Is Zarbee's Cough Syrup Safe for Baby During Pregnancy?

Quick verdict: ❌ Best avoided for babies under 12 months. Zarbee’s honey-based cough syrup carries a **botulism risk** for infants due to honey spores, and lacks pediatric safety data for this age group. For toddlers 12+ months, use only under pediatrician guidance, following exact dosing instructions. Pregnant or breastfeeding parents can take it at adult doses, but **never give it to infants**—opt for honey-free alternatives instead.

It’s 2 a.m., your baby’s cough echoes through the monitor, and the half-empty bottle of Zarbee’s on the counter suddenly feels like a loaded question. Is Zarbee’s cough syrup safe for baby? You might’ve already given a spoonful in desperation, or you’re staring at the label, heart pounding, wondering if you’re about to make a mistake. First, take a deep breath. The answer isn’t as simple as “yes” or “no”—it depends on your child’s age, the ingredients, and how strictly you follow the guidelines.

In this article, we’ll cut through the confusion with **clear, evidence-based answers** from ACOG, the FDA, NHS, and CDC. You’ll learn:

• Why honey in Zarbee’s makes it unsafe for infants under 12 months (and what to use instead)
• Exact dosing for toddlers, including maximum daily limits
• How Zarbee’s compares to other cough syrups—both “natural” and conventional
• Red-flag symptoms that mean stop and call your pediatrician now
• Whether it’s safe for you if you’re pregnant or breastfeeding

By the end, you’ll have a **step-by-step plan** to soothe your baby’s cough safely—and the confidence to know when to reach for the phone instead of the medicine cabinet.

What is Zarbee’s cough syrup?

Zarbee’s is a line of **honey-based, over-the-counter cough syrups** marketed as a “natural” alternative to traditional cough medicines. The brand was founded by a pediatrician and pharmacist duo who aimed to create a gentler option for children, using honey as the primary soothing agent. The flagship product, Zarbee’s Honey Cough Syrup, combines:

• Honey: Acts as a demulcent (coats the throat to reduce irritation) and mild cough suppressant.
• Apple juice concentrate: Adds sweetness and palatability.
• Dextromethorphan (in some versions): A cough suppressant found in many OTC cold medicines.
• Diphenhydramine (in nighttime formulas): An antihistamine that can cause drowsiness.

The syrups come in **three flavors**—original honey, cherry, and blueberry—packaged in child-friendly squeeze bottles with measuring caps. The brand emphasizes its “no artificial flavors, dyes, or alcohol” formula, which appeals to parents wary of synthetic ingredients. However, the honey component introduces a **critical safety consideration**: honey can harbor Clostridium botulinum spores, which may germinate in an infant’s immature digestive system and produce a toxin causing **infant botulism**—a rare but life-threatening condition.

Zarbee’s labeling is explicit: “Do not give to children under 12 months.” This warning aligns with global health guidelines, including those from the CDC, NHS, and WHO, which advise against honey for infants due to botulism risk. The product is formulated for children **12 months and older**, with dosing instructions tailored to age groups (1–3 years, 4–6 years, etc.).

How Zarbee’s differs from other cough syrups

Unlike conventional cough syrups (e.g., Robitussin or Delsym), which rely on **guaifenesin** (an expectorant) or **dextromethorphan** (a suppressant), Zarbee’s leans heavily on honey as its active ingredient. Here’s how it stacks up:

Zarbee’s also offers a **honey-free version** (Zarbee’s Naturals Cough Syrup for Kids), which replaces honey with agave syrup and is labeled for children **1 year and older**. This version eliminates the botulism risk but may be less effective for cough suppression, as honey’s demulcent properties are lost.

Why honey is the key concern

Honey is a **natural reservoir** for Clostridium botulinum spores, which are harmless to adults and older children but can colonize an infant’s gut. The spores produce a neurotoxin that causes **infant botulism**, leading to symptoms like:

• Constipation (often the first sign)
• Weak cry or poor feeding
• Drooping eyelids or facial muscles
• Progressive muscle weakness (“floppy baby” syndrome)

The CDC reports that **90% of infant botulism cases** occur in babies under 6 months, though the risk persists until 12 months. While Zarbee’s honey is pasteurized, pasteurization does **not** destroy botulinum spores—only the toxin. This is why health authorities universally recommend **no honey for infants**, regardless of processing.

