Doctors urge caution as more parents use melatonin to help their children sleep
The current24:25Concerns about the use of melatonin in children
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Bedtime became a hassle for Lorien’s neurodivergent son about a year after moving from Vancouver to Kootenays, BC. The lack of sleep that accompanied it affected his behavior, his relationships, and his happiness.
Therefore, after hearing a conversation in a health store that melatonin can be used for sleep, including in children, she thought she would give her son some.
“One of the things they really emphasized in that conversation… [was] low dose is key,” she said. “What you want to do is give your child just that little nudge toward sleepiness, not knock them off the cliff.”
Lorien, whose last name we’re not using to protect her child’s privacy, said it’s working as expected so far.
“I started with just literal drops, and all of a sudden it was enough that 20 minutes after taking them we were all doing our bedtime story and he would just feel sleepy,” she shared. The current Matt Galloway.
Melatonin is a hormone humans produce naturally through the pineal gland of the brain, and supplements can be purchased over the counter as a sleep aid. And according to research in the US, it is becoming increasingly popular.
a study, published in the Journal of the American Medical Association found last year that melatonin use “expanded significantly” across all demographics between 1999 and 2018.
Dr. Michael Rieder, a professor of pediatrics at Western University in London, Ontario, says melatonin helps regulate the brain’s circadian rhythm — a system of physical, mental, and behavioral changes that follow a 24-hour cycle.
“For example, it’s been shown quite clearly that if you have a disruption in the circadian rhythm… melatonin can help get the circadian rhythm back to where it’s supposed to be,” he told Galloway.
Different effects on different children
Dr. Suresh Kotagal, professor emeritus in the department of neurology at the Mayo Clinic in Rochester, Minnesota, said it’s understandable why parents like Lorien use melatonin to help with their child’s sleep problems.
“Sleep is so important for kids because it’s only when they get good, deep sleep at night that restorative functions in the brain start to click,” he told Galloway.
“And the next day, after a good night’s sleep, kids can stay more alert and be happier and learn better.”
But according to him, that does not mean that melatonin is a suitable supplement for every child.
“In typically developing children who don’t have autism, I think I’d look elsewhere for an answer to improving sleep rather than melatonin first,” he said.
According to a 2019 study published in the National Library of Medicine50 to 80 percent of children with autism spectrum disorder experience sleep disturbances, compared to nine to 50 percent of neurotypical children.
Kotagal, who also chairs the World Sleep Society task force, said there are studies showing that the enzyme Acetylserotonin O-methyltransferase (ASMT), which is important for the body to make melatonin, is deficient in children with autism.
“So indeed, when we give melatonin to children with autism or other neurodevelopmental disorders, we improve or increase the levels of melatonin in them,” he said.
He and his colleagues are conducting their own rigorous analysis of published data on melatonin use in children with autism and other neurodevelopmental disorders between 2012 and 2022. They are trying to learn more by studying about 850 neurodivergent children.
Still, he said there is evidence showing that melatonin helps children with autism and neurodevelopmental disorders sleep better. But he says the evidence isn’t as clear in other kids who just have trouble sleeping.
Lorien’s son had not yet been diagnosed with ADHD of the inattentive type when she first got melatonin for him. But she said at the time, “the risk of doing nothing was that my child was having a very, very hard time sleeping” and other aspects of daily life.
“So for me, the very small risk of the unknown was offset by the need not to just do nothing,” she added.
The use of melatonin as a sleep aid has increased significantly over the past two decades, but experts say it’s not a panacea and taking too much could cause health problems.
Understand the risks
Although the evidence for the use of melatonin in neurotypical children is weak, the supplement is widely used anyway.
That’s a concern for doctors like Rieder, because he says there’s a risk of parents giving too much melatonin to their children.
“The doses of melatonin that work in children are very small. You don’t have to give a lot of melatonin to work,” he said. “The problem was if you give it [and] it doesn’t work, there’s a natural tendency to think, ‘Maybe they should just go a bit more.'”
Rieder said melatonin can be purchased in a 10-milligram tablet, which is the right dose for an adult but too much for a child.
But because it’s usually sold as an over-the-counter supplement in Canada, there’s no middleman that can stop parents from giving their kids unnecessarily large tablets.
“You can go into your pharmacy and use a self-check and not even talk to a human being at all to get this dose,” he said.
According to data provided to The current by SickKids, which operates the Ontario Poison Center, the number of melatonin-related calls from Ontario, Manitoba and Nunavut for children five and under has increased each year from 2017 (160 calls) to 2021 (438 calls).
Lorien, who started taking melatonin supplements with her other child, understands this risk. Therefore, she takes precautions such as interruptions in use to avoid overdosing.
“We literally use scissors and we cut them into quarters to keep that dose down where we want the kids to take it,” she said.
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Nevertheless, Kotagal suggests looking at other solutions to address sleep problems.
He said if a child is under two years old, nearby noise or medical issues could be the problem and that should be looked at first.
“When we get to older children, I would try behavioral sleep measures first. If possible, discuss that with the GP or sleep specialist.”
