Melatonin Use Increasing in Children and Teens

Insomnia doesn’t just impact CEOs of big companies or parents of newborns. A new study from the University of Colorado at Boulder finds that nearly 20% of school-aged kids and preteens now use melatonin for sleep. In addition, some parents consistently provide the hormone to preschoolers, according to a new study published in the November 13th issue of JAMA Pediatrics.

Dietary supplements lack Food and Drug Administration (FDA) regulation, which concerns the researchers as the safety and efficacy of using these products are also limited.

Lead author Lauren Hartstein, PhD, a postdoctoral fellow in the Sleep and Development Lab at CU Boulder, notes, “We hope this paper raises awareness for parents and clinicians and sounds the alarm for the scientific community. We are not saying that melatonin is necessarily harmful to children. But much more research needs to be done before we can confidently state that it is safe for kids to take long-term."

Calls to Poison Control Centers on the Rise

The pineal gland produces melatonin naturally and tells the body that it’s time to sleep and manage its circadian rhythm- the physiological cycle over 24 hours.

The hormone is classified as a medication in many countries and is available by prescription only.

Yet, chemically created or animal-based melatonin is available over the counter as a dietary supplement in the US. It’s also increasingly available in kid-friendly gummies.

Hartstein, who studies how environmental cues, including light at night and children's sleep quality and melatonin production, notes, "All of a sudden, in 2022, we started noticing many parents telling us that their healthy child was regularly taking melatonin”.

Between 2017 and 2018, roughly 1.3% of parents in the US reported that their children used melatonin.

Hairstein and colleagues questioned nearly 1,000 parents in the first half of 2023 to evaluate the current prevalence of melatonin use.

18.5% of children between the ages of 5 and 9 surveyed had been given melatonin in the past 30 days. In preteens between the ages of 10 and 13, the number increased to 19.4%. Almost 6% of preschoolers between the ages of 1 and 4 had been given melatonin in the previous month.

Grade-school-aged kids and preteens have used melatonin for an average of 18 and 21 months, while preschoolers who used it had been using it for roughly one year.

The dosage increased with the age of the child, with preschoolers using between 0.25 to 2 mg and preteens using up to 10 mg.

Caution Advised

A study published in April 2023 analyzed 25 gummy melatonin products and found that 22 contained various amounts of melatonin compared to what the label stated. One supplement contained over three times the amount on the label, while one had none at all. Additionally, some melatonin supplements have been discovered to contain other substances of concern, including serotonin.

Harstein is concerned that, "Parents may not actually know what they are giving to their children when administering these supplements,”

Other researchers are concerned that giving melatonin to children whose brains and bodies are still growing could impact the timing of the onset of puberty.

Inconsistent results have been seen in a few small-scale human studies investigating this.

Another concern is gummies, as they look and taste like candy. The authors note that from 2012 to 2021, reports of melatonin ingestion to poison control centers were up 530%, primarily in children under age 5. Over 94% were unintentional, and 85% were asymptomatic.

A Place for Appropriate Use

According to co-author Julie Boergers, Ph.D., a psychologist and pediatric sleep specialist at Rhode Island Hospital and the Alpert Medical School of Brown University, “when used under the supervision of a health care provider, melatonin can be a useful short-term aid, particularly in youth with autism or severe sleep problems.

"But it is almost never a first-line treatment," she said, noting that she often recommends that families look to behavioral changes first and use melatonin only temporarily. "Although it's typically well-tolerated, whenever we're using any kind of medication or supplement in a young, developing body, we want to exercise caution."

Her patient’s parents have noted that the supplement typically works well in the beginning, but over time, kids may require higher doses to get the same effect.

Harstein warns that using melatonin early in life could also have another unintended consequence. It could send a message that if you have trouble sleeping, pills are the answer.

According to the authors, this study was small and doesn’t necessarily represent nationwide usage.

However, "If this many kids are taking melatonin, that suggests there are a lot of underlying sleep issues out there that need to be addressed," Hartstein said. "Addressing the symptom doesn't necessarily address the cause."

Below are some natural ways to improve sleep in children and preteens:

·         Set a consistent bedtime schedule, even on weekends.

·         Encourage a regular wake-up time during the week and also on weekends.

·         Reduce screen time, especially at night before bedtime.

·         Avoid caffeine consumption, mainly after 2 PM.

·         Teach children ways to relax, such as meditation or deep breathing.

·         Encourage regular exercise and getting outside, which aid in regulating the circadian rhythm

·         Avoid stressful discussions or arguments right before bed

·         Ask your doctor about using melatonin or other sleep aids before using.

Lisa Andrews, MEd, RD, LD

Reference:

1.    Lauren E. Hartstein et al. Characteristics of Melatonin Use Among US Children and Adolescents. JAMA Pediatrics, 2023 DOI: 10.1001/jamapediatrics.2023.4749