Too Many Children Are Taking Melatonin

Melatonin supplementation may help reset your internal clock leading to a better night's sleep, but its use in healthy children is controversial, especially for long periods.

STORY AT-A-GLANCE

• Supplementing with small amounts of melatonin can help to reset your internal clock, but the effects of long-term supplementation in children are largely unknown

• Melatonin supplementation may help children with autism, ADHD or other neurodevelopmental or psychiatric conditions

• While occasional melatonin supplementation in healthy children may help sleep and is unlikely to cause harm, most sleep problems should be addressed via improved sleep hygiene and behavioral changes

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Editor's Note: This article is a reprint. It was originally published June 22, 2017.

Melatonin is an important hormone produced by your body's pineal gland. One of its primary roles is regulating your body's circadian rhythm. When it gets dark, your brain starts secreting melatonin (typically around 9 or 10 p.m.), which makes you sleepy. Levels typically stay elevated for about 12 hours, then, as the sun rises, your pineal gland reduces your production, and the levels in your blood decrease until they're hardly measurable at all.

When your circadian rhythms are disrupted, such as from shift work, jet lag or nighttime light exposure, your body produces less melatonin. It's these instances when supplementing with small amounts of melatonin can be most useful, as it may help to reset your internal clock.¹ However, a growing number of children are reportedly now taking the supplement to help them sleep, which could be associated with long-term risks.

Melatonin May Help Children With Certain Sleep Disorders

If your child has a unique medical need that makes nighttime sleep difficult, melatonin may be helpful and is likely safer than prescription sleep aids. One example would be children with autism, for whom sleep disorders are common and may intensify autistic symptoms. Melatonin has been found to help synchronize circadian rhythms and improve sleep quality and behavior in individuals with autism.²

Among children with attention deficit hyperactivity disorder (ADHD) and chronic sleep onset insomnia, melatonin was also found to be an effective therapy in 88% of cases even when used long-term, with no serious adverse events reported.³ Further, behavior and mood also improved in 71% and 61% of the cases, respectively.

Most Children Should Be Able to Get a Sound Night's Sleep Without Melatonin

For children who are otherwise healthy but struggle with bedtime on occasion, however, melatonin should be used with caution, if at all. "Most pediatricians know little about sleep or melatonin. For non-autistic children it is a fashionable treatment for parents wanting 'perfect' children," Dr. Neil Stanley, former director of sleep research at the University of Surrey, told The Guardian.⁴

While melatonin is thought to be relatively safe when used for short or even medium periods (up to 18 months), some children are taking the supplement for six or seven years. The long-term effects of melatonin on children are largely unknown, but there is some research that suggests it could interfere with the production of hormones related to puberty. According to one study, caution is warranted even in children with ADHD and chronic insomnia:⁵

"Very little systematic research has been done into the possible impact of melatonin intake on puberty and the endocrine system. Therefore, treatment with melatonin in children with ADHD and (C)SOI [chronic sleep-onset insomnia] is best reserved for children with persistent insomnia which is having a severe impact on daily functioning, particularly in cases where [there] is an obvious phase-shift of the endogenous circadian rhythm."

There are, however, those who support its use, even among healthy children — 25% of whom are said to suffer from insomnia (this rises to 75% in children with neurodevelopmental or psychiatric conditions).⁶

According to a review published in the journal Canadian Family Physician, "For children with otherwise undiagnosed insomnia and healthy sleep hygiene, melatonin use should be considered. While melatonin seems to be safe, there is a lack of evidence for its routine use among healthy children."⁷

Proper Sleep Hygiene Should Be Addressed First

There are concerns that a synthetic form of melatonin is being overprescribed to children who could improve their sleep using other methods, like adopting a regular bedtime routine. This may be as simple as pulling down your window shades, putting your child in pajamas, reading a story and turning on some white noise, followed by a hug and kiss.⁸

Behavioral modifications and attention to proper sleep hygiene should always be the first line of treatment if your child is having trouble sleeping, even before trying a natural supplement like melatonin. In particular, the College of Family Physicians of Canada suggested:⁹

• Napping during the day should be avoided

• Dinnertime should be at least two hours before bedtime

• Screen time (watching television, playing computer or video games) should be discontinued at least one hour before bedtime

• Regular bedtime routine including routine sleep and wake-up times should be maintained

• Children should sleep in their own beds

• Sleep environment should be dark and quiet; room should not be too hot

• Caffeine, nicotine and alcohol should be avoided

Attention to light and darkness, at the appropriate times of day, is also important. Your body requires exposure to bright daylight, especially in the early morning, to produce healthy amounts of melatonin each night. Getting sunlight in the morning is one way to help reset your circadian clock daily. Ten to 15 minutes of morning sunlight sends a strong message that it's time to rise and shine. In this way, your body is less likely to be confused by weaker light signals later in the day.

My rule of thumb is, if there is enough light in your bedroom at night to see your hand in front of your face, then there is too much light. Your body requires light during the day to produce healthy amounts of melatonin, but at night, light inhibits production.

So, it's difficult to get too much light during the day and easy to get too much at night. In addition to installing blackout drapes in your child's bedroom, avoid exposure to blue light at night and have your child wear blue-light-blocking glasses after the sun sets.

At What Age Should Your Children Sleep in Their Own Room?

In 2016, the American Academy of Pediatrics (AAP) released their sleep guidelines for infants, intended to reduce the risk of SIDS and other sleep-related infant deaths.

