The Melatonin Question
It is no surprise to me that Melatonin is as popular as it is. The allure of a pill to guarantee your child gets tired and falls asleep is very tempting, especially in a world when so many of us struggle with sleep.
But is Melatonin a good choice for your child?
Here are my thoughts.
For those who want just the summary…
Melatonin is widely available, effective and generally well-tolerated. We do not have a lot of data in children, and the studies we do have are primarily in specific populations (see below). There have been some reassuring studies looking at longer-term use, but these studies have limitations. At this point, as a pediatrician I would say we don’t have a lot of great data on the consequences of long-term use in children with immature brains.
For children with underlying chronic conditions such as ADHD, sleep onset insomnia, delayed sleep phase syndrome, and for neurodivergent populations who often have issues with their body’s own Melatonin production, it can be a great tool.
It is also useful for short-term use (such as jet lag or shift work).
However, many parents forget that Melatonin is still a hormone, and a medication. Its use can sometimes act as a “bandaid” so that the underlying cause for sleep issues does not get addressed. Thinking through whether or not to use it requires weighing the consequences of inadequate sleep (which are significant) against the consequences of long-term use of a medication.
As a pediatrician, for the vast majority of children (including those with underlying health conditions), I do not think Melatonin should be used in isolation. Instead, it should be thought of as an adjunct - an extra tool - that the child and family can use as they work on assessments and interventions for underlying sleep issues. Even children who need it longer-term should have optimized sleep hygiene.
This means that if your child is taking Melatonin, you should also have them going to bed at a reasonable time and with a consistent bedtime routine, as well as limited screen time in the hour or two before bed.
I also have some concerns about the lack of FDA regulation and the quality of products (read below for more info).
What is Melatonin?
Melatonin is a hormone that is naturally produced by the body to help regulate circadian rhythm. It is secreted in the brain around the time it begins to get dark outside (usually 2-3 hours before sleep onset).
For many parents, the idea of Melatonin is appealing because it feels “natural”and therefore safer — after all, it is made by our bodies. It doesn’t feel like you’re introducing risk by giving your child "a medication" in the same way as taking another medication. But it is still a hormone, and it is still a medication.
Why the hype?
The excitement around Melatonin is based on the fact that it does work. For many (but not all) children, it decreases the time to fall asleep. And especially for children with certain underlying conditions that can lead to circadian rhythm or other sleep issues (such as ADHD, sleep onset insomnia, delayed sleep phase syndrome or blindness) it is a fantastic tool. Melatonin is also a useful intervention for short-term issues such as jet lag.
Neurodivergent populations
There is also some data that children who are on the spectrum have disorders in Melatonin physiology, which means that their body may not make enough Melatonin. Even with attention to sleep hygiene, these children struggle to sleep and benefit from taking Melatonin.
But what about neurotypical children without those health conditions?
Especially in a world with more screen time and less physical activity, with busier parents and children who have activities late into the evening, there is often not a lot of time or bandwidth for a robust sleep hygiene routine. Many families turn to Melatonin as an “bandaid”. Believe me, I understand how hard it can be to fight the screen-time battle when you’re tired yourself. But this is an important place to draw the line. While Melatonin may be useful for these children, it should be a temporary intervention while you work on behavioral interventions.
What are the risks?
Melatonin risk-benefit calculations can be tricky. There are risks to not getting sleep. There are also risks in taking meds instead of fixing the underlying issue. Figuring out the “right” answer depends a lot on the specific situation, which is why this is a good discussion to have with your pediatrician.
When it comes to Melatonin, there are two main risks to think about:
Is the medication itself safe?
For most medications and supplements, the data on adults far exceeds the available data on children. With that said, we do have some research on Melatonin use in kids and some of it is reassuring; especially short-term, when taken judiciously in appropriate doses, it seems to be generally well tolerated and safe.
Longer-term data is more limited - there are a few studies looking at use for up to 2 years which do not show any red flags when it comes to puberty or growth (PMID: 31982581).
But like anything else, Melatonin can have side effects, including nightmares, dizziness, headaches, morning drowsiness and nausea. And it is possible to overdose — over the past decade there have been almost 6x the number of ingestions reported to Poison Control.
Dosing information can vary as well, and should be discussed with your doctor.
Am I actually giving my child what I think I'm giving them?
As with other dietary supplements, Melatonin is not regulated by the FDA. This means that companies that produce it are not required to adhere to the same safety standards as pharmaceuticals.
There have been multiple studies that showed the actual Melatonin content in a range of products was variable and not always consistent with the label. In fact, a recent study in JAMA (PMID: 37097362) looking at 25 gummy brands of Melatonin found the majority of them to be inaccurately labeled. While some contained less Melatonin than advertised, some contained more. One contained CBD instead of Melatonin. A study from Canada in 2017 had similar findings.
Obviously this is concerning on many levels, not least of which that children should not be taking CBD.
So should you give it to your kids?
Sleep is important. It impacts short and long term health. Its important to do what you can to optimize it.
If your child is under 3y:
Social media sometimes makes us forget what is developmentally appropriate for sleep in infants and toddlers. Some sleep challenges & night-time wakings are developmentally appropriate in this group
We also don’t have great safety or dosage data in this age group. Side effects and medication processing are not always the same as in adults or older kids.
Behavioral interventions for kids and parents have more long-term benefit for these ages.
Always remember: this age group is also at higher risk for accidental ingestions.
If your child has a chronic condition that may be causing sleep issues:
Talk to your pediatrician. Particularly for neurodivergent children or those with ADHD, they may be candidates for longer-term Melatonin use. Make sure you follow the practical tips below.
If a child is sleeping okay:
They should NOT take Melatonin (many products advertise as “ a way to help a child get “more” restful / better sleep” - this is not a thing).
If a child is struggling to sleep:
Figure out why. Sleep apnea? Restless leg syndrome? Anxiety? Other meds?
For these kids, Melatonin can be a great temporary tool as you work to figure it out, but remember: your goal is to help your child no longer need it.
We have great data that behavioral and psychological interventions can help sleep long-term (and do not have side effects). Lean into these to help your child figure out how to sleep well. You’re playing the long game.
Practical tips
If you and your pediatrician decide your child should take Melatonin, here are some best practices to keep in mind:
Identify an “exit ramp” — what it would take to no longer need it? Make a concrete plan for when you will re-assess the use. Put it on your google calendar.
Dose at the right time. This can be tricky, but aim for about an hour before bedtime. Use the smallest dose you can.
Sleep hygiene is essential. This means cutting out that screentime in the 1-2h before bed, going to bed and waking up at a consistent time daily, ensuring your child is physically active during the day. Other tips include using blackout blinds, white noise, and more. Check out this book for more.
Look into the underlying causes of your child’s sleep issues as well, and make sure it is addressed.
Read the ingredients. Know what you are giving your child.
Pick a brand that has been third party tested (some companies that do this are NSF and USP). These tests theoretically ensure that the supplement contains what is on the label and in the amounts listed, and that there are no contaminants or undeclared products. The tests do not ensure the recommended dosing is accurate or the product does what it claims.
Store it appropriately. Many parents assume that over-the-counter medications are safe but they are still medications. It should be stored out of reach in a locked child-proof container.
Overall, compared to many other medications, Melatonin has better safety data. But I worry very much about the lack of regulation and the possibility of contaminants. I also worry about it being a “bandaid” that may lead to losing opportunities to work on sleep hygiene.
If your child is on it, don’t panic. But talk to your pediatrician and make sure you’ve made thoughtful, intentional habit changes as well. And make sure you are reassessing the need regularly.
