By: Anna Esparham, MD, FAAP, DABMA, DABOIM
Trouble falling and staying asleep can be common among children and
teens. Not getting enough sleep often leads to some pretty difficult behaviors and health problems—crankiness, trouble paying attention, high blood pressure, weight problems and obesity, headaches, and depression. It's no wonder why many are searching for a solution.
What is melatonin?
Melatonin is a natural, 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.
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. However, this also means that it's use is not regulated by the Food and Drug Administration (FDA) or approved for that purpose.
Melatonin poisoning & supplement mislabeling
As more people turn to melatonin as a sleep aid, reports of poisonings in children 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 United States, it is important to know that some melatonin supplements also may contain serotonin, cannabidiol (CBD) or varying amounts of melatonin. In fact, one recent
study found that some had potentially dangerous amounts of melatonin—much more than was listed on the label.
To prevent poisoning in your home, store melatonin and all medicines, vitamins and dietary supplements in a safe place, away from children. Always read and follow the instructions on the label. 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.
Using melatonin supplements: what to know
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 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. 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 some neurodevelopmental disorders such as autism or attention-deficit hyperactivity disorder (ADHD). Its use in these circumstances should be carefully monitored a child's pediatrician.
If melatonin is going to be used, the American Academy of Pediatrics (AAP) encourages parents and pediatricians to make those decisions together―cautiously and carefully.
Melatonin supplement dosages for kids
Melatonin comes in a number of 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 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.
Good sleep habits are the best medicine.
Often, a child's shut-eye troubles can be solved with good bedtime routines. What the actual routines are can be specific to your child and their 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.
How 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 AAP 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.
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.
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.
About Dr. Esparham:
Anna Esparham, MD, FAAP, DABMA, DABOIM, a member of the American Academy of Pediatrics Section on Integrative medicine, is a triple-board certified physician in pediatrics, medical acupuncture and integrative medicine. She is currently an integrative pediatrician at Empowered Wellness. Dr. Esparham is also founder of Health Is PowHer, where she coaches women on how to help heal from chronic pain, headaches and autoimmune disorders. She is also getting training in Osteopathic Neuromusculoskeletal Medicine at AT Still University in Kirksville, MO.