There is a determined honey lobby out there touting the health benefits of honey. That’s fine with me, as I am not an enemy of honey. On the other hand, honey, while “natural,” is not a completely harmless foodstuff, especially for infants. You wouldn’t know it reading the spate of news articles on a Penn State study touting the benefits of honey over cough medicine for kids:
The study found that a small dose of buckwheat honey given before bedtime provided better relief of nighttime cough and sleep difficulty in children than no treatment or dextromethorphan (DM), a cough suppressant found in many over-the-counter cold medications.
Honey did a better job reducing the severity, frequency and bothersome nature of nighttime cough from upper respiratory infection than DM or no treatment. Honey also showed a positive effect on the sleep quality of both the coughing child and the child’s parents. DM was not significantly better at alleviating symptoms than no treatment. (Medical News Today)
The study in question was a randomized trial involving 105 2 to 18 year olds seen for conditions that caused cough (presumably upper respiratory infections). The first night parents provided baseline information on how both they and their child slept. The next night they were randomized into groups that received honey, honey flavored DM or nothing. Outcome questions were the same as for the baseline (first) night. The honey and fake honey DM groups didn’t know the treatment, while those that received nothing obviously did. The press reports were that there was uniformly better sleep for both children and parents in the honey group.
Fine. But buried in the press reports (I haven’t seen the original paper) was a single sentence that usually stated that honey is safe for children over 12 months old. What it really should have said, however, is that honey may not be safe for children younger than 12 months. For a long time pediatricians have been warning parents that honey may be a source of infant botulism. Most botulism is caused by ingestion of botulinum toxin, an extremely potent poison that paralyzes muscles, including the muscles that are used to breathe. The toxin is produced by the botulism organism (Clostridium botulinum), which forms hardy spores when the environment is unfavorable but when it finds itself in airless environments with the right temperature and other features it needs for growth (say in an improperly canned food) it reverts to a vegetative form and produces toxin. Thus most botulism is caused by ingestion of the toxin [corrected]. Ingesting the organism either in spore form or vegetative form is not a risk.
Unless you are an infant. Infant botulism was first described in the 1970s. Its cause appeared to be ingestion of botulism spores which then were able to make toxin in the infant’s digestive tract. Apparently this can happen in infants but not older children or adults. The typical symptoms were babies that became constipated, had floppy arms, legs and neck, a weak cry and poor sucking and seemed lethargic. Where did the botulism spores come from? A series of epidemiologic studies (concise review here) identified honey as a major (although not the only) risk factor. The case fatality rate for infant botulism isn’t as high as the adult variety (less than 5%) but this is still a serious disease.
A recent FDA directive that cold and cough medicines not be given to children under 6 years of age will likely prompt many parents to use “natural” remedies and the publicity that honey is effective in reducing cough is likely to send many in that direction. It is unfortunate that study authors didn’t do more in their press releases and interviews to alert parents of infants that adding honey to their child’s diet if they are under a year old is not considered safe.
Many scientists worry (unduly in my view) they might “get burned” talking to reporters. I worry more the public will get burned when scientists who are too enthusiastic or too eager to promote their work talk to the press. Usually nothing bad happens, but this one has me a bit worried.