As any parent of a child with sleep difficulties can attest, sleep does not always come easily for many children. According to a June 2010 Pediatrics article, 20 to 30 percent of infants and toddlers and 5 percent of school-aged children experience behavioral sleep problems.
The authors further note that at least 4 percent of children have a sleep disorder, such as obstructive sleep apnea or restless leg syndrome. When you have a child who experiences difficulty falling or staying asleep, you naturally want to find a solution. Many parents consider over-the-counter melatonin supplements but worry about safety.
Melatonin and Sleep
The tiny pineal gland deep in the center of the brain produces and secretes the hormone melatonin. Often called the sleep hormone, melatonin plays a key role in regulating the body's wake-sleep cycle. Natural melatonin secretion is low during daylight hours and increases at night, largely in response to darkness.
Adults commonly use over-the-counter melatonin supplements as a sleep aid although research data supporting effectiveness are limited, according to the American Academy of Sleep Medicine and the National Sleep Foundation. Use of melatonin as a sleep aid for children has primarily been studied in those with a underlying condition, such as attention deficit/hyperactivity disorder or autism spectrum disorder.
Safety in Children
A June 2009 Pediatrics in Review article addressed the safety of melatonin use in children. The authors stated that use of melatonin supplements for a few days to weeks is relatively safe. They noted, however, that the safety of melatonin use for longer than 4 weeks remains uncertain.
Side effects such as morning sleepiness, restless sleep, nightmares, headaches, dizziness and stomach upset have been reported in studies evaluating melatonin use in children although it is unclear whether the supplement caused these symptoms.
In addition to its role in sleep, melatonin influences puberty and reproductive function. For this reason, there is concern among some healthcare providers that long-term use of melatonin supplements in young children might delay or negatively affect sexual development. Melatonin also influences immune system function. The possible effects of melatonin supplements on a child's immune system remain uncertain.
Product quality is a consideration with respect to the safety of melatonin supplements for children. Although the US Food and Drug Administration has deemed over-the-counter melatonin generally safe, it does not monitor and regulate over-the-counter supplements with the same stringency applied to prescription medicines.
A study published in February 2017 in the Journal of Clinical Sleep Medicine evaluated the content of 31 over-the-counter supplements containing melatonin. The researchers found the melatonin content in 71 percent of the products tested was greater or less than 10 percent of the labelled content.
The range was 83 percent less to 478 percent more than the labelled melatonin content. Additionally, 8 of the 31 supplements tested contained serotonin, a nerve signaling chemical that was not listed as an ingredient.
Other Considerations and Precautions
Although melatonin supplements are generally considered safe for short-term use in children, it's important to discuss your child's sleep problems with your doctor before giving melatonin. Most sleep difficulties in children are behavioral and typically respond well to nonmedicinal sleep hygiene measures, such as:
- Going to bed and waking up at the same time each day
- Establishing a regular bedtime routine
- Avoiding stimulating activities before bedtime
- Avoiding caffeine-containing foods and beverages in the afternoon and evening
- Sleeping with a security object, such as a favorite blanket or stuffed animal
Visiting your doctor before giving your child melatonin also provides an opportunity to check for medical problems that might interfere with sleep, such as enlarged tonsils or adenoids, asthma, acid reflux or a developmental delay.
Melatonin might not be safe if your child has an existing medical condition such as diabetes, liver or kidney disease, a seizure disorder, cerebral palsy, migraines, a bleeding disorder or a weakened immune system. If your doctor recommends use of melatonin, she will advise you regarding the appropriate dosage for your child, what time to give the supplement and how long to use it.
If your child is taking a melatonin supplement and develops any unexplained new symptoms, stop the supplement and contact your healthcare provider.
- Pediatrics: Prevalence of Diagnosed Sleep Disorders in Pediatric Primary Care Practices
- Journal of Clinical Sleep Medicine: Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline
- National Sleep Foundation: Melatonin and Sleep
- International Journal of Pediatrics: Clinical Uses of Melatonin in Pediatrics
- Pediatrics in Review: Complementary, Holistic, and Integrative Medicine: Melatonin
- Agency for Healthcare Research and Quality: Melatonin for Treatment of Sleep Disorders
- Journal of Clinical Sleep Medicine: Melatonin Natural Health Products and Supplements: Presence of Serotonin and Significant Variability of Melatonin Content
- International Journal of Molecular Sciences: Melatonin: Buffering the Immune System