Melatonin for children? Use of this sleep-inducing hormone among children has risen steeply in the past five years. Doctors look at possible consequences of long-term use and suggest non-drug options to help children sleep.
By Dona Suri
Melatonin supplements for children are easily available, apparently safe and free from side-effects, and more and more parents are dosing their sleep-resistant kids with this neuro-hormone.
Just how many children take melatonin and how frequently?
Earlier this year, Dr Lauren Hartstein, of Colorado University’s Sleep and Development Lab, made a start on answering those questions. Using a small sample of just 1000 parents of children aged one year to 18 years, Hartstein and her colleagues asked them if they had given melatonin to their child in the previous 30 days.
The answers:
Of the parents of children aged 1 to 4, 6 percent said yes.
Of the parents of children aged 5 to 9, 18.5 percent said yes.
Of the parents of children aged 10 to 13, 19.4 percent said yes.
The percentages show a steep jump from 2017 figures. During 2017–18, only about 1.3 percent of US parents reported that they gave their children melatonin.
Hartstein’s study found that the preschoolers who used melatonin had been taking it for a median length of a year. The grade-schoolers and preteens had used it for median lengths of 18 and 21 months, respectively. The older the child, the greater the dosage, with preschoolers taking anywhere from 0.25 to 2 mg and preteens taking up to 10 mg.
This study was published in the November 13, 2023 issue of the Journal of the American Medical Association (Pediatrics).
The Colorado researchers also analyzed 25 melatonin gummy products and found that 22 contained different amounts of melatonin than the label indicated. One had more than three times the amount on the label. One had none at all. And some contained substances, such as serotonin (another hormone). In other words, when you buy a bottle of melatonin, you don’t know what you’re getting.
In many countries, melatonin is classified as a drug and available by prescription only. In the United States, melatonin is classed as a supplement and the FDA does not regulate it. Anyone can buy it over the counter. How you use it is up to you. The American Academy of Family Physicians considers it safe with low risk of side effects and lists it as first-line pharmacologic therapy for the treatment of insomnia, and beneficial for people whose sleep is disturbed by shift work or jet lag
It is possible to overdose on melatonin. For insomnia, most doctors recommend dosage between 0.3 and 5 milligrams; a dose of 10 mg should always be supervised by a doctor. Doses above 20 mg are prescribed only in special circumstances: it lowers toxicity of certain substances in chemotherapy. Doses above 80 mg are getting into serious overdose territory: nightmares, paranoia, dizziness, headaches, diarrhea, nausea, vomiting, hormonal changes. An overdose of melatonin is not going to kill you but it’s not going to be fun either.
Under normal circumstances it should not be necessary for anybody, young or old, to take melatonin. The body makes its own in just the right amount.
Picture your brain. Right in the middle, behind your eyes, on the backside of the hypothalamus, you have the suprachiasmatic nucleus (SCN). It responds to light signals from your eyes and communicates with the pineal gland, locates slightly above the brain stem. As light dims, the pineal gland starts producing melatonin and releases it into the blood stream. As light increases, the pineal gland switches off melatonin production. Eyes plus SCN plus pineal gland regulate your circadian rhythm, in other words, sleepiness and wakefulness.
Melatonin concentration begins to rise before sleep, peaks during the night or early morning, and falls to daytime levels before morning rise time. Melatonin initiates a cascade of physiological events that are sleep-promoting e.g., thermoregulatory and neural changes. Actually, while you are sleeping, your body is doing important things such as healing and growing. Melatonin also regulates the start of menstruation
Various things can disturb your circadian rhythm – chiefly exposure to light when the body is expecting darkness. In the case of very young children, their circadian rhythms are in the process of forming. They generally have shorter circadian cycles – meaning that they need more sleep and frequent naps. However, as children grow older, reasons why children have trouble sleeping generally go beyond the purely physiological.
The American Academy of Pediatrics (AAP) estimates that 15 to 25 percent of kids and teens struggle to fall asleep or to stay asleep on a regular basis.
“Sleep problem” can describe several situations.
A child may accept bedtime, crawl into bed, switch off the light and then … just not fall asleep. It could be that the bedtime set by the parent is unrealistic, or the child is stressed or excited about something, the evening pre-bedtime routine has been modified, or the child’s natural circadian rhythm has been disturbed by a change in schedule.
A child may come to see bedtime as an opportunity to assert, demand and negotiate. It doesn’t take children long to figure out that sleep cannot be commanded. Deliberate sleep resistance, can be a child’s way of asking for parental attention and affection. Commonly, it comes about as a consequence of parenting errors of the tactical variety.
It may take thought, planning and applied psychology, but it is possible for parents to create all the conditions that strongly predispose kids to sleep.
Here are some tips for helping your child to fall asleep naturally.
* Expose children to natural light during the day and limit exposure to artificial light at night. This helps them learn to distinguish between day and night, which establishes a regular sleep routine. Small children can go through phases of sleeping more during the day than at night, or waking up frequently during the night. This is normal and resolves on its own over time.
* In order to fall asleep easily, a child needs to be tired but not too tired. Make sure that a child gets the right amount of exercise and stimulation during the day. A good parent is a sure judge of the child’s fatigue level.
* Nobody falls asleep instantly. Parents need to set up a pre-bedtime routine. It should be a time free of stress and excitement. Free of screens – TV, computer or phone. Free of bright lights and noise generally. Getting into the jammies, brushing the teeth, enjoying an end-of-day cuddle and bedtime story … all these things make for a successful lead-up to sweet dreams. For the best chance of success, model the desired behavior. If you want kids to unglue themselves from a screen at night, unglue yourself too. Instead of dictating, offer some options. Giving children some say in the matter goes a long way toward establishing cooperation.
* Bedtime routine should be consistent: same time, same place, same sequence. Maintaining consistency is particularly important whenever something disrupts normal life: moving to a new house or town, change in school schedule, an evening birthday party … anything. Routine makes kids feel safe and comfortable … and sleepy at the right time. Bedtime routines can’t be lifted out of a book because every child is different. Parents gradually discover the right routine for a particular child and then they keep modifying it as the child matures.
* When it’s time to sleep, a bedroom, whether for a child or an adult, should be quiet, cool and dark. A small night-light or glow-in-the-dark decorations often offer just the right touch of reassurance to a child.
* If a child gets out of bed and tells you “I can’t sleep” take some time to listen. “I’m [thirsty, hungry, hot, cold, itchy] is usually child-speak for “I want some extra love”. No harm. Offer a sip of water, a backrub and a game of inhale-exhale and then back to sleep.
So, here is the parent of a wide-awake child. The parent knows that the child needs sleep. The parent needs rest too. Quick, simple answer: pop a couple melatonin gummies down that little throat and let chemistry solve the problem.
Except that the gummy solution may not be such a good idea long term. Life is full of problems. Should we be looking for a pill or a fix or a shot of single-malt to solve every difficulty? Why head down that road if we don’t have to?