Honey benefits: there is evidence for children's cough — and none of it applies under 12 months

Key benefits

1. 01Moderate evidence

   Acute cough in children — the Cochrane numbers as they stand

   2018, Cochrane Database of Systematic Reviews, updating earlier versions from 2010, 2012 and 2014.

   Inclusion criteria: randomised controlled trials comparing honey with no treatment, placebo, honey-based cough syrup or over-the-counter cough medicines, for acute cough in children aged 12 months to 18 years. Six trials, 899 children were included.

   Measurement was mostly on a 7-point Likert scale, where a lower score meant better relief.

   The results:

   Comparator	Mean difference	95% CI	Studies / children	Certainty
   No treatment	−1.05	−1.48 to −0.62	2 / 154	Moderate
   Placebo	−1.62	−3.02 to −0.22	2 / 402	Moderate
   Dextromethorphan	−0.07	−1.07 to 0.94	2 / 149	Low
   Diphenhydramine	−0.57	−0.90 to −0.24	1 / 80	Low

   I² was 0% for both the no-treatment and placebo comparisons, meaning the included trials agreed with each other.

   How to read those numbers.

   First, it is about one point on a seven-point scale. −1.05 is roughly one point out of seven. Not nothing, but not the cough going away either.

   Second, it was no different from an over-the-counter cough medicine. Against dextromethorphan the difference was −0.07, with an interval well across zero. That can be read as "honey is as good as the medicine" or as "neither does much" — the evidence for over-the-counter cough medicines themselves is not strong.

   Third, past three days there is no advantage. The review states that up to three days honey was probably better than placebo or salbutamol at relieving cough, but beyond three days there was no advantage in cough severity, bothersome cough, or the impact of cough on sleep for children and parents (moderate certainty).

   And adults? A 2021 systematic review and meta-analysis in BMJ Evidence-Based Medicine looked at honey for symptomatic relief in upper respiratory tract infections, reporting better symptom scores and cough frequency than usual care. Here too the included trials are limited in size and quality.

   The honest summary: a spoonful of honey at bedtime for a child with a cold cough is an evidence-based choice. The effect is about a point, it does not persist past three days, and a cough that drags on is a reason to see a doctor.

   [1][2]
2. 02Nutrition data

   82.1 g of sugar in 100 g — nutritionally, honey is sugar

   Per 100 g of honey:

   • 304 kcal, sugar 82.1 g, carbohydrate 82.4 g
   • Protein 0.3 g, fat 0 g, fibre 0.2 g
   • Potassium 52 mg, calcium 6 mg, iron 0.42 mg
   • Vitamin C 0.5 mg, riboflavin 0.038 mg, selenium 0.8 µg
   • Sodium 4 mg

   82.1 g of it is sugar. Table sugar is 100 g of sugar per 100 g, so honey is about 82% of the way there. The rest is mostly water.

   Honey's sugars are fructose and glucose. Table sugar (sucrose) is the two bonded together; in honey they are already separate. That is why honey tastes sweeter — fructose is sweeter than sucrose.

   Per tablespoon (21 g):

   	100 g	1 tbsp (21 g)
   Energy	304 kcal	64 kcal
   Sugar	82.1 g	17.2 g
   Potassium	52 mg	11 mg
   Iron	0.42 mg	0.09 mg

   One tablespoon is 17.2 g of sugar. The WHO recommends free sugars below 10% of total energy, and ideally below 5%. On 2,000 kcal that is 50 g and 25 g. A tablespoon of honey spends two-thirds of the 5% allowance.

   How far does "honey is better than sugar" hold?

   • It has minerals — it does. Per tablespoon, 11 mg of potassium and 0.09 mg of iron. Not meaningful amounts
   • It has a lower glycaemic index — honey's GI varies by type but generally sits similar to or slightly below sugar. Not a large difference
   • It has antioxidants — darker honeys carry more polyphenols. But no evidence was identified that this changes a health outcome in people

   The honest conclusion: honey is a slightly better sugar. Swapping sugar for honey is not a substitute for using less sugar.

   On heating. Boiling honey drives off the aroma and inactivates its enzymes. But there is no evidence those enzymes do anything in the body, so the reason to avoid heat is flavour, not health.

   Crystallisation is not spoilage. It is glucose separating out, and a jar stood in water at around 40°C will clear it. Avoid the microwave — it overheats in spots.

3. 03Not established

   Never give honey to an infant under 12 months — infant botulism

   This entry is about safety rather than benefit. It is the most important thing on this page.

   Honey must not be given to a child under 12 months of age — not a small amount, and not cooked into food.

   The reason is spores of Clostridium botulinum.

   Honey can carry spores of this bacterium. Spores are its dormant form and ordinary cooking does not kill them. In adults and older children, the established gut flora prevents them from germinating, so nothing happens.

   An infant under one year has not yet established that gut flora. The spores can germinate in the intestine and produce toxin, which is infant botulism.

   How it presents:

   • Constipation, usually the first sign
   • Weak feeding and a poor suck
   • A weaker cry
   • Loss of head control, floppiness
   • Drooping eyelids
   • In severe cases, paralysis of the muscles of breathing

   This is an emergency. If you see these signs, seek medical care immediately.

   Common questions:

   "Isn't it fine if it's cooked?" — No. Botulinum spores are heat-resistant and are not destroyed at domestic cooking temperatures.

   "Even a tiny amount?" — Yes. There is no established safe amount.

   "What about biscuits or cereal containing honey?" — Processed foods containing honey should also be avoided under one year. Check the label.

   "When is it safe?" — After 12 months. That is also where the Cochrane review's age range begins.

   And one more thing. If you are reaching for honey because of a cough, a cough in an infant under one year is itself a reason to see a doctor. Look for the paediatrician rather than for a substitute for honey.

How to eat it well

What to watch out for