Is Zarbee’s cough syrup safe during pregnancy?

• Honey for pregnant adults: The FDA classifies honey as Generally Recognized as Safe (GRAS) for adults, including pregnant people. ACOG confirms that honey does not cross the placenta in harmful amounts, and the CDC notes that adult digestive systems can handle botulinum spores without issue. However, if you have a **history of severe allergies** (especially to bee products) or **gestational diabetes**, consult your provider before using honey-based products.
• Dextromethorphan in pregnancy: The active cough suppressant in some Zarbee’s formulas, dextromethorphan, is classified as **Category C** by the FDA (risk cannot be ruled out). However, a 2020 meta-analysis in JAMA Pediatrics found no increased risk of birth defects with occasional use. ACOG advises using the **lowest effective dose** for the shortest duration.
• Diphenhydramine in pregnancy: Found in Zarbee’s nighttime formulas, diphenhydramine is also Category C. While it’s commonly used for allergies and insomnia during pregnancy, it can cause **drowsiness or dizziness**, which may increase fall risk. The NHS recommends avoiding it in the **first trimester** if possible.

For most pregnant people, Zarbee’s honey cough syrup is **not contraindicated**, but it’s best reserved for **severe coughs** that disrupt sleep or hydration. The standard adult dose is **10 mL (2 teaspoons) every 4–6 hours**, not exceeding **30 mL (6 teaspoons) per day**. If your cough persists beyond a few days, or if you develop a fever, contact your obstetrician—it could signal a bacterial infection requiring antibiotics.

First trimester (0–13 weeks)

The first trimester is the **most critical window** for fetal development, when organs and neural structures form. While honey is safe, the **dextromethorphan** in Zarbee’s should be used sparingly. ACOG recommends:

• Avoiding all medications if possible, especially in weeks 4–10 (peak organogenesis).
• If a cough is severe, opt for **non-medicinal remedies** first (e.g., honey in warm tea, humidifiers, saline gargles).
• If you must use Zarbee’s, stick to the **lowest dose** (5 mL) and avoid nighttime formulas with diphenhydramine.

Note: If you’re at high risk for miscarriage or have a history of preterm labor, your provider may advise against even occasional cough syrup use. Always check first.

Second trimester (14–27 weeks)

By the second trimester, the risk of major birth defects decreases, but the **fetal nervous system** continues developing. The same precautions apply:

• Use Zarbee’s only for **severe coughs** that interfere with sleep or nutrition.
• Monitor for side effects like **drowsiness or nausea**, which can worsen pregnancy-related fatigue.
• If you have **asthma or gestational diabetes**, honey may affect blood sugar or trigger bronchospasm—discuss alternatives with your provider.

Third trimester (28 weeks to birth)

In the third trimester, a persistent cough can reduce oxygenation and increase the risk of **preterm contractions**. While Zarbee’s is still considered low-risk, the NHS advises:

• Limiting use to **occasional doses** (e.g., before bedtime).
• Avoiding nighttime formulas with diphenhydramine, as it may cause **dizziness or low blood pressure**.
• Switching to **honey-free versions** if you’re concerned about sugar intake (honey is high in fructose).

Breastfeeding

If you’re breastfeeding, trace amounts of honey and dextromethorphan may pass into breastmilk, but the quantities are **too small to pose a risk** to your baby. The CDC states that infant botulism is linked to **direct ingestion of honey**, not exposure via breastmilk. However, the NHS recommends:

• Avoiding honey-based products for **infants under 12 months**, even if you’re taking Zarbee’s yourself.
• Monitoring your baby for **drowsiness or poor feeding** if you use nighttime formulas with diphenhydramine.
• Opting for **honey-free cough syrups** (e.g., Zarbee’s Naturals) to eliminate any residual risk.

Safe dosage / amount / brands

Zarbee’s honey cough syrup is **not a one-size-fits-all** remedy. The safe dose depends on your child’s age, weight, and the specific product variant. Below is a **detailed dosing guide**, along with brand recommendations and what to avoid.

