Parent Alert: How Safe is Melatonin for Kids?

children sleeping

If you’re like most parents, sleep feels like a relic of the past, and your kids, well, they aren’t exactly concerned with whether you get your z’s. From newborns to toddlers to teens, children can go through a variety of phases and problems that keep them—and their moms and dads—from sleeping. Many parents who’ve said they’ve tried everything to help their children drift off have turned to melatonin for kids, proclaiming this naturally derived hormone a miracle.

It’s easy to find and you can buy it over the counter, too. In fact, in the last decade, melatonin sales have skyrocketed, increasing from $90 million in 2007 to $260 million in 2012.

But is this over-the-counter sleep remedy really safe for kids? Before we begin to answer that question, let’s take a quick look at what melatonin is and how it works to help promote sleep:

What is Melatonin?

brainMelatonin is a hormone naturally produced by our brains to help us regulate sleep and wake cycles. Melatonin levels typically start to increase in the late evening (e.g., around 8 p.m. for kids and 10 p.m. for teenagers), stay high for most of the night and finally drop in the early morning around a couple of hours before waking. Light disrupts melatonin and slows down the amount of melatonin produced by your body. This includes light emitted from screens (e.g., smartphones, tablets, computers, TVs). Making sure your kids are outside during the day helps their brains distinguish day vs. night, which is critical for anybody having issues with sleep. Plus, kids who have had plenty of exercise tend to sleep better.

How Does Melatonin Work?

woman sleeping on couchAgain, the main job of melatonin in the body is to regulate our sleep-wake cycles. Darkness causes the body to produce more melatonin, signaling us to get ready for sleep. Light decreases melatonin, signaling us to be awake. Some people who have sleep problems have low levels of melatonin, and therefore, melatonin supplements are prescribed or used to help them sleep.

Who is Melatonin Commonly Used For?

girl with insomniaMelatonin may be used or prescribed for a variety of reasons. Some of these include:

  • Insomnia (inability to fall asleep)
  • Delayed sleep phase syndrome (DSPS)
  • Insomnia linked with ADHD (attention deficit-hyperactivity disorder)
  • Insomnia related to certain high blood pressure medications (beta-blockers)
  • Sleep problems in children with developmental disorders such as autism, cerebral palsy and intellectual disabilities
  • For those who have discontinued benzodiazepine drugs or who have quit smoking (to reduce side effects)

Melatonin for Kids: Safety Concerns

tired childUnlike several other medications that help people fall asleep, you cannot overdose on melatonin. That’s the good news. Parents, however, should keep in mind that melatonin is not regulated by the U.S. Food and Drug Administration (FDA). (Melatonin is only available with a prescription in the European Union and Australia). It’s also a hormone and that means it affects the entire body. Last but not least, we don’t know what the long-term effects of melatonin use are in children, because it hasn’t been widely studied.

Lack of research on this supplement’s long-term effects, combined with limited federal oversight, should give all parents reason to be cautious when considering melatonin for their child(ren). As with any other over-the-counter remedy or supplement (including vitamins), it’s best to talk to your child’s pediatrician before using it.

Side Effects of Melatonin

sleeping childRecently, sleep researchers at the University of Adelaide in Australia recommended that parents and doctors not use melatonin for kids with sleep problems. In an article published in the Journal of Paediatrics and Child Health, author and professor David Kennaway cautioned that the use of melatonin in kids may result in serious side effects when the children are older.

While Kennaway is correct that melatonin doesn’t come without side effects, another physician, Dr. Craig Canapari, director of the Yale Pediatric Sleep Center, doesn’t entirely condemn the supplement for children. He does use it in his practice, and notes that melatonin can be safe and effective for kids in certain situations. According to his blog, his areas of concern include:

“Side effects (known): In the short-term, melatonin seems to be quite safe. Unlike many other sleep inducing agents, no serious safety concerns have been raised. The most common side effects include morning drowsiness, bedwetting, headache, dizziness, nausea and diarrhea. These effects are generally mild, and in my practice only the morning drowsiness seems to be significant. It can also interact with other medications (oral contraceptives, fluvoxamine, carbemazepine, omeprazole, and esomeprazole, to name a few).

Side effects (theoretical): Melatonin given to children may lead to persistently elevated blood melatonin levels throughout the day. This can be associated with persistent sleepiness, but the other effects are unclear. It is important to know that melatonin has NOT been tested as closely as a pharmaceutical, as the FDA regulates it as a food supplement. The studies following children who have been using melatonin long-term have relied mostly on parental reports as opposed to biochemical testing. A physician in Australia named David Kennaway [see above link] has published two editorials this year pointing out the inadequacy of information on long-term use in children.

Problems with preparations: Melatonin preparations have been shown to have variable concentrations from preparation to preparation. Moreover, the amount that a child’s body absorbs may vary.”

