Melatonin for children — 5 things to know

melatonin sleepYour child’s lack of sleep is beginning to affect her school performance. You’ve tried to establish a consistent bedtime, to no avail. You’re half-crazy with sleep deprivation yourself tending to her insomnia.

You’ve heard melatonin — a natural hormone — can help. Perhaps your pediatrician has already recommended it. But is it really beneficial, and can your child take it safely?

Thriving checked in with Dr. Judith Owens, director of the Sleep Center at Boston Children’s Hospital, and her answer is: Probably. But we don’t really know for sure.

What is melatonin?

The melatonin available over the counter at drug and health food stores is a synthetic form of a hormone our brains naturally produce to help us fall asleep. Our own melatonin helps regulate the circadian clocks that control not only our sleep/wake cycles but virtually every function of our bodies.

Melatonin is normally released in the evening, stimulated by darkness. In the morning and during the day, it’s largely shut off.

Can melatonin help my child sleep?

There is good scientific evidence melatonin can shorten the time to fall asleep in children with insomnia, including children with ADHD, autism and other neurodevelopmental disorders. But there is much less evidence melatonin helps children stay asleep, even in its extended-release forms.

There are many reasons why children may have trouble falling asleep; anxiety, restless legs symptoms or a too-early bedtime are just a few. Before considering melatonin, have your pediatrician conduct a thorough evaluation for other potential causes.

Many sleep problems are much better addressed with behavioral measures or other kinds of interventions. Case in point: Melatonin won’t help a child or teen who’s on their electronic device just before bed! These light-emitting devices actually suppress melatonin.

melatonin for children

Is melatonin safe for children?

It’s no wonder parents are uncertain about this. If you surf the web, you’re likely to get mixed messages:

  • “Melatonin should not be used in most children. It is POSSIBLY UNSAFE. Because of its effects on other hormones, melatonin might interfere with development during adolescence.” Medline Plus
  • “Melatonin, according to more than 24 studies, is safe for children and has been used with little to no side effects.”
  • “Although the use of low doses of melatonin to help children sleep seems to be safe and effective, more research is needed to answer lingering questions.”

This last quote is probably closest to where we actually are. In general, melatonin seems to have few side effects in children, most of them minor, such as headaches, increased bedwetting and morning grogginess.

However, there are ongoing concerns based on studies in animals showing melatonin can affect puberty-related hormones. While there is very little evidence to suggest this is true in humans, the reality is no long-term clinical trials (which would settle the question) have yet been conducted.

In addition, actual melatonin concentrations can vary from product to product or even lot to lot. This can affect both safety and effectiveness. For that reason, some experts recommend going online and purchasing pharmaceutical-grade melatonin, which may be more reliable in regards to dose.

When should melatonin not be used?

As mentioned above, children lose sleep for many reasons. Avoid melatonin:

  • if the insomnia is situational (stemming from anxiety about a new school year, for example)
  • if the insomnia is short-term (caused by an ear infection, for example)
  • if the insomnia is due to an underlying physical cause (like sleep apnea or restless legs)
  • if your child is under 3 years old.

Melatonin should never substitute for healthy sleep practices: a regular, age-appropriate and consistent bedtime and bedtime routine, no caffeine and no electronics/screens before bedtime.

What’s your bottom-line advice?

Consider melatonin only in consultation with a health care provider. Melatonin is likely to have the least risk and the most benefit if your child has significant difficulty falling asleep and when it is used in combination with the institution of behavioral interventions and healthy sleep practices.

Learn more about Boston Children’s Sleep Center.