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Aug 14, 2023

New advice on melatonin use in children

Child & Teen Health . When it's bedtime, what parents really,

Child & Teen Health

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When it's bedtime, what parents really, really want is for their kids to go to sleep. Not only do parents want their children to get the rest they need, but parents want to get some rest themselves! So it's understandable that when children have trouble falling asleep, many parents reach for melatonin. Recent warnings about melatonin call this into question.

Melatonin is a hormone that the body makes to regulate sleep. Commercially, it is sold without a prescription as a sleep aid. If you give your body more of a hormone that helps you sleep, you are more likely to fall asleep, right? This isn't always true, of course; for many people, taking extra melatonin does little or nothing. But for some people it does help — including some children.

Over the past couple of decades, use of melatonin supplements has increased significantly. It's the second most popular "natural" product parents give to their children after multivitamins.

Whenever a lot of people do something, things can go wrong. And indeed, there have been many reports of melatonin overdoses in children. While overdoses can lead to excessive sleepiness, headaches, nausea, or agitation, luckily they aren't dangerous most of the time. That doesn't mean that over-the-counter melatonin is completely safe, however. In fact, the American Academy of Sleep Medicine (AASM) recently issued a health advisory with warnings about its use.

Over-the-counter melatonin is classified as a dietary supplement. This means it's not regulated by the FDA the way over-the-counter medicines like ibuprofen, acetaminophen, or diphenhydramine are regulated. There is no oversight on what companies put in the melatonin that parents buy.

And what they put in it is exactly the issue. The AASM warns that the amount of actual melatonin in tablets or liquid can vary, from less than what the label says to much more. The greatest variation is found in the chewable tablets, which are unfortunately the ones children are most likely to take. It's also hard — impossible, even — to know what else might be in the supplement. The AASM reports that some melatonin products also contain serotonin, a hormone and neurotransmitter that requires a prescription.

The thing is, while some children really do benefit from melatonin, such as children with neurologic or neurodevelopmental problems, most don't need it to get a good night's sleep. Before buying a sleep aid — especially one that may not contain what you think it does — there are some strategies parents should try first.

If you have tried all this and your child is still having trouble falling asleep, talk to your doctor before giving them melatonin. There may be other issues at play. By brainstorming together you may come up with ideas.

If you decide to use melatonin:

Bottom line: if your child is having trouble falling asleep, there's lots to try before trying melatonin. Talk to your doctor before you buy — or try — it.

Follow me on Twitter @drClaire

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

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