Is Melatonin Safe for Kids?
Melatonin use is on the rise
Thanks to pandemic stress and the global pressure cooker we live in, the state of sleep is epically bad—it’s no wonder sales of melatonin have skyrocketed, increasing from $285 million in 2016 to $821 million in 2020. The reality is that parents are leaning on melatonin to help them sleep, and to help their kids fall asleep faster.
…and gummies are left on tired parents’ nightstands across America.
In 2020, melatonin became the most ingested substance among children reported to national poison control centers. It’s everywhere, so let’s talk about melatonin: What is it? What are the risks? How can you keep your kids safe from overdose? Who might it benefit? And what can you do to naturally enhance your child’s sleepiness at bedtime and ease in falling asleep?
Melatonin & Kids
In spite of it’s ubiquitousness, melatonin isn’t a wonder-drug, it can’t teach a child to feel safe and secure in their beds, and it comes with risks.
As parents, we need to know the whole story when making health decisions about our children. And giving your child a melatonin supplement is absolutely a health decision.
But, please: NO SHAME. If you’ve used it with your kids, it’s probably because you’re exhausted and your kids are fighting sleep. They need sleep. You need sleep. But its likely they can sleep even better without it—more on this later.
In full transparency: I’ve given both of my kids melatonin on occasion and see how there’s a slippery slope from occasional to nightly use. But given my background in public health, my general dislike of risk-taking, and the fact that I know I’m doing everything in my power to drive their natural sleepiness at bedtime, I’ve opted to keep melatonin use to minimum with my kids.
What is melatonin?
Melatonin is a hormone released in the evening by the pineal gland, a pea-sized gland in the middle of the brain. It plays an important role in regulation of the sleep–wake cycle, helping our bodies fall in line with the natural dark and light cycles of the sun. When the sun goes down, melatonin levels rise to make you sleepy.
Melatonin Risks
The lack of regulation
Melatonin isn’t regulated by the FDA in the way that prescription drugs are, so there’s no oversight regarding purity of ingredients or accuracy of dosing. That means, you might think you’re taking or giving your kid 1 mg of melatonin, but in fact it could be far more.
Scientific evaluations of the OTC melatonin brands have found concentrations that range from 83% less than that claimed on the label to 478% more than stated. YIKES!
Also, in a 2017 study that tested 31 different melatonin brands, the researchers found that 26% contained seratonin, an entirely different hormone that can have harmful effects in even relatively small doses. In many countries, melatonin requires a doctor’s prescription. So you might be giving your kids a cocktail of hormones. Dear companies manufacturing melatonin supplements: THIS IS NOT COOL!!!
Overdosing is frightening trend
Melatonin overdose is rising (parallel to melatonin use), and ingestions in children, resulting in calls to poison control, increased 530% between 2012 and 2021. Over the 10 years studied, more than 4,000 kids were hospitalized, five needed to be put on machines to help them breathe, and two — both younger than 2 — died. Most of the hospitalized children were teenagers, and many of those were believed to be suicide attempts.
Go to the pharmacy, grocery or health foods store and you’ll see oodles melatonin options, many with berry and fruit flavors, sugar coating, and even melatonin chocolates. It’s no wonder kiddos are finding these “treats” and helping themselves.
PLEASE LOCK UP THE MELATONIN. Just because it’s OTC doesn’t mean it’s safe to leave out, and this goes for all supplements.
What does melatonin overdose look like?
Melatonin overdose is serious, requiring immediate medical attention. If you give your child a melatonin supplement, be mindful of the following symptoms:
Sweating
Increased heart rate
Agitation or irritability
Restlessness
Anxiety
Upset stomach
What is the appropriate melatonin dose for a child?
First: please consider that in most cases, your kid can start falling asleep easily and sleeping well with tweaks to their schedule and/or routine. Or maybe they need a little security building at bedtime! But, if you’re considering, please do talk with your child’s pediatrician first and follow appropriate dosing for children. The American Academy of Pediatrics recommends a low dose of 0.5 to 1 milligrams 30 to 90 minutes before bedtime, but experts are still researching what’s safe and effective in the short term, what’s considered too much, and what the longterm risks/benefits may be.
Impact on puberty and growth
Because melatonin is a hormone, it’s possible that these supplements could affect hormonal development, including puberty, menstrual cycles, and overproduction of the hormone prolactin. But we don’t know for sure because there isn’t enough research yet. Until we have scientifically rigorous longitudinal date, we just can’t know if it’s safe or if it will impact your child’s development.
Lack of research
Again, because there aren’t many studies on children and melatonin supplements, we can’t draw any confident conclusions about benefits. We don’t know what the best dose and timing is for children, nor do we know what the longterm impact of use may be. Given the lack of research, and specifically well designed research where long term outcomes are measured, we just can’t know if the benefits outweigh the risks.
Potential benefits in kids with ASD, ADHD, and atopic dermatitis
Children with atopic dermatitis, attention-deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD) are more prone to sleep problems than other children. There are no overall guidelines how to best improve sleep in children, but behavioral treatments like improving bedtime habits and parental education tend to be the gold standard. However, some studies (mostly with small sample sizes and limited follow up) have shown that melatonin supplements can improve sleep latency and duration in the short-term for these kiddos, in comparison to placebo. Again, we don’t know what the longterm impact is. But some families in consultation with their child’s health care provider may decide that the benefits outweigh the risks.
