A Sleep Expert’s Take on Melatonin for Children

As melatonin usage in adults continues to rise (into the millions world-wide), many parents assume it is okay for children to use, too.  Parents turn to melatonin out of desperation when their toddlers or young children struggle to sleep.  However, a better, long-lasting, behavioral sleep change can make all the difference in the world for most children!

A common misconception is that melatonin is a “natural” herb or supplement.  However, melatonin is, in fact, a hormone.  Rebecca Robbins, an associate scientist at Brigham and Women’s Hospital in Boston who studies sleep, shared that “The truth is, we just really don’t know the implications of melatonin in the longer term, for adults or kids,” she said.  For many of us as parents, the unknown alone is enough to give us pause.  

Where does our body’s melatonin come from?

The pineal gland deep within the brain secretes melatonin into the bloodstream to regulate the body’s sleep cycles.  Melatonin production is based on the exposure to light or darkness.  This is why sleep consultants and sleep physicians alike recommend avoiding blue light before bedtime in children and adults.  Screen time exposure near sleep times can increase the time it takes to fall asleep and promote restlessness through the night.  We can encourage our kiddos’ own melatonin production in two simple ways: 1.) Avoid blue light in the evening hours.  2.) Embrace darkness in the sleep environment.

Is additional melatonin ever recommended?

Short-term use is common when combatting jet lag.  Some families find melatonin temporarily helpful while adjusting to a drastic change in time zones.

Additionally, sometimes a child truly has a deficiency in melatonin production when a pediatrician may prescribe its use.  This is rare, but more common in children diagnosed with Autism Spectrum Disorder.  Children with Autism tend to struggle more with the ability to calm the brain and fall asleep.

Sometimes children with attention deficit hyperactivity disorder may also benefit from melatonin.  This is especially true for those medicated with a stimulant for ADHD.  This does not mean that children with these disorders must take melatonin in order to fall asleep.  A pediatrician and parental team that best knows the child should work together to make the safest decision in these cases.  

According to Dr. Cora Collette Breuner, a professor in the department of pediatrics at Seattle Children’s Hospital at the University of Washington, the biggest benefit of an increase in melatonin is a slight reduction in the amount of time an individual requires for sleep onset.  A CNN report shared that “in six randomized controlled trials on melatonin treatment in the pediatric population, melatonin decreased the time it took to fall asleep, ranging from 11 to 51 minutes.”  Yes, you read that correctly… Increasing sleep onset by a mere 11 minutes could be the ‘best’ result of giving your child this hormone.

What are some of the potential dangers or unknowns?

Let me list what the research reflects at this point:

•  Some scientists and medical professionals believe that melatonin usage can delay puberty, affect the timing of a female’s menstrual cycle, and/or impact hormonally-medicated diseases.  These studies are not conclusive and thus not yet proven – or disproven.  This is alarming for many parents.
•  Some side effects of giving children melatonin include headaches, agitation, bed-wetting, or more frequent urination.
• Melatonin can affect hormonal development, including the overproduction of prolactin in females.
•  The recommended dose and the recommended timing of the dose are still argued, according to the National Center for Complementary and Integrative Health.  Small doses are best, but often times, what is being sold is far above the amount that would be recommended for any human to take.
•  There is no quality control over melatonin because it is sold as a dietary supplement.  Without the U.S. Food and Drug Administration’s safety process, melatonin products often do not contain what is listed on the label.  This inaccurate information can be dangerous to consumers.

The bottom line is that long-term use is not recommend.  No one yet knows the full effects in children’s overall growth and development.  Until we know more, we must do what we can to avoid the risks in children.  Many children who stop taking melatonin for six weeks actually show very little change in sleep habits.  Thus, some experts argue that the benefits are not noticeable enough to continue adding this hormone to children’s bodies.

Is there an alternative?

If studies are inconclusive about the potential dangers of melatonin usage, we are led to ask another question: what can tired parents do in the meantime?  We agree that sleeplessness should not be the answer.  Every child deserves to sleep well.  Every household thrives best when well-rested.

Undoubtedly, teaching proper sleep hygiene is the most impactful way to promote great sleep. 
1.  Establish an age-appropriate schedule.
 2. Eliminate screens in the hours leading up to bedtime.
 3. Create a dark sleep environment. 
 4. Implement a predictable bedtime routine, such as a bath and a time to read books together. 
  5. Give your child confidence in falling asleep independently.

Restorative sleep is always possible, and for the vast majority of children, it can and should be obtained without melatonin.  

About the author: Kelsey Hotchkiss has a degree in Elementary Education and a Master’s Degree in Educational Administration.  Kelsey is a Senior Consultant at Sleep Wise, having helped hundreds of families in her four years at the company.