04/02/2022
Melatonin use in children: Is it safe and effective? 😴 I know some of you are desperate to get your child's sleep schedule on track!
Sleep difficulties are very common, affecting up to 25% of children. 🌙 When your child struggles with sleep, the whole family suffers. It’s no wonder why families search out safe solutions. Fortunately, medications are often not necessary.
First, we need to address “sleep hygiene.” This part is really important, so please don’t skip over it! ‼️ Kids should have a solid nighttime routine before melatonin is even a consideration. Here are the rules to keep in mind:
1. Once your child enters grade school, avoid napping throughout the day
2. Eat dinner roughly 2 hours before bedtime
3. Eliminate screen time (TV, video games, tablets, phones) at least 1 hour before bedtime
4. Maintain regular bedtime hours, ideally between 7:00-8:00 PM ⏰
5. Have a set nighttime routine to signal the body that it’s time for bed (bath, brush teeth, read book, sing a lullaby, etc.)
6. Provide your child with their own bed to sleep in
7. Sleep environment should be dark, quiet, and not too hot
8. Avoid caffeine throughout the day (soda, coffee, tea), especially in the afternoons ☕️
I can’t emphasize screen time ( #3) enough. 📱 Tablets, iPads, and phones emit blue light waves that alter your body’s natural melatonin production and prevent you from falling asleep. Make sure to cut off all screen time at least 1 hour prior to bed time.
If your child constantly tosses, turns, kicks, or snores loudly throughout the entire night, it may be a sign of an underlying sleep disorder such as sleep apnea or restless leg syndrome. Bring this to your doctor’s attention. 👩⚕️ Sometimes a sleep study is necessary.
If all of these things have been addressed and your child is STILL having a hard time falling asleep, melatonin may be an option. In the body, melatonin is a natural hormone that regulates the sleep-wake cycle. Melatonin supplements are purchased over-the-counter in the United States, often with the goal of falling asleep more easily at night.
Short-term use of melatonin is generally an acceptable way of getting your child’s schedule back on track after a disturbance in their sleep schedule is caused by travel, vacation, hospitalization, pandemic lockdowns, or other major life events. 🧸 Melatonin is also a reasonable long-term option for children with sleep-onset insomnia in the setting of autism spectrum disorder or ADHD. I typically do not recommend it for children less than 2 years old due to lack of studies.
Let’s move on to safety. Overall, melatonin has very low toxicity, which means that overdose or “drug poisoning” does not commonly occur. It is not chemically “addictive” like other prescription sleep medications. The most common side-effects are tiredness, headache, GI upset, and mood alteration (ie, crabby child). 😬
Some studies suggest that melatonin supplementation has the potential to impair reproductive function and delay the onset of puberty. Melatonin can negatively affect the way that other prescription medications work. It is sold over-the-counter as a "dietary supplement" and is therefore not approved by the FDA for safety or effectiveness. These are a few of the reasons why it's best to limit use to roughly 3 months or less.
Has it been proven effective? Yes – to an extent. In a recent meta-analysis, patients taking melatonin fell asleep roughly 22 minutes sooner than those taking placebo, and total sleep time was increased by roughly 23 minutes. 💊 In another study on children with neurodevelopmental disorders, total sleep time improved by 48 minutes. There was no difference in the number of nighttime awakenings, suggesting that melatonin can help you fall asleep sooner but it doesn’t necessarily keep you asleep.
The ideal dose can vary from child to child. 👧 It may be wise to start at a small dose of 1-2 mg per day. Eventually, giving 3-6 mg at night is common. Take 30-60 minutes prior to bedtime. When purchasing, look for the USP (United States Pharmaceuticals) logo on the label to assure that you’re actually getting the dose advertised. Talk to your pediatrician about the optimal timing and dosage of melatonin to fit your child’s specific needs.
Like many things in the field of pediatrics, long-term effects of melatonin are unknown. 😞 We need more studies on the downstream safety and effectiveness. Until then, the answer is not black and white. We must weigh the risks and benefits of everything that we do! ⚖️
Achieving healthy sleep is extremely important. In general, most would agree that melatonin is a safe supplement that may be worth a shot when proper sleep hygiene just isn't enough.
Primary sources:
Abdelgadir IS, Gordon MA, Akobeng AK. “Melatonin for the management of sleep problems in children with neurodevelopmental disorders: a systematic review and meta-analysis” Arch Dis Child 2018;103:1155–1162.
Wei S, Smits MG, Tang X, et al. Efficacy and safety of melatonin for sleep onset insomnia in children and adolescents: a meta-analysis of randomized controlled trials. Sleep Medicine. 2019.