In addition to putting babies to sleep on their back until 1 year of age, they also recommend both a firm sleep surface with no other bedding or soft objects and breastfeeding. In addition, AAP recommends that infants sleep in their parents' room, close to the parents' bed (such as in a bedside portable crib) for at least the first six months and ideally for the first year.¹⁰

In contrast, a study published in Pediatrics in June 2017 found that room-sharing at ages 4 months and 9 months was associated with worse sleep outcomes.¹¹ Instead, babies who slept in their own rooms prior to 4 months of age slept 40 minutes more a night than babies still room-sharing at 9 months.¹² There's much controversy in this area, however, and how long your infant stays in your bedroom may depend on practical matters and personal preferences as well.

Further, while health officials typically advise against bed-sharing with infants, some experts believe the practice of bed-sharing, when done safely and with a breastfeeding mother, may actually reduce the risk of SIDS and provide a safe sleeping environment.¹³ In case you're wondering how much sleep your child actually needs, here are the guidelines from the National Sleep Foundation (NSF):¹⁴

• Infants (4 to 12 months) — 12 to 16 hours

• Toddlers (1 to 2 years) — 11 to 14 hours

• Preschoolers (3 to 5 years) — 10 to 13 hours

• School-age children (6 to 12 years) — 9 to 12 hours

• Teenagers (13 to 18 years) — 8 to 10 hours

Sleep Tips From Fellow Parents

Sometimes, fellow parents have insightful tips to help children get to sleep. In an article posted on Growing Slower, one mom shared what finally helped her toddler get a good night's sleep, and it involved a long process of trial-and-error to find the right combination of "tricks" that worked for their family. Among them:¹⁵

• Organic cotton sleepwear in lieu of synthetic and possibly irritating fabrics

• Immune system support in the form of vitamin D, vitamins and omega-3 fats

• A teaspoon of coconut oil before bed, to curb hunger pains during the night

• Epsom salt baths prior to bed

• Magnesium oil, massaged onto the belly before bedtime

• A breastfeeding elimination diet as well as addressing food allergies and sensitivities in the child

• White noise (in the form of a fan)

• A predictable bedtime routine

It's important to remember, too, that children sleep better when parents take an active role in creating a positive sleep environment. According to NSF, "When parents set and enforce sleep rules, children sleep longer."¹⁶

For instance, setting and enforcing a set bedtime and limit on how late your child can watch TV or use the computer may boost sleep by more than one hour a night. Being a good role model is also important, including limiting your own exposure to electronic devices and blue light at night and wrapping up your work prior to bedtime.

Even doing homework too late at night may make it difficult for your child to fall asleep. "Make sleep a healthy priority in your family's busy schedule," NSF states. "Set appropriate and consistent bedtimes for yourself and your children and stick to them, and talk to your child about the importance of sleep for health and well-being."¹⁷

Boost Your Child's Natural Melatonin

Before considering melatonin supplementation for your child, it makes sense to engage in habits that will increase your child's natural melatonin production and improve overall health. The tips that follow apply to both children and adults.

• Sunshine during the morning — Melatonin is affected by your exposure to light and dark. When it is light, production of melatonin naturally drops. Getting at least 15 minutes of sunlight in the morning hours helps to regulate the production of melatonin, dropping it to normal daytime levels, so you feel awake during the day and sleep better at night.

• Sleep in the dark — Your body produces and secretes melatonin in the dark, helping you to go to sleep and stay asleep. Sleeping in a completely darkened room, without lights from alarm clocks, televisions or other sources will improve your sleep quality. If you get up during the night to use the bathroom, it's important to keep the lights off so you don't shut off your production of melatonin. Also, wear blue-light-blocking glasses after sunset to avoid blue-light exposure.

• Turn off your computer and hand-held electronics — Although these are light sources, they deserve special mention as the type of light source from digital equipment may also reduce your body's production of melatonin in the evening when you need it most.

  Brightness and exposure to light in the blue and white wavelengths appear to affect the production of melatonin, exactly the wavelengths of light emitted from tablets, laptops and computers.¹⁸ To protect your sleep, put your computers and digital equipment away at least one hour before bed.

• Reduce your caffeine intake — Caffeine, found in coffee, dark chocolate, cola and other drinks, has a half-life of five hours. This means 25% remains in your system 10 hours later. For a better night's sleep, cut out your caffeinated foods and drinks after lunch.

• Lower your stress level and your cortisol level — The release of melatonin is dependent on the release of another hormone, norepinephrine. Excess stress, and the resulting release of cortisol, will inhibit the release of norepinephrine and therefore the release of melatonin.¹⁹ Stress-reducing strategies you may find helpful before bed include yoga, stretching, meditation and prayer.

• Increase foods high in magnesium — Magnesium plays a role in reducing brain activity at night, helping you to relax and fall asleep more easily. It works in tandem with melatonin. Foods containing higher levels of magnesium include green leafy vegetables.²⁰

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2.  Chronobiol Int. 2017;34(4):527-530

3.  J Pineal Res. 2009 Aug;47(1):1-7

4.  The Guardian May 29, 2017

5.  Tijdschr Psychiatr. 2013;55(5):349-57

6.  Can Fam Physician. 2016 Apr; 62(4): 315–316

7.  Can Fam Physician. 2016 Apr; 62(4): 315–316

8.  Huffington Post March 7, 2016

9.  Can Fam Physician. 2016 Apr; 62(4): 315–316

10.  Pediatrics October 2016

11.  Pediatrics June 2017

12.  Time June 5, 2017

13.  Pediatric Respiratory Reviews 2005, 6, 134-152

14.  National Sleep Foundation, January 3, 2024

15.  Growing Slower, 11 Ways to Help Toddlers Sleep Through the Night

16.  National Sleep Foundation March 3, 2014 (Archived)

17.  National Sleep Foundation March 3, 2014 (Archived)

18.  Scientific American Mind 23, 13 (2013)

19.  Drug Development Research July 2005, Volume 65, Issue 3, Pages 119-125

20.  WebMD (Archived)