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 asked me to share thoughts 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 long-term studies just haven't been done in the general pediatric population. If it were my child, I'd use melatonin if sleep dysfunction at bedtime was getting in the way of necessary sleep (8-10 hours for school-age, 8.5-9.5 hours for teens), but I'd also do everything I could to get them off of it as soon as I could. Often when I hear of how families are using melatonin, I end up advising changes in the sleep schedule and family routine more than advising them on a need for meds. 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.
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.
What we do know: Supplemental melatonin can help children with sleep dysfunction (those who lie awake for hours at bedtime) fall asleep. However, melatonin only helps with sleep initiation (falling asleep) not staying asleep. So if you are dealing with wake ups during the night... melatonin is not the solution. Normal awakenings shift and change due to 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!
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 (around 8 p.m. for kids, around 10 p.m. for teens), 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! Light from screens (Kindles, iPads, tablets, computers, TVs) inhibits melatonin from being released. Getting outside during the day helps teach your brain day vs. night -- an important strategy for anyone struggling with 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). Potency varies by brand and even between different batches from the same manufacturer. Always avoid "natural" melatonin (derived from cow or pig brains) and purchase only the man-made synthetic supplement that is far more readily available.
Melatonin Dosing Recommendations
"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," said my friend, sleep expert Dr. Maida Chen of Seattle Children's Hospital.
Typically I advise families that you always want to use the lowest dose: 0.5mg or 1mg -- then consider increasing by 0.5mg every few days if your child isn't falling asleep within an hour of bedtime. While increasing dose, make sure you're also working on consistent bedtimes, policing screens in the bedroom, and working to get good exercise OUTSIDE during the day. Many children will respond to a dose 0.5mg or 1mg 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. Talk with your child's physician about how to determine a dose if or when melatonin is being used and if it's not working GET OFF OF IT. Not all children respond to the hypnotic effect of supplemental melatonin.
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 on how melatonin works and when to administer from Dr. Craig Canapari -- a pediatric sleep expert at Yale.
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.
Sleep matters. Good sleep is essential. But it's rare for a child to need meds.
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 can impair your body's natural melatonin spike).
• Avoid sleeping with a smartphone. Data shows small screens are worse for sleep than TV!