Melatonin: Safe Solution for Sleepless Kids?

The importance of sleep can't be over stated. Sleep matters... a lot. But in our 24/7 society, life is hectic and many children have trouble drifting off.

Well-rested kids are better behaved at home and perform better in school. Tired kids have difficulty problem solving, staying focused, and just plain coping. And that's not the worst part. Behind every sleep-deprived child is a sleep-deprived (and very cranky) parent!

Desperate for help at bedtime, many parents are turning to melatonin, a naturally-secreted hormone.

Located near the middle of the brain, the pea-sized pineal gland produces melatonin which plays a critical role in determining when our bodies fall asleep and wake up. Melatonin is secreted in direct response to light and dark.

The amount of melatonin released at night varies among individuals but appears to be somewhat related to age. Children on average secrete more melatonin than adults and levels generally drop as we age. For decades it's been used successfully in adults to treat insomnia, sleeplessness related to shift work, jet lag, and delayed sleep onset. But Judith Owens, MD and director of sleep medicine at Children's National Medical Center in Washington, DC says this may not be the best course of action for children who can't sleep.

"Melatonin isn't a medication and is not regulated by the Federal Food and Drug Administration (FDA). Like vitamins and minerals, it's allowed to be sold as a dietary supplement and can be commonly found in grocery stores and health food chains," the sleep expert explains.

Found naturally in some foods (oats, corn, and rice—both white and brown—contain it and there are small amounts in ginger, barley, tomatoes, and bananas), melatonin may seems like a benign way to bring on sleep, but Dr. Owens cautions against this type of thinking.

"Though there isn't sufficient evidence to suggest a high level of safety risk, melatonin hasn't been well studied in typically developing children. We simply don't know much about its effectiveness or safety," she points out.

Dosing Out Sleep

Proper dosage is an issue related to the lack of regulation. Because it isn't categorized as a drug, synthetic melatonin is made in factories that are also not regulated by the FDA. Listed doses may not be controlled or accurate and side effects do not have to be listed on the product's packaging. (Fatigue and depression in adults have been reported with the use of melatonin.)

Jodi Mindell, PhD is the author of Sleeping Through the Night and says the way you use melatonin depends on what you want it to do for you. "Our bodies produce very small amounts of melatonin—much less than what is provided in the supplements. There are no recommended dosage guidelines but the usual recommendations are between 1 and 3 mg," she says. "If you use it to shift the circadian clock (change your bedtime) small doses—anywhere from 0.1 to 0.5—are usually given in the late afternoon or early evening. Used as a hypnotic, it is given 30 to 60 minutes before bed in a larger dose."

Where children are concerned, the 2010 Journal of Pineal Research reports that there is no consensus on the optimal dose of melatonin to promote sleep.

According to the report, "An orally-administered dose of 0.3 mg melatonin increases levels to the nighttime peak physiologic range, whereas oral administration of melatonin at high doses elevates melatonin levels up to 100 times higher than the physiologic nocturnal peak within an hour. The high levels of melatonin do not impede its ability to cause sleep—it may actually improve the quality of sleep—and melatonin at the elevated doses has no known toxicity."

Until more is known about using melatonin in typically-developing children, Dr. Owen recommends diagnosing the cause of the insomnia first. "Insomnia is a complex condition and can be the result of multiple factors such as obstructed sleep apnea or restless leg syndrome. Often, it's related to medication a child may take during the day and can also be the result of poor sleep hygiene," Dr. Owens says.

Any sleep aid—including melatonin—should only be used in combination with good behavior management (for example the Ferber method in young children) and good sleep hygiene, such as having the same bedtime and avoiding caffeine and other substances that can interfere with sleep.

In the meantime, if you want to try melatonin don't do it without your physician's knowledge. For the highest quality, Dr. Owens recommends purchasing online pharmaceutical grade melatonin. "In theory it's more reliable in terms of concentration than what can be found at the health food stores."  

National Center on Sleep Disorders Research (NIH)

Journal of Pineal Research, 2011
Review Article, The Use of Melatonin in Pediatrics

Interview with Judith Owens, MD
Director of Sleep Medicine at Children's National Medical Center in Washington, DC

Interview with Jodi Mindell, PhD
Author, "Sleeping Through the Night"