By: Anna Esparham, MD, FAAP, DABMA, DABOIM
Trouble falling and staying asleep affects 15% to 25% of children and adolescents. Not getting enough sleep can lead to some pretty difficult behaviors and health problems—crankiness, trouble paying attention, high blood pressure, weight problems and obesity, headaches and depression. Not surprisingly, many parents are searching for solutions to their child's sleep troubles, and some are considering dietary supplements like melatonin. Here's what you should know about these products.
What is melatonin?
Melatonin is sold as a sleep aid. It can be found over the counter as a dietary supplement, which means you can buy it at the pharmacy or a health food store, without a prescription. Its use is
not regulated by the Food and Drug Administration (FDA) or approved for that purpose.
Melatonin is a hormone-like substance produced by an area in the brain called the pineal gland. It is released naturally at night and tells the body it's time to sleep.
While melatonin plays a role in sleep, it is NOT a sleeping pill. It should only be used after a discussion with your pediatrician and pre-established healthy sleep habits that do not include medication.
Melatonin poisoning reports in children
As more families have turned to melatonin as a sleep aid,
reports of poisonings in kids have rapidly increased. From 2012-2021, there were more than 260,000 child poisoning reports involving melatonin. In most cases, there were no symptoms and the children recovered. But some children needed hospital care and two children died. Because supplements are not regulated as medications in the U.S., some melatonin supplements also may contain serotonin or varying amounts of melatonin. The chewable tablet form that children often use have been found to have the most widely varying amounts of melatonin, sleep medicine experts said in a health advisory.
To prevent poisoning, store melatonin and all medicines, vitamins and dietary supplements in a safe place, away from children. For information about poison risks, visit the
Poison Control website or call 1-800-222-1222. If your child has collapsed, is having a seizure, trouble breathing or can't be awakened, call 911.
Good sleep habits are the best medicine.
Often, a child's sleep issues can be solved with
good bedtime routines. What the actual routines are can be specific to your child and his or her age, but they should occur each night around the same time. This will help your child understand that it's time to settle down and get
ready to sleep.
The key to successful sleep routines is consistency. When starting a new sleep routine, it may take a while to get established. But don't give up! Routines are great for kids and well worth the time it takes to get them going.
Does blue light affect sleep?
Blue lights (as from tablets, e-readers, or smartphones) have a short wavelength that affects levels of melatonin more than any other wavelength does. The blue light fools the brain into thinking that it is daytime―making us feel more alert when we should be feeling sleepy since we're lying in bed. Over time, this wreaks havoc on our body's natural production of melatonin. The American Academy of Pediatrics recommends avoiding exposure to screens for at least 1 hour before going to bed. Using devices past bedtime, especially for violent video games or shows, can also interfere with sleep.
If no matter how hard you try, you are unable to establish a good bedtime routine for your child, talk with your pediatrician to see if there are any other issues that might be causing your child's sleep difficulties.
What parents should know about melatonin
Melatonin may be a
short-term way to help some kids get rest while you keep trying to establish good bedtime routines. It may also help some older children and teens reset sleep schedules―such as after vacations, summer breaks, or other interruptions. Most teens, after all, require more sleep―not less. Getting enough sleep each night can be hard for teens whose natural sleep cycles make it difficult for them to fall asleep before 11 p.m.―and who face a first-period class at 7:30 a.m. or earlier the next day; this is where melatonin may help.
Melatonin may also help children with neurodevelopmental disorders such as
attention-deficit hyperactivity disorder (ADHD). It's use in these circumstances should be carefully monitored a child's pediatrician.
If you're considering melatonin for your child, decide with your pediatrician―cautiously and carefully.
Melatonin comes in several forms―liquids, gummies, chewable, capsules and tablets―all with varying dosages. And since there are no specific guidelines on melatonin dosing for children, it can be confusing.
The quality may not be the same for all melatonin products. It is not possible to tell how much melatonin you are getting. Also, there may be other ingredients in the products that can interact with other medicines or supplements you are taking. Look for supplements with "USP Verified" on the label. This mark indicates that the product contains the ingredients that are listed on the label, in that potency and amount.
The melatonin dosage and timing depend on why and how you plan to use it.
Start with the lowest dosage. Many children will respond to a low dose (0.5 mg or 1 mg) when taken 30 to 90 minutes before bedtime. Most children who do benefit from melatonin―even those with ADHD―don't need more than 3 to 6 mg of melatonin.
Always talk with your pediatrician about the proper dose and timing of melatonin. And remember, melatonin should not be a substitute for a good bedtime routine.
We need more research on the use and safety of melatonin in children.
While studies have shown that short-term use is relatively safe, less is known about longer uses of melatonin. For example, there are concerns about how it might affect a child's growth and development, particularly during puberty. Studies have also found that morning sleepiness, drowsiness, and possible increased
urination at night are the most common side effects that occur while taking melatonin. Further, melatonin may
interact with other medicines a child takes.
About Dr. Esparham:
Anna Esparham, MD, FAAP, DABMA, DABOIM, is a triple-board certified physician in pediatrics, medical acupuncture, and integrative medicine. She is the founder of the Health Is PowHer Podcast and a headache pain specialist at a pediatric academic medical center. Within the American Academy of Pediatrics, she is an executive committee member on the Section of Integrative Medicine (SOIM).