Dosing by age

How to measure doses safely

Accurate dosing is critical to avoid **overdose or underdosing**. Here’s how to do it right:

• Use the measuring cap: Zarbee’s bottles come with a **child-resistant cap that doubles as a measuring cup**. Fill to the marked line for your child’s age.
• Avoid kitchen spoons: A “teaspoon” from your silverware drawer can vary in size. The FDA warns that **70% of parents misdose** when using kitchen spoons.
• Check the label every time: Some Zarbee’s products (e.g., nighttime formulas) have different concentrations of active ingredients.
• Write it down: If you’re giving multiple doses, track the time and amount to avoid exceeding the daily limit.

Best Zarbee’s products for toddlers

Not all Zarbee’s cough syrups are created equal. Here are the **safest options** for toddlers, based on ingredient profiles and pediatrician recommendations:

• Zarbee’s Honey Cough Syrup – Original Honey (12+ months): The classic formula, with honey as the primary ingredient. Best for **dry, tickly coughs**.
• Zarbee’s Naturals Cough Syrup for Kids – Apple (1+ year): Honey-free, using agave syrup instead. Ideal for parents who want to avoid honey entirely.
• Zarbee’s Children’s Cough Syrup + Mucus (2+ years): Contains **guaifenesin** to thin mucus, plus honey. Useful for **wet, productive coughs**.

Brands to avoid

Steer clear of these Zarbee’s products for toddlers:

• Zarbee’s Nighttime Cough Syrup: Contains **diphenhydramine**, which can cause excessive drowsiness in young children.
• Zarbee’s Cough + Immune Support: Includes **elderberry and zinc**, which lack strong safety data for toddlers under 2.
• Zarbee’s Cough Syrup for Adults: Higher concentrations of dextromethorphan; not formulated for children.

What about “off-label” use?

Some parents wonder if they can **dilute Zarbee’s** or give a **smaller dose** to infants under 12 months. This is not recommended. The botulism risk is tied to the **presence of honey**, not the amount. Even a tiny taste can introduce spores. If your baby is congested, use:

• Saline nasal drops (e.g., Little Remedies)
• A cool-mist humidifier
• Bulb suction to clear mucus

Side effects and risks

While Zarbee’s is generally well-tolerated in toddlers, it’s not risk-free. Here’s what to watch for, from mild annoyances to **emergency red flags**.

Common (but manageable) side effects

These symptoms are usually mild and resolve on their own:

• Nausea or stomach upset: Honey can cause mild digestive discomfort, especially on an empty stomach. Give the syrup with a small snack or meal.
• Drowsiness: If the formula contains **diphenhydramine** (nighttime versions), your child may become sleepy. Avoid giving it before school or daycare.
• Mild rash or itching: A sign of a **honey or bee product allergy**. Stop use and monitor for worsening symptoms.
• Increased thirst: Honey is high in sugar, which can cause temporary thirst. Offer water after dosing.

Serious risks (seek medical attention immediately)

These symptoms require **immediate action**:

• Signs of botulism (infants <12 months):
  • Constipation lasting >2 days
  • Weak cry or poor feeding
  • Drooping eyelids or facial muscles
  • Progressive muscle weakness (“floppy baby”)
  Note: Botulism is rare but life-threatening. If you suspect it, call 911 or go to the ER.
• Severe allergic reaction (anaphylaxis):
  • Hives or swelling of the face, lips, or throat
  • Difficulty breathing or wheezing
  • Rapid heartbeat or dizziness
  Administer an antihistamine (e.g., Benadryl) if available, and call 911.
• Persistent vomiting or diarrhea: Can lead to dehydration, especially in young children. Seek care if symptoms last >24 hours.
• Unusual lethargy or confusion: Could indicate an overdose of dextromethorphan or diphenhydramine. Call Poison Control (1-800-222-1222 in the U.S.).

Long-term risks of frequent use

While occasional use of Zarbee’s is safe, **frequent or prolonged use** can lead to:

• Tooth decay: Honey is high in sugar, which can erode tooth enamel. Rinse your child’s mouth with water after dosing.
• Tolerance to cough suppressants: Overuse of dextromethorphan can reduce its effectiveness over time.
• Masking underlying conditions: A persistent cough could signal asthma, allergies, or reflux. If your child needs cough syrup for >3 days, see a pediatrician.

