difficulty due to upper respiratory tract infection.


Dr. Hari Dass Khalsa is a chiropractor specializing in the non-surgical treatment of spinal conditions with offices in the Hawthorne District. 503.238.1032


A Sweet Thought for Night Time Cough

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