title: Parents' and primary healthcare practitioners' perspectives on the safety of honey and other traditional paediatric healthcare approaches.
abstract: BACKGROUND
  Traditional and complementary healthcare approaches (TCA) are widely used for children, often because of perceived safety. Honey is a traditional remedy for upper respiratory tract symptoms in infants. Health officials currently advise limiting honey use because of the risk of botulism.
  
  
  OBJECTIVE
  This paper discusses honey as a traditional healthcare approach for children in a multi-ethnic community, and parents' and primary healthcare practitioners' (PHPs) perceptions of its safety.
  
  
  METHODS
  As part of a larger study exploring beliefs about TCA, this paper focuses on perceived safety and use of honey, using data extracted for detailed analysis. Eleven parent focus groups (n= 92) and 30 interviews with PHPs were conducted. Qualitative data analysis used the Framework approach.
  
  
  METHODS
  London Boroughs of Brent and Harrow
  
  
  RESULTS
  TCA, particularly home remedies, dietary and religious approaches were popular for children. Honey was a particularly common TCA, reportedly used by 27 (29%) parents for their children. Honey was believed to be traditional, acceptable, accessible, natural and safe. It was most commonly used for respiratory tract symptoms and administered with hot water and lemon juice. PHPs were more concerned about the safety of TCA than parents. Almost half (40%) of PHPs mentioned the use of honey for children, few perceived it as a 'treatment' or were concerned about botulism. Others were aware of the risks and some reported challenges in communicating risk to parents.
  
  
  CONCLUSIONS
  TCA are commonly used for children, honey in particular for respiratory tract symptoms. Parents and some PHPs appear unaware of the risk of botulism from honey use in infants. Healthcare practitioners should ask routinely about the use of honey and other TCA, and consider different parental belief systems in ethnically diverse populations. Further research is required on the use and efficacy of honey for infants, to raise awareness of its benefits and risks.
authors.affiliation: River Island Paediatric and Child Health Academic Centre, Imperial College Northwick Park Hospital Campus, Harrow, UK.
authors.forename: Raekha
authors.initials: R
authors.lastname: Kumar
authors.forename: Ava
authors.initials: A
authors.lastname: Lorenc
authors.forename: Nicola
authors.initials: N
authors.lastname: Robinson
authors.forename: Mitch
authors.initials: M
authors.lastname: Blair
mesh_terms: D056705:Apitherapy / Q000009:adverse effects*; D001294:Attitude to Health; D001906:Botulism / Q000209:etiology*; D003257:Consumer Product Safety; D005260:Female; D017144:Focus Groups; D006306:Health Surveys; D006801:Humans; D008297:Male; D008519:Medicine, Traditional / Q000009:adverse effects*; D010290:Parents / Q000523:psychology*; D010372:Pediatrics; D010821:Physicians, Family / Q000523:psychology*; D011320:Primary Health Care; D036301:Qualitative Research; D012141:Respiratory Tract Infections / Q000188:drug therapy