What parents should know about melatonin

Melatonin supplements and kids

Getting a good night of sleep in important for the physical, mental and emotional health of kids and teens. For parents and caregivers of kids who have trouble sleeping, of course, they want to find a safe and healthy solution for them.

You may find yourself reaching for over-the-counter melatonin supplements in these instances. You know they are popular for adults, but are they safe for kids?

In this Q&A, CHOC Clinical Pharmacist Sakina Hussain discusses what parents should know before giving their child melatonin supplements.

What exactly is melatonin?

Melatonin is a hormone naturally produced in the brain mostly during the night in response to darkness. It helps to sync the body’s sleep-wake cycle with the day-night cues from the environment. 

As it gets dark, melatonin levels rise, which in turn signals the body to sleep. During the day, the light suppresses melatonin production, allowing the body to wake up. Synthetic melatonin supplements can be useful in children who have difficulty falling asleep.  Sleep may be affected by environmental, psychological, biological or other factors. 

It is important to determine and address the underlying causes of sleep disturbances before trying melatonin. Discuss melatonin with your child’s pediatrician before use.

Are melatonin supplements safe for kids? Are they necessary?

Melatonin supplements are generally considered safe if used in the short term — over the course of two to three months. However, there is limited research on long-term melatonin use in children.

The most common side effects seen with melatonin use are:

• Daytime sleepiness.
• Dizziness.
• Headaches.
• Upset stomach.
• Vomiting.

Melatonin supplements can be purchased over the counter without a prescription; however, since they are not regulated by the Food and Drug Administration (FDA) in the United States, there is a wide variability in the strength, purity, form and quality amongst the different batches, products and brands of melatonin. 

Therefore, the response to melatonin can also vary from one child to the next.  These supplements can also contain other ingredients and substances that may or may not be safe for your child.

While kids with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) may benefit from melatonin, most kids don’t need it to help them sleep better during the night.

What is the proper dosage of melatonin for kids? For teens?

Although no clear dosing guidelines have been established, the general consensus is to start at a lower dose and increase slowly until a favorable response is achieved. 

Here are some dosing recommendations for temporary sleep disturbances based on age:

• 2 to 5 years old: 1 to 3 milligrams daily 60 minutes before bedtime.
• 5 to 13 years old: 3 to 5 milligrams daily 60 minutes before bedtime.
• 14 years or older: 5 milligrams up to 10 milligrams daily 60 minutes before bedtime; although doses greater than 6 mg do not show greater benefit.

If using for insomnia related to ASD, ADHD or other neurodevelopmental disorders, please consult with a doctor before giving your child melatonin. 

Are there any precautions parents should take when giving their kids melatonin?

It is critical to choose the right formulation that works best for your child’s needs. Melatonin can come in immediate-release and extended-release formulations:

• Immediate-release formulations will help your child fall asleep faster, but they don’t do anything to help them stay asleep.
• Extended-release formulations mimic the body’s production of melatonin. It is slowly released into the bloodstream and stays around longer to not only improve with how quickly they fall asleep but also how well they sleep through the night. Do not cut, crush or chew extended-release pills as they won’t work properly.

Make sure to have your kids take melatonin with food.

Can kids take too much melatonin? What are the signs?

Yes, it is possible to take too much melatonin, which can actually worsen your child’s sleep problems and cause daytime drowsiness. Stick to the dose that the pediatrician recommends.   

What is liquid melatonin? Is it safe for kids?

Liquid melatonin is an immediate-release formulation and can be helpful if your child has trouble swallowing pills. They get absorbed faster so it can be taken 20 to 60 minutes before bedtime. Like other melatonin forms, short-term use can be safe in kids. 

Is melatonin good for kids with ADHD?

Kids with ADHD often struggle with sleep issues. These sleep disturbances can be related to lower melatonin production, behavioral challenges associated with the disorder and stimulant medicines used to treat the condition. 

Melatonin can help with bedtime resistance, sleep duration and overall quality of sleep.  Consult with your child’s doctor to help you decide if melatonin is a good choice for them.

Are there other alternatives to melatonin to help kids sleep?

Proper sleep hygiene is the best alternative to melatonin. Here are some recommendations to help your child get a good night’s sleep:

• Have a bedtime routine at the same time every night.
• Avoid screen time or blue light one to two hours before bedtime.
• Avoid caffeine and sugar before bedtime.
• Keep the bedroom dark, cozy and comfortable.
• Avoid daytime naps.
• Encourage an active lifestyle during the day.

Is there anything else you think parents should know about melatonin?

Though melatonin can be a useful sleep aid, it may not work for everyone. The risks and benefits associated with its long-term use are still being studied. Therefore, it is important for parents to stay informed and keep an open mind about treating sleep problems with behavioral changes first. 

Start small lifestyle modifications to promote better sleep patterns before considering melatonin. Speak with a healthcare professional to figure out what works best for your child’s needs.

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