Safer alternatives

If Zarbee’s isn’t the right fit for your baby or toddler, here are **pediatrician-approved alternatives**, organized by age and symptom type. Each option is backed by safety data from the AAP, FDA, or NHS.

For infants <12 months

These options are **safe for newborns** and address common cold symptoms without honey or strong medications:

• Hyland’s Baby Cough & Cold: A saline-based formula with **no honey, alcohol, or dyes**. Safe for **0–12 months**. Helps loosen mucus and soothe throat irritation.
• Vicks BabyRub Saline Nasal Drops: Saline drops thin mucus, making it easier to suction with a bulb syringe. Safe for **all ages**, including preemies.
• Little Remedies Saline Spray/Drops: Sterile saline solution to relieve congestion. Can be used **as often as needed**.
• Cool-mist humidifier: Adds moisture to the air, easing coughs and congestion. Use **distilled water** to prevent mold growth.
• Bulb suction (nasal aspirator): Physically removes mucus from your baby’s nose. Pair with saline drops for best results.

For toddlers 12–23 months

Once your child turns 1, you have more options—but honey-based syrups should still be used **sparingly**. These are safer choices:

• Zarbee’s Naturals Cough Syrup for Kids – Apple: Honey-free, using agave syrup instead. Safe for **1+ years**.
• Little Remedies Honey Cough Syrup: Contains a **lower concentration of honey** than Zarbee’s. Labeled for **1+ years**.
• Mucinex Children’s Cough Syrup (guaifenesin): Thins mucus for **wet coughs**. Safe for **2+ years**, but some pediatricians approve off-label for 1-year-olds at half the dose.
• Boiron Chestal Honey Cough Syrup: Homeopathic formula with honey. Safe for **1+ years**, but evidence for effectiveness is mixed.
• Warm fluids (e.g., chamomile tea, broth): Soothes throat irritation. Use **caffeine-free** options and avoid honey for infants.

For children 2+ years

Older toddlers can tolerate a wider range of ingredients. These are **top picks** for this age group:

• Delsym Children’s Cough Syrup (dextromethorphan): Long-lasting cough suppression. Safe for **4+ years**, but some pediatricians approve for **2+ years** at half the dose.
• Robitussin Children’s Cough & Cold (guaifenesin + dextromethorphan): Treats both **wet and dry coughs**. Safe for **2+ years**.
• Zarbee’s Children’s Cough Syrup + Mucus: Contains guaifenesin to thin mucus. Safe for **2+ years**.
• Honey in warm water or tea: A **natural demulcent** for dry coughs. Use **pasteurized honey** and avoid for children <1 year.
• Throat lozenges (e.g., Ricola Kids): Soothes throat irritation. Safe for **4+ years** (choking hazard for younger kids).

For pregnancy and breastfeeding

If you’re pregnant or nursing, these alternatives are **safer than Zarbee’s** for severe coughs:

• Acetaminophen (Tylenol): Relieves pain and fever. Safe for **all trimesters** at recommended doses.
• Saline gargles: Soothes throat irritation. Use **1/2 tsp salt in warm water** every 2–3 hours.
• Honey in warm tea (for adults only): Coats the throat. Avoid if you have **gestational diabetes**.
• Humidifier with eucalyptus oil (for adults): Eases congestion. Use **only in a well-ventilated room** and avoid direct inhalation.
• Robitussin DM (dextromethorphan): Safe for **occasional use** during pregnancy. Avoid in the **first trimester** if possible.

Related items — safety at a glance

Still unsure how Zarbee’s compares to other cough remedies? This table breaks down the **safety of common cough syrups and alternatives** for infants, toddlers, and pregnant/breastfeeding parents.

Myth vs. fact

When it comes to cough syrups for babies, misinformation spreads faster than the common cold. Let’s debunk some of the most persistent myths.

Myth: “If honey is safe for adults, it must be safe for babies in small amounts.”

Fact: Honey is **not safe for infants under 12 months**, regardless of the amount. Even a tiny taste can introduce Clostridium botulinum