When I recently shared this article on my Mama Doc Facebook about a “magic” children’s bedtime story promising to make the going-to-sleep process easier, many parents inquired about melatonin.
No question that supplemental melatonin has a role in children’s sleep dysfunction but also no question that parents are turning to melatonin out of a need for convenience. I’ve had COUNTLESS curbside consults from parents asking me if melatonin is safe to use in the short-term but also for years on end. The short answer is we don’t entirely know because studies just haven’t been done. Often when I get the story of how families are using melatonin, I end up advising changes in the sleep schedule more than a need for meds. What we do know: melatonin can help children fall asleep with sleep dysfunction, sleep dysfunction and inadequate sleep have serious health consequences, and although melatonin only helps with sleep initiation (falling asleep) it can be hugely beneficial for children who lie awake at night for hours at bedtime. The other thing we know: melatonin is not regulated like medicines (it’s overseen as a food supplement) that has been studied in very few pediatric populations so it’s difficult to generalize safety for children everywhere. Lots of definitions, dosing info, and pediatric sleep expertise below.
If your child can fall asleep in about 30 minutes after the lights are out (especially when you have made sure no screen time for 1-2 hours prior, no caffeine in afternoon) then melatonin is unnecessary.
If it were my child I’d use melatonin if sleep dysfunction at bedtime was getting in the way of necessary sleep, but I’d also do everything I could to get them off of it as soon as I could. Many children respond to the hypnotic effect of higher doses of melatonin, but many children are also given it for family convenience, too. In my experience, sometimes families use it to treat anxiety (those kids whose mind spins and spins and spins and worries) at bedtime. Although sometimes melatonin helps kids fall asleep, it’s just a band-aid.
Children are sleeping less than ever before and there are mounting impediments to a good night’s sleep (screens, early school start times, stimulants in the food source, busy school days and activities keeping kids up late). However inconvenient, I think sleep hygiene (routine bed time, no screens before bed, bed used only for sleeping) and consistency with what we do as parents may be the only magic wand to wave for sleep throughout childhood. Awakenings typically rise from all sorts of developmental milestones and changes as children grow. Overnight awakenings will always be normal although how our children get back to sleep on their own changes our night of sleep dramatically. When it comes to challenges falling asleep, sometimes melatonin can really help, especially in children with underlying autism spectrum disorder, attention deficit disorders, or children with shifted sleep schedules.
Only a few long-term studies have looked at prolonged use and associated effects, but most sleep specialists consider melatonin safe, particularly for occasional short-term use. The bigger question is why parents feel the need to give their child melatonin. –Dr. Maida Chen
What is Melatonin?
Melatonin is a naturally occurring hormone that our brains produce to help regulate sleep and wake cycles. People call it the “sleep hormone” because unlike the parts of body that drive wakefulness, melatonin drives sleepiness. Normally, melatonin levels begin to rise in the late evening, remain high for most of the night, and then drop in the early morning a couple hours before we wake up. Light inhibits melatonin and affects how much melatonin your body produces. Hence why being outside in the light during the day with a newborn (especially the ones who want to party all night) or when switching time zones makes a lot of sense! Getting outside during the day helps teach your brain day versus night. Melatonin typically rises in the late evening for children (around 8pm) and teens — when you give supplements of synthetic melatonin you can sometimes help decrease sleep-onset insomnia. BIG IMPORTANT NOTE: melatonin does not prevent overnight awakenings. So don’t use it to prevent those frustrating 2-am wake-ups.
Melatonin is the hormone that helps your brain chill out and drift off to sleep.
The Melatonin Supplement
The melatonin supplement you find at your local drug store is synthetically produced in factories. Because it’s a supplement and not a medicine it’s not regulated by the FDA like medicines. Therefore inconsistency in dosing is possible (no one can say that one brand’s 1-mg tablet is the same dose as another’s). Melatonin supplements are most commonly used to treat jet lag or sleep problems like insomnia but it’s certainly a supplement that has been discovered the past 10 years. Sales have doubled for melatonin in recent years and therefore it’s far more common in people’s kitchen cabinets than it used to be.
Melatonin Dosing Recommendations
Dr. Chen advises, “There are no clear-cut dosage guidelines because neither melatonin nor any other medication or supplement is approved by the FDA for the purpose of treating insomnia in children. If parents or teens are considering using melatonin, they need to talk to their pediatrician about whether or not it’s necessary, timing of the medication and dosage.”
