Melatonin commonly taken by kids not a magic bullet, pediatricians say

New research says it’s becoming “exceedingly common” for children and teens in the U.S. to take melatonin supplements for sleep, a trend some Canadian pediatricians are watching with caution in this country.

Researchers behind a University of Colorado Boulder letter published in the November issue of the journal JAMA Pediatrics say they want to raise awareness for parents and clinicians and sound the alarm for the scientific community on the trend.

The study’s authors found nearly one in five school-aged children under the age of 14 now take melatonin, based on a survey of 993 families.

“Melatonin forms and preparations are more child friendly (eg. gummies), which may be factors in increased use,” lead author Lauren Hartstein, a postdoctoral fellow at the university’s sleep and development lab wrote alongside her co-authors.

What’s more, parents often reported giving melatonin for more than 12 months, but research on its long-term safety in kids and teens is lacking.

At SickKids in Toronto, sleep medicine physician Reshma Amin said they’re definitely are seeing more use of melatonin in children from young preschoolers to teens.

“It’s not just a benign medication,” Amin said in an interview. “By the time patients come to see us … [they] are desperate. They are tired. They’re frustrated and they just want their child to sleep so that they also can get a good night’s sleep. And so what they’re hoping for is a magic pill to make their child fall asleep.”

But experts say it’s not a magic pill.

Melatonin is a hormone your body makes in the pineal gland.

Amin said starting at three months of age, when it is dark outside, you release a lot of melatonin to make you sleepy. Less is released when it is bright outside.

“This balance between release of melatonin when it’s dark versus light outside is what really helps to entrain what’s called our circadian rhythm, which is our sleep-wake cycle,” she said.

Despite melatonin being known for regulating circadian rhythm, Amin said people take the supplemental form for its hypnotic effect — which scientists know the least about.

One of Amin’s concerns is that Health Canada regulates melatonin for use in sleep disruption in adults only, meaning all use in kids and teens is off label at a prescriber’s discretion.

It’s also not regulated in the same way as a prescription or over the counter product like a fever reducer.

“Although the packaging might say three milligrams of melatonin, we know from even a Canadian study that was done a few years ago that the dosing will have a huge amount of variability,” she said.

Won’t work right before bed

Wendy Hall, professor emeritus at the University of British Columbia’s nursing school, treats and studies behavioural sleep problems by helping parents.

Hall said we secrete melatonin about two hours before bedtime.

“If you’re just giving a child melatonin right before bed, it’s not mimicking what the hormone would normally do in the body.”

“I know it’s not realistic to tell people to throw it out because a lot of people are using it — they swear by it,” Hall said.

“I would also advise that they really pay close attention to the amount of dose children should be getting because if they get too much, it can have very negative side effects too.”

Side effects include bad dreams and aggression, Hall said.

“You want the lowest dose possible that’s effective. Keep it locked up. Don’t let children get access to it unless you’re giving it to them,” she said.

Both Amin and Hall recommend prevention before turning to supplements:

• Keep a sleep diary and see what happens after you introduce melatonin, and if it makes a difference.
• Prepare children for sleep by relaxing without screens and doing a quiet activity before bed.
• Keep consistent wake times and bedtimes both during the week and on weekends.
• Make sure the child is not going to bed hungry or not eating too much before bed.
• Give a child the chance to get the number of hours of sleep that’s age appropriate.

“I think a lot of parents get told when they do go and seek professional help with a child with a sleep problem, ‘Don’t worry, they’ll grow out of it,’ or, ‘It’s normal for children not to sleep well.’ And neither of those things are actually accurate.”

Risa Waldman, owner and director of a music school for young families in Toronto, said her family was desperate to get their daughter to sleep as a preschooler.

“We did the tiniest smallest dosage, like a quarter of one milligram, just to see what happened,” Waldman said of the melatonin. “Honestly, it really has worked for us.”

Now 11, Waldman’s daughter sleeps better.

For teens, Amin said they’re prone to “erratic sleep schedules” because teens go through a delayed sleep phase by staying up late and getting up early for school.

“They’re completely sleep deprived,” Amin said. “Then on the weekends, it’s like they’ve flown all the way to Vancouver and back.”

If a family is struggling, Amin said to speak to a family physician or pediatrician because help is available.