But can melatonin improve my child’s sleep?
Not likely, and here’s why: if you’re using melatonin to make your kid konk out who would otherwise be having difficulty falling asleep, you’re using it as a bandaid and not a solution (potential caveat: the medical conditions we just talked about) .
I talk with parents all the time who use melatonin supplements for one of two reasons: 1) because their kid isn’t tired enough to fall asleep at bedtime and 2) because their kid won’t let them leave the room at bedtime.
Using melatonin to make your kid fall asleep earlier
If you make a kid who isn’t tired go to sleep before they are biologically ready, night wakings and early rising are likely on the other end. I frequently talk with folks who use it with their toddlers and preschoolers who are napping well during the day but not ready for sleep at bedtime when parents are ready for them to be asleep. Most of us are ready to be “off duty” by 7 or 8PM. But if your 3 year old naps from 1-3 PM, it’s possible (and normal!) they won’t be ready for bedtime until 9:00PM or later.
If you use melatonin to help your kid fall asleep before they’ve accumulated enough sleep pressure to actually sleep well, you’re likely looking at night wakings, early rising, or diminished sleep quality by forcing them to bed earlier than their body needs. What your kid actually needs in this scenario is a later bedtime or a shorter nap.
Using melatonin to cut down on bedtime worries and make kids fall asleep
When kids have separation anxiety, worries, or fears at bedtime, they have a much harder time falling asleep without a parent there to help them feel safe. If you use melatonin supplements to help them konk out faster (because you’re held hostage in their room until they’re asleep), yes, they *may* fall asleep faster and you may be released of your duty sooner. But you aren’t solving any problems (and you may be putting them at risk by using melatonin nightly). Again, no judgement. Parenting is hard. We’re tired. And sometimes bandaids feel like the only thing we have energy for.
But please, please, please, know this: your child can learn to feel safe, secure, and independent at bedtime. You can accomplish this without a poorly studied, poorly regulated hormonal supplement!
Plus, a melatonin supplement won’t keep your kid asleep all night. It’s not going to help them back to sleep when they wake up scared in the night. If you’ve found yourself in this scenario, consider scheduling a free intro call with us to learn how we can help you break free of the hostage-at-bedtime-and-relying-on-melatonin-to-help situation.
How can I safely make my kid sleepier at bedtime?
Watch out for evening light exposure
Evening light exposure tricks the brain into thinking its still daytime. That’s why you don’t get as sleepy when you’re on your tablet, phone, or watching TV. The blue light emitted suppresses the natural production of melatonin. So even if we know we’re exhausted and need to go to sleep, our brain is getting the opposite message from our environment which can make falling asleep harder. You can learn more about the impact of blue light exposure here and realistic tips on how to keep your kids entertained in the evening without screens here.
Spend more time outdoors
Exposure to sunlight in the morning can help strengthen the body’s internal clock. Spending time outside in the fresh air and daylight can also improve sleep, and generally make everyone feel better.
Make the bedroom REALLY dark
When the bedroom is pitch black, the brain gets the message that it should be sleeping and that it should stay asleep. You can read more about the benefits of creating a cozy cave for sleep here, and how to do it.
Implement a bedtime routine
And yes, a calm and consistent bedtime routine that fosters deep connection between parent and child does wonders for sleep. Learn more about the benefits of bedtime routines and how to get one started here.
What’s the bottom line when it comes to kids and melatonin?
Kids can learn to sleep peacefully, easily, and blissfully, all night long without the use of any OTC or prescription sleep aids. Children with ASD, ADHD, atopic dermatitis and other conditions may benefit from melatonin supplementation at bedtime. More research is needed on the the longterm risks and benefits of melatonin use in children, safe and optimal dosing, and administration.
If your kid isn’t sleeping well, go back to the basics, or the healthy sleep foundations,
When does this Sleep Coach use melatonin with her kids?
Rarely. But when we travel across time zones, I definitely bring it with me to help reset their internal clocks. Also, one of my kids is neurodiverse and has eczema. When his sleep hygiene is crappy (like staying up too late watching baseball), we occasionally give him melatonin to help him fall asleep. He doesn’t like to take it though.
References:
Rzepka-Migut, B., & Paprocka, J. (2020). Efficacy and Safety of Melatonin Treatment in Children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder-A Review of the Literature. Brain sciences, 10(4), 219. https://doi.org/10.3390/brainsci10040219
Lelak K, Vohra V, Neuman MI, Toce MS, Sethuraman U. Pediatric Melatonin Ingestions — United States, 2012–2021. MMWR Morb Mortal Wkly Rep 2022;71:725–729. DOI: http://dx.doi.org/10.15585/mmwr.mm7122a1
Gummin DD, Mowry JB, Beuhler MC, et al. 2020 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 38th annual report. Clin Toxicol (Phila) 2021;59:1282–501. PMID:34890263 https://doi.org/10.1080/15563 650.2021.1989785
Melatonin for kids: What parents should know about this sleep aid. HealthyChildren.org. (n.d.). Retrieved July 3, 2022, from https://www.healthychildren.org/english/healthy-living/sleep/pages/melatonin-and-childrens-sleep.aspx
https://nationaleczema.org/blog/melatonin-eczema/. HealthyChildren.org. (n.d.). Retrieved July 3, 2022, from https://www.healthychildren.org/english/healthy-living/sleep/pages/melatonin-and-childrens-sleep.aspx