Debate over the use of melatonin to induce sleep in children

For three grueling years, Lauren Lockwood tried to get her son Rex to sleep through the night. When he was a baby, he couldn’t sleep without a blanket covering him completely to isolate him from the outside world. At age 2, he would sometimes take hours to fall asleep—and so would his mom—and then he would wake up with a start, terrified by nightmares that made him scream in panic.

For years, Lockwood, a nurse midwife who works with a group of new mothers at her home in Oakland, California, experimented with a variety of approaches to bedtime.

As a baby, I let him cry so he would learn to fall asleep on his own. As he grew older, she lay next to her for hours each night. Ultimately, she hired a sleep consultant who came up with another plan that didn’t solve the problem. By the time Rex turned 3, Lockwood, with another baby on the way, was exhausted and desperate.

Then you read about melatonin, a hormone released by the pineal gland that helps regulate the sleep cycle. Melatonin is sold as a dietary supplement in pharmacies and is marketed to children in the form of chewable tablets, flavored liquids, and gummies. “I thought maybe he just needed a little help,” Lockwood said.

Lockwood said that from the first night his son “became a totally different boy.” He gave her a melatonin pill and read her a story, and she fell asleep almost immediately. “Our plan was to use melatonin for two weeks and then stop.”

Six years later, he is still taking it every night.

Throughout history, parents have searched for the secret to calming bedtime: sleeping together, sleeping apart, the “Ferber Method” war of wills, offering stuffed animals and pacifiers and hot milk, even spending $1,600 on a “smart” bassinet that responds to a baby’s cries with white noise (quiet) and movement.

In recent years, melatonin supplements have become an increasingly common childhood sleep aid, which in the United States do not require a prescription and are only lightly regulated by the Food and Drug Administration (FDA).

In 2021, Americans spent $1.09 billion on melatonin supplements, an increase of nearly 150% over 2018 sales, according to data provided by NielsenIQ. Meanwhile, the number of melatonin poisoning reports involving young children — meaning they ingested excessive doses — more than doubled from 2017 to 2021, according to the American Association of Poison Control Centers.

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There were about 46,300 reports of poisoning in children 5 years old and younger in 2021, compared to nearly 19,400 in 2017. Potential symptoms of an overdose include headaches, dizziness, and irritability. Only a handful of the reported incidents led to major medical problems.

“This speaks to the wide use of melatonin. It has spread to younger and younger children,” said Dr. Judith Owens, co-director of the Sleep Center at Children’s Hospital Boston and a professor of neurology at Harvard Medical School. “What I find especially alarming is that pediatricians recommend it as a quick fix. It sends to parents, and then to older children, the message that if you can’t sleep, you have to take a pill.”

The American Academy of Sleep Medicine advises against the use of melatonin for chronic insomnia, both in adults and children, and will soon issue a public health advisory stating that melatonin should not be used in children without the supervision of a doctor, said Dr. Muhammad Adeel Rishi, co-chairman of the academy’s public safety committee and a sleep specialist at Indiana University.

“Most of the time insomnia in children is a behavioral problem, and it is related to their bedtime routine, access to electronic devices at bedtime and other activities in which they are involved. concentrate instead of sleep,” Rishi said. “It can often be treated without medication, with behavioral interventions.”

Rishi attributes the recent rise in melatonin use in children, in part, to the marketing efforts of supplement manufacturers, including products like gummies specifically targeted at children. But he also believes the pandemic has spawned a “growing epidemic of insomnia.”

“We are going through a very stressful time as a society. And this is available on the shelf, so it’s easy to access. Parents usually take it. And it’s supposed to be safe,” Rishi added. “It’s kind of a perfect storm.”

But despite the concerns about melatonin, it also has staunch supporters among sleep specialists and pediatricians, creating a mixed message for parents looking for a solution to the sleep problem at home.

Dr. Rafael Pelayo, a professor in the division of sleep medicine at Stanford Medicine, said he believes melatonin is a useful tool for treating sleep disorders in the very young. “It just tells the brain that night is coming,” he said. “I think the real problem is not that it is overused, but the large number of sleep problems that children have.”

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“A small improvement in a child’s sleep,” he added, “can have a dramatic impact on the family.”

Pelayo said he sometimes recommends melatonin for little ones while the family implements behavior changes to address an underlying problem. Many kids get by without it once they learn to sleep on their own, he said, but some end up taking it for a long time. He said it works better for kids who have trouble falling asleep, rather than those who wake up frequently during the night.

Melatonin is a hot topic of conversation in Facebook groups like The Mamahood-SF Bay Area, of which Jill Kunishima is a member. Kunishima first tried melatonin for her son at the suggestion of her pediatrician. She had slept well until she started preschool at age 3. The nap schedule at school disrupted her sleep routine, and she stayed up until almost 10 p.m.

“The next day it was a disaster. We went into his room in the morning and he was all grumpy,” said Kunishima, who lives in Oakland.

The pediatrician recommended a one-milligram melatonin pill for a week or two, and her son’s bedtime was back to 8:30 pm. “It got his body to calm down,” she said. “It was just what he needed.” But when he withdrew her pill, the problem started all over again.

When Kunishima returned to the doctor with her son, the pediatrician told her not to worry. “’If that’s what’s going to help you with your life, go ahead,’” he recalled the doctor’s words. “But now she’s 6 years old, she’s in first grade, and she’s still on the pill.”

Studies suggest that melatonin appears to be safe for short-term use in children, but there is little information on long-term effects, according to the National Institutes of Health. Since melatonin is a hormone, some experts are concerned that its use may delay puberty, although the evidence is scant. Other possible side effects include drowsiness, bedwetting, and restlessness.

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Because melatonin is considered a supplement in the United States—and not a drug—quality and dosage levels can vary widely. A 2017 study looking at 31 melatonin supplements found that actual melatonin levels ranged from less than one-fifth to almost five times the dosage stated on their labels.

One in four products tested also contained serotonin, a hormone that can have serious side effects even at low doses.

Owens said he is concerned about teens and young adults who have been taking melatonin for a decade or more, the effects of which are still unknown. “Whenever a sleep medication is recommended or prescribed, you have to have an exit strategy. What is your point of reference for deciding that we are going to stop this medication?” he asked himself.

“I have patients who ask for their sleeping pill every night, and it gives me the creeps.”

She is also concerned that the American Academy of Pediatrics has not published official guidelines on the use of melatonin in children, given that melatonin is frequently recommended by pediatricians as a sleep aid and in increasingly younger patients, sometimes as young as 6 months.

Lockwood said her son, now 9, continues to take a quarter milligram of melatonin every night before bed. It’s such a small dose that he wonders if maybe he’s experiencing a placebo effect, but efforts to wean it off rekindle his insomnia.

At Lockwood’s group for new moms in Oakland, sleep is often the main topic of conversation. “It’s something that consumes us as mothers,” she said. “What happened to me was that no one helped me and no one gave me a solution.”

“Sometimes I wonder if he’s going to have to keep doing this his whole life,” he added. “But I no longer torment myself. It works, and he’s happy.”

Phillip Reese, adjunct professor of journalism at California State University-Sacramento, contributed to this article.

KHN (Kaiser Health News) is the newsroom of KFF (Kaiser Family Foundation), which produces in-depth health journalism. It is one of three major programs of KFF, a nonprofit organization that analyzes the nation’s health and public health issues.

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