Most children who benefit from melatonin – even those with diagnoses of ADHD or Autism Spectrum Disorders – don’t need more than 3 to 6 mg of melatonin. Some children benefit from as little as 0.5 mg before bedtime. Younger children tend to be given 1 to 3 mg and older children/teens a little more. Start with the lowest dose and work up if you’re not getting the desired effect. While increasing dose, make sure you’re also working on consistent bedtimes, etc.
Dosing: You always want to use the lowest dose of melatonin you can. Many children will respond to a dose 0.5 mg or 1 mg an hour or two prior to bedtime. Some children and teens with significant challenges falling asleep are often given doses as high as 3mg to 6mg with severe insomnia at bedtime but in my experience many children get the hypnotic effect at smaller doses. Always avoid “natural” melatonin (derived from cow or pig brains) and purchase only the man-made synthetic supplement that is far more readily available. Talk with your child’s physician about how to determine a dose if or when melatonin is being used or trialed for sleep dysfunction. Always start with a low dose (0.5mg or 1mg) — then consider increasing by 0.5 mg every few days if your child isn’t falling asleep within an hour of bedtime.
Timing: You want to give melatonin prior to bedtime to help with increasing sleepiness. Most physicians recommend giving about 1-2 hours prior to ideal bedtime when helping little children fall asleep. However, it does depend why and how you plan to use melatonin. Here’s a GREAT video on how melatonin works and when to administer (if you’re using it just for quick sleep onset or re-shifting the clock) from Dr. Craig Canapari — a pediatric sleep expert at Yale. He explains how a dinner time low-dose of melatonin (0.5mg or 1mg) may help more with changing the sleep-wake cycle, while a slightly higher dose prior to bedtime can assist with just falling asleep from the “hypnotic effect.” It can be confusing, so no question this is worth reviewing with your own pediatric provider.
Safety in Toddlers & Young Children
Dr. Maida Chen, who leads the Pediatric Sleep Center summarizes this well, “There have only been a few studies to look at long-term melatonin use and associated effects, but some sleep specialists consider melatonin safe, particularly for occasional short-term use. Often the child has a chronic sleep disorder and melatonin is covering up the underlying symptoms. It can be a slippery slope for families because continuing use of melatonin can delay obtaining more appropriate treatment for the underlying sleep disorder.”
Generally, research finds that supplemental melatonin is not tremendously effective in children who aren’t diagnosed with underlying ADHD or ASD, though some kids get benefit in falling asleep more quickly. I sincerely believe that many young children getting melatonin would do better with improved consistent bedtime routines, strict rules about no emitting devices for 1 hour prior to bedtime (kindle, iPad, tablet, TV, computer). For any child having trouble falling asleep, work to avoid screens and/or dim the screen light in the hours before bedtime.
Children with ADHD and/or autism spectrum disorders (ASD)
Children with ADHD and/or autism spectrum disorder are known to have challenges falling asleep. Studies with melatonin have been done in these populations of children. Dr. Chen explains,
More trials of melatonin for sleep difficulties have been done in children with ADHD or ASD than studies for typically developing children. Evidence from these trials suggests that melatonin is safe and does shorten the length of time it takes to fall asleep. However, the effects are not generally overwhelming and not every child who takes melatonin shows sleep improvement. The studies mostly evaluate short-term use only.
Most worries about long-term use and safety are speculative (based on studies in animals or adults) but without clarity from research it’s always best to get kids off melatonin when you can.
Potency Difference Between Brands
Without FDA regulation dose of melatonin sold in the U.S. isn’t controlled.
Potency varies by brand and even between different batches from the same manufacturer. It’s important to note that many studies using melatonin have been done using pharmaceutical grade melatonin, which is not commercially available in the United States. ~Dr. Maida Chen
Mama Doc Tips & Resources:
- Helping an anxious child at bedtime (quick tip to try)–> VIDEO & quick explanation: Blowing Colors
- Read this fantastic overview of melatonin from pediatric sleep doc, Dr. Craig Canapari
- Try a soothing and consistent bedtime routine (no question data shows this does wonder for sleep, behavior, school, and mood).
- Avoid screen time before bed (that light will impair your body’s natural melatonin spike).
- Avoid sleeping with a smartphone. Data shows small screens are worse for sleep than TV!