Bedtime rolls around, and you can’t wait for your head to hit the pillow — or to indulge in a show on Netflix after your kid has conked out. But maybe this always seems to be the time when your child revs up every night. For many, this is a familiar and frustrating scenario. And more parents are reaching for the help of the supplement melatonin. But is it safe?
A 2015 study published in the European Journal of Paediatric Neurology reports that melatonin use in children doubled from 2004 to 2011. And in 2018, The Guardian reported a 25 percent increase in melatonin prescriptions to kids in England over the past three years. But scientists have called for more research on whether long-term melatonin use in youth has side effects.
What is melatonin?
The pineal gland, located in the middle of the brain, secretes the hormone melatonin naturally when we’re exposed to darkness. The process begins with our eyes. Our retinas relay signals about our exposure to light along pathways in the brain and spinal cord to the pineal gland, telling it to release melatonin. As a regulator of our circadian rhythm — aka our internal clock — melatonin tells our bodies when it’s time for some shuteye.
How does supplemental melatonin work?
Unfortunately, for several reasons, our internal clocks don’t always work like clockwork. Kids (or adults) might have trouble falling asleep only to then have difficulty waking up on time in the morning. That’s why more parents are giving their children melatonin. Both synthetic melatonin (manmade) and natural melatonin (produced from animals) are available over the counter in the U.S.
Using supplemental melatonin may help kids fall asleep faster than if they were to rely solely on their own levels of the hormone to do the trick. For example, a 2016 study published in JAMA Pediatrics, found that children with atopic dermatitis were able to fall asleep about 20 minutes earlier than usual after they were given melatonin during a clinical trial.
What conditions can affect a child’s sleep?
The itchy symptoms of atopic dermatitis can certainly keep someone awake, and so can other conditions. For example, asthma is associated with insomnia, according to a 2016 study published in the journal CHEST. Plus, Canadian Family Physicians reports that about 75% of kids who have neurodevelopmental and psychiatric conditions have sleep issues. Children with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) or anxiety often experience trouble falling asleep or other sleep disturbances, says a 2017 article published in the Journal of Translational Medicine.
Why do kids have trouble falling asleep?
Even if your child doesn’t have a medical issue, many factors can still disrupt a kid’s circadian rhythm. About 25% of healthy children and teens also have sleep troubles. Early school start times and increased periods of daylight can mess with one’s internal clock, too, and rob kids of valuable sleep time, according to a 2016 article in Endocrine Reviews.
But there’s another sneaky slumber thief: the blue light from our devices. Just two hours of blue light exposure at night impacts melatonin production and messes with our sleep-wake cycle, reports a 2019 systematic review published in Chronobiology International.
Considering how often we use our mobile devices, it’s not a stretch to assume they are a big culprit in lost sleep for both parents and children. A 2019 survey by Common Sense Media, a nonprofit research organization that explores media use in kids, reports that 40% of teens use a mobile device within five minutes before attempting to fall asleep. About 36% of teens report waking up to check their device during the night, and 29% report actually sleeping with it. So it’s not just the blue light that can cause a loss of those forty winks. Dinging or buzzing notifications are an issue as well.
Is melatonin use safe for children?
Although the reasons for kids having trouble falling asleep vary, sleep issues are an increasing concern for parents. And they’re looking for solutions like melatonin. But the question of safety in long-term use remains.
The National Institutes of Health (NIH) reports that melatonin is safe for short-term use in kids. In other words, if your pediatrician okays it, the occasional use of melatonin on difficult nights is considered fine. Minor possible side effects include drowsiness, headache, dizziness, increased urination or bedwetting and agitation. But the NIH cautions parents on long-term use because studies are lacking.
In a 2019 article published in the journal Nature and Science of Sleep, researchers called for more studies on whether melatonin supplementation in kids could delay the onset of puberty. The researchers cite indications that a drop in melatonin levels in adolescence correlates with the progression of sexual maturation and development. They also point to animal studies that have linked melatonin supplementation with suppression of gonadotropin-releasing hormone secretion, which is responsible for kickstarting puberty.
One 2018 study of children with ASD reported safe melatonin administration for up to a year. The study, which was published in the Journal of Child and Adolescent Psychopharmacology, administered pediatric prolonged-release melatonin (PedPRM) for 52 weeks. Three out of four children had long-term sleep benefits with mild side effects consisting of fatigue and mood swings (though researchers say the mood changes could be attributed to the underlying disorder). Still, lengthier studies are still needed to confirm safety beyond a year.
And aside from length of use, another concern with melatonin use is supplement mislabeling. In a small 2017 study in the Journal of Clinical Sleep Medicine, researchers analyzed about 30 melatonin supplements and found that label claims of melatonin content were significantly wrong. Some products contained 80% less melatonin than stated, and others contained more than 400% melatonin than stated. And many products, 26%, also contained serotonin, a substance used to treat neurological disorders. It’s important to remember that, although the Food and Drug Administration regulates them, dietary supplements do not undergo the strict testing and requirements for approval as prescription medications.
So what should parents do?
If you’re considering using melatonin to help your child fall asleep, talk to your pediatrician first. A health care provider can give you recommendations for a trusted formulation, the right dosage for your child, and when and how often to use. A pediatrician can also help treat underlying disorders that may be related to lost sleep or offer recommendations for various sleep solutions.
The Mayo Clinic advises people with insomnia or other sleep difficulties to try cognitive behavioral therapy before resorting to medications or supplements. Methods for kids usually involve ways to improve sleep hygiene. These might include limiting screen time in the evening hours, keeping devices away from the bed and trying a routine that helps cue children for bedtime.
The bottom line: Try options that don’t involve supplements or medication first. If they don’t work, talk to a trusted health care provider to find the best solution for your kiddo to get more ZZZZs — which will help you hit the hay faster too.