Perceived risks and benefits of the use of honey for infants

Question

Traditional and complementary healthcare approaches (TCA) are widely used for children. Honey is one such TCA used for upper respiratory tract symptoms. A recent Cochrane review suggests honey has potential benefit for acute cough in children [1]. However, health officials advise limiting the use of honey due to the risk of contamination with Clostridium botulinum. As part of a larger study about TCA for children, parents’ and health professionals’ beliefs about the benefits and risks of honey were explored.

Methods

The study was conducted in a multi-ethnic community (London Boroughs of Brent and Harrow). Eleven parent focus groups (n=92) and individual interviews with healthcare practitioners (n=30) explored beliefs about TCA. Qualitative data was analysed using the Framework approach and validated with inter-rater coding. Data on the use of honey were extracted for detailed thematic analysis.

Results

Of the 92 parents interviewed, 27 (29%) reported use of honey for their children. Honey was believed to be culturally acceptable, easily accessible, natural and safe. Only 2 parents expressed concern over safety. Reported uses were for colds (11), coughs (10), sore throats (2), flu (2), fever (2) and loose motions (1). Modes of use included honey combined with lemon juice in hot water (19), or with ginger, lime, pepper, beetroot or hot milk, for its perceived healing properties and sometimes to improve taste.

Almost half (40%) of practitioners mentioned the use of honey for children, but many believed that it ‘may not even be classed as healthcare’. One midwife and one GP cited honey and lemon as safe for infants. Only health visitors (9) stated the risk of infant botulism, 2 described a conflict with parents’ traditional beliefs. Some reported challenges in communicating risk to parents.

Conclusion

Honey is frequently used as a treatment for respiratory tract symptoms, Parents and some health practitioners are unaware of/choose to ignore safety advice. Healthcare professionals need to be attentive to the use of honey, and other TCA, according to belief systems. They must appreciate parental perception of risk and benefit and continue to raise awareness of contamination danger. Further research on the efficacy of honey for acute cough is needed as honey has potential as an inexpensive alternative to pharmacological intervention.

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