Parents are giving kids melatonin to help them sleep. Doctors have concerns

BY ALEX JANIN | UPDATED NOV 16, 2022 08:00 AM EST

Parents turned to supplements to treat kids’ pandemic-induced stress and sleep problems. But is long-term use OK?

Stressed-out parents are increasingly giving their kids melatonin to help them sleep, raising concerns among some pediatricians about the long-term effects.

Doctors report steep increases in child melatonin consumption in recent years, driven partly by parents trying to help their kids cope with sleep disruptions during the pandemic. Americans overall spent nearly twice as much on melatonin products in the past 12 months—nearly $1.1 billion—as they did in the same period three years ago, according to data from market research firm NielsenIQ. The company doesn’t track melatonin consumption specifically among kids.

One reason melatonin is popular among adults and kids alike is that it is broadly considered by doctors to be safe as a temporary sleep aid. The melatonin in dietary supplements is most often a synthetic form of the naturally occurring hormone our brains produce to help us fall asleep.

The concerns arise with long-term use. Judith Owens, a pediatrician at Boston Children’s Hospital sleep center, says that while melatonin isn’t addictive, she is worried that it can be psychologically habit-forming, eventually making it more difficult to fall asleep without it.

“I cringe when a parent tells me that their child asks for their melatonin every night," says Dr. Owens. She estimates that almost all of the patients she sees now are on melatonin or have taken it previously, compared with only 20% of her patients five to 10 years ago.

This fall, the American Academy of Sleep Medicine released a health advisory urging parents to talk to a doctor before giving their kids melatonin, mirroring similar recommendations posted by the National Institutes of Health in July.

The number of pediatric ingestions reported to poison-control centers has surged in recent years, suggesting a rise in accidental ingestions as well as intentional ones. The annual number of pediatric cases involving melatonin ingestion reported to poison centers across the U.S. increased by 41% to about 53,000 in 2021 compared with 2019,according to America’s Poison Centers.

Among the pediatric ingestion cases reported to poison-control centers, 90% are managed at home and are relatively harmless, typically involving mild drowsiness, says Kaitlyn Brown, APC’s clinical managing director. Headaches and dizziness also sometimes occur.

Pediatricians often recommend melatonin for short-term use along with other behavioral changes, including limiting screen time and setting consistent bedtimes and wake-up times. When coupled with behavioral interventions, melatonin can be a good, temporary option for some kids with sleep problems, Dr. Owens says.

Yet sleep doctors and mental-health professionals are expressing concern about increased use in kids because there’slittle clinical research on the long-term effects of pediatric melatonin use.

Sleep doctors say they have more questions than answers about kids and melatonin, including whether long-term usecould reduce efficacy or could affect the body’s natural production of melatonin or other hormones as they enter puberty.

“It’s difficult to even answer the question when a parent says, ‘What’s the risk?’" says Nicole Christian-Brathwaite, a child psychiatrist and chief executive of Well Minds Psychiatry and Consulting in Boston.

Many parents reached for melatonin to fend off pandemic-induced stress and sleep disturbances, sometimes at the suggestion of their pediatricians, doctors and mental-health experts say. A growing number of melatonin products are filling drugstore shelves, both for kids and adults. The ease of access and reliability of the product has made it a more popular solution to kids’ sleep troubles, too, says Dr. Christian-Brathwaite.

Approximately 80% of her child and adolescent patients in the past year are currently taking or have previously taken melatonin, which is an increase from the year prior.

“There’s almost a desperation," says Dr. Christian-Brathwaite. “I can’t tell you how many conversations I have with parents who say, ‘I need my child to sleep, I can’t keep doing this if they don’t sleep.’"

Prescriptions are required to access melatonin in many countries, but it is available over the counter in the U.S., including as sugary gummies.

Like other dietary supplements, melatonin is regulated less strictly by the Food and Drug Administration than a prescription or over-the-counter drug would be. The FDA doesn’t approve supplements and doesn’t usually review them until after they enter the marketplace.

Parents should contact a poison center if they are concerned their child has taken more than recommended by a pediatrician, says Dr. Brown.

Serious problems following accidental or too much melatonin use in kids are rare, she says. “We would only expect some mild drowsiness, meaning that they may fall asleep and you can gently try to rouse them and they should come to or stir," she says.

Tablets and capsules are often less appealing to kids than their chewable and gummy counterparts, but likely to be more reliable. Manufacturers often include higher doses of ingredients in gummies to account for quicker degradation, says Tod Cooperman, president of ConsumerLab.com, a watchdog company that tests supplement brands for quality.

Prescription dosages of melatonin are also more likely to be reliable than over-the-counter, says Dr. Owens at Boston Children’s Hospital sleep center. However, it is usually more expensive than over-the-counter versions.

Sofia Axelrod, a chronobiologist and author of the book “How Babies Sleep" said she used melatonin gummies last year as a last resort for her then-7-year-old daughter who was struggling with falling asleep on time.

“She was so incredibly exhausted and it continued for weeks," she recalls.

Dr. Axelrod, who has spent her career studying circadian rhythms, tried every behavioral sleep intervention she knew of before turning to melatonin, including keeping a regular bedtime schedule and keeping all light out of her daughter’s room. After a few months of success with melatonin, she forgot to bring it with them on vacation and her daughter discovered she no longer needed it.