Coughing is one of winter’s inevitable symptoms for all families. As viruses pass back and forth, the usual runny nose and cough can be very disruptive, especially if it’s keeping both you and your child awake all night. For cough relief, we all have our favorite cough syrups — but which ones actually work?

Unfortunately, if you strictly follow pediatric and family medicine academy recommendations, then there really is no over the counter cough syrup which is heartily endorsed! There is actually a growing consensus that not only do most syrups not help, but the side effects are often much worse than the benefit. For example, many syrups are combinations of a fever medicine such as Tylenol (acetaminophen). But oftentimes parents will combine these syrups with “fever pills” which may also be Tylenol, and thus a child could overdose. Thousands of children each year are in emergency rooms, sometimes with life-threatening symptoms, from overdoses of cough syrups. Overdosing was such a major issue in the USA that in 2008 the US FDA ordered all companies to stop offering any OTC syrups to any child under 2 years old, and with strict limitations for kids 2-6 years.

I know it’s a bit depressing, as you really have to try something for your child’s cough. But all the popular major ingredients — dextromethorphan, guaifenesin and others really have shown little or no benefit in the best studies. A few syrups in China may also have clenbuterol or ephedrine, which theroretically may help to clear the airway but actually don’t help and have major side effects at low doses. In America, my favorite for kids was Delsym, as it was a higher concentration of dextromethorphan and seemed to work well for some. Other people liked Benadryl syrup, but as with Delsym, this also isn’t available here in China.

The bright side to all this is that the most useful cough syrup may be in your home right now. It’s honey! Quite a few good studies have shown that a bit of honey for a child over one year old (not before, due to risk of botulism) does have some benefit for most people, with minimal side effects. It seems to be due mostly to the thick coating over the throat, but honey also has some anti-inflammatory properties. Some feel that manuka honey may be more effective than other honeys, but manuka is extremely expensive, and I don’t think the evidence justifies the cost. For children under 5 years, try half a teaspoon (2.5ml); one teaspoon (5ml) for kids 6-11 years; and 2 teaspoons (10ml) for kids over 12. Adding some lemon also helps with throat swelling and loosening up mucus. With bedtime doses, don’t forget to have your child brush their teeth afterwards.

My favorite Chinese medicine is a honey-based cough syrup called pi pa gao, 枇杷膏. I’ve found this very tasty, thick syrup to be more effective for people than Tylenol Cold, Robitussin, or others. Plus, the side effects are minimal. This syrup’s main ingredient is honey, along with many Chinese herbs including loquat fruit (pi pa), which TCM believes to help with cough.

Of course, a cough can mean many things — is it pneumonia, asthma, or a bacterial infection? If your child’s cough seems much worse than the usual viral illness, definitely check in with your doctor.

(This article was originally printed in Beijing Kids magazine, where I am a contributing editor. You can click here to read the rest of my BeijingKids “The Doc Is In” columns.)