Melatonin for Kids: Dosage Recommendations

children in bed

Photo credit: donnierayjones via Foter.com / CC BY

Because melatonin is not approved or regulated by the FDA, dosage recommendations aren’t clear, and labeling can be confusing and sometimes even misleading. As a general rule, you should always try to use the lowest dose possible. In the case of melatonin for your children, begin with 0.5mg or 1mg (milligram/s). If that doesn’t seem to be helping, you may want to consider increasing the dose by 0.5mg every few days if your child isn’t falling asleep within an hour of bedtime. While increasing the dose, be sure you’re also setting consistent bedtimes and helping your child practice good sleep habits (see “Practicing Good Sleep Hygiene With Kids” below to learn more).

Many children will respond well to a dose of 0.5mg or 1mg given one or two hours before bedtime, while others (including teens with severe challenges falling asleep) may require significantly higher doses. Again, you should discuss the timing and administration of melatonin with your child’s doctor.

Melatonin and ADHD

ADHD brainAttention deficit hyperactivity disorder (ADHD) has been linked with sleep problems. In fact, as many as 70 percent of kids with ADHD may have issues with sleep, including difficulty falling asleep, abnormalities in sleep architecture (interruptions within the different stages of sleep) and daytime sleepiness. Clinical trials of melatonin (dosages ranged from 3mg to 6mg) revealed the supplement did help kids with ADHD fall asleep faster. However, there was no evidence of improvement of attention problems during the day. Side effects reported included night waking and daytime sleepiness in some children.

Melatonin and Autism

autistic childAs with ADHD, children who have autism often have trouble with sleep. A wide variety of problems can happen, including prolonged time to fall asleep, less sleep during the night, and problems with night and early morning awakenings. Some kids with autism have lower levels of melatonin, along with decreased variation in melatonin production throughout the day. This is why melatonin has been used with autistic children, which has shown to cause less difficulty falling asleep and more sleep during the night. While some studies used immediate release preparations, others used long-acting forms of melatonin. Most studies gave out melatonin 30 to 60 minutes before bedtime.

In addition to sleep benefits, these studies revealed some demonstrated improvements in other areas associated with children with autism, such as communication, social withdrawal, stereotyped behaviors and anxiety. As with other children, melatonin for kids with autism should only be added to a sleep behavioral management plan.

If your child has autism, Autism Speaks offers free sleep tips and toolkits you can download.

Practicing Good Sleep Hygiene With Kids

kids watching TVIf your child is already on melatonin or you’ve tried it in the past, don’t hit the panic button. There is little concrete evidence available suggesting that using melatonin for kids will cause serious harm. With that said, if melatonin is something you’ve simply tested on your own, it is best to talk to your child’s doctor about whether you really need to use it. If you’ve been using it for a while and your child has been sleeping well, you might want to consider slowly reducing it, or using it as needed vs. nightly, to see if it’s still really necessary.

Simply put, melatonin is not a substitute for setting good sleep hygiene practices, which include:

Developing a ritual: A bedtime ritual (e.g., taking a bath, then getting into pajamas, followed by reading a story and bed) can be a powerful cue telling your child it’s time to sleep. Be sure your bedtime ritual is simple. Infants and young children should be put to bed when they appear tired but still awake. They shouldn’t fall asleep in their parents arms or in another room. Parents should avoid getting into bed with children in order to get them to sleep.

Being mindful of the environment: A cool, dark, quiet room is best. The bedroom should be slightly cooler (60 degrees to 67 degrees Fahrenheit) to promote sleep. Background noises, sleep partners, bedding, favorite toys and lighting can all affect a child’s ability to fall asleep.

Establishing consistent waking times: Bed times and wake times should be as consistent as possible, seven days a week. Remember, it’s easier to enforce a waking time than a bed time. “Sleeping in” could be a sign of sleep deprivation.

Managing screen time: No screen time one to two hours before bedtime (this includes smartphones, TVs, computers and tablets).

Skipping caffeine: Caffeine is a powerful stimulant and is an ingredient in many beverages (and foods).

Getting exercise: Working to ensure your child gets a good amount of exercise (60 minutes is ideal) every day will nurture quality sleep. If it’s possible for them to play outside, that’s even better.

Avoiding medication: Medications for sleep can become ineffective over time and can also affect daytime alertness. Some medications can also cause nightmares and other kinds of sleep disturbances. Good sleep is essential, but it is rare when a child needs meds on a long-term basis (including melatonin).

Discouraging excessive evening fluids: Allow your child to drink only to quench thirst.

Building a sleep-only zone: If your child is having routine trouble falling asleep or is frequently awake at night, remove most toys, games, TVs, computers and other distractions from the bedroom. Teens might need a designated space outside their bedroom to do homework.