February 1, 2023

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Up to 25 percent of kids and adolescents have trouble falling and staying asleep, according to the American Academy of Pediatrics. If bedtime is a struggle in your home, you may be wondering whether giving your child a melatonin supplement could help.

According to a nationally representative survey by Consumer Reports of 3,070 adults conducted in June and July, a total of 10 percent of people with kids under 18 at home say at least one of those children takes melatonin, including 11 percent of those with children ages 2 to 4.

Melatonin is a naturally occurring hormone produced by the pineal gland, a small structure at the center of the brain. In people with normal sleep-wake cycles, the body starts secreting melatonin about an hour before bedtime, says Craig Canapari, director of the Yale Pediatric Sleep Medicine Program. This signals to the body that it’s time to sleep.

In many countries, melatonin is available only with a prescription. But in the United States, it is sold over the counter as a supplement. Some pediatricians recommend melatonin for kids with sleep disorders, but it can be hard to determine whether supplements are safe for everyday use — especially for children. Plus, as with all drugs and supplements, melatonin must be stored out of reach of any children in your home. The Centers for Disease Control and Prevention has said that accidental ingestions of melatonin among kids are on the rise.

Here’s what you need to know about using melatonin for kids, experts say.

To some extent, yes. A 2013 meta-analysis found that people with insomnia fell asleep about seven minutes faster when they took melatonin. But that study was in both adults and children, and the researchers said there was not enough data on children to analyze the relationship between age and efficacy.

Much of the research suggesting that melatonin might be helpful in children has focused on those with autism or sleep problems related to attention-deficit/hyperactivity disorder, rather than in kids whose primary issue is sleeplessness, Canapari says. In such kids, it’s generally “given a half-hour before bedtime and helps the transition from wake to sleep,” says Judith A. Owens, director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital.

Research also suggests that melatonin taken in small doses at certain times can help school-age children with delayed sleep cycles, in which they consistently go to bed late and wake up late.

Kids with sleep-onset insomnia, who usually take longer than 20 to 30 minutes to fall asleep at night, may also benefit from melatonin’s sleep-inducing effects, says Anna E. Esparham, a pediatrician at Children’s Mercy Hospital and a clinical associate professor of pediatrics at the University of Missouri-Kansas City School of Medicine.

Melatonin doesn’t affect sleep quality, Canapari says. He discourages relying on it, especially as a replacement for good bedtime practices such as sticking to a regular sleep-wake schedule and maintaining a relaxing bedtime routine — which should include avoiding screen time for a few hours before bed, Esparham says.

Is melatonin safe short and long term?

Scientific research about the long-term safety of melatonin use is scant, and how long-term use might affect kids’ development is still unknown, Esparham says.

Melatonin is a hormone, so the primary concern is that persistent use could delay puberty or cause premature sexual development. “Melatonin has an impact on the [hypothalamic-pituitary-gonadal axis], which governs the development of pubertal changes,” Owens says. “In theory, melatonin could affect that.”

A 2021 study of melatonin in children with autism found no negative effect on hormonal development over the course of two years. In a longer-term study of young adults who took melatonin for an average of about seven years, some participants reported delayed puberty. But this was a retrospective study and was not designed to show cause and effect.

In the short term, Esparham says, melatonin isn’t likely to cause serious side effects, although some kids may experience daytime sleepiness or even develop nighttime bed-wetting.

Finally, parents should be aware that supplements are not regulated in the same way as drugs and that the Food and Drug Administration does not verify that supplements contain what they say they do before they go to market.

Research has even found issues with melatonin supplements in Canada, where supplements are regulated more like drugs. Groups such as U.S. Pharmacopeia and NSF International verify the contents of certain supplements, so you can look for their mark on the label when you’re shopping.

“With a heavy dose of caution, melatonin in the short run, for three to six months, seems to be relatively safe from the standpoint of short- or long-term side effects,” Owens says. “But we simply don’t have the data to make a definitive statement about it.”

What else should parents know?

The American Academy of Pediatrics recommends discussing the possibility of using melatonin with your child’s doctor before starting a supplement. A pediatrician can rule out medical issues that may interfere with sleep, such as anxiety or sleep disorders, along with recommending healthy sleep routines.

The maximum dose of melatonin for children who weigh less than 88 pounds, Canapari says, is 2 milligrams. The maximum for kids who weigh more than that is 5 mg. Canapari recommends using the lowest dose for the minimum amount of time possible.

Be mindful, too, of your own expectations for how long your child should be sleeping. While ample sleep is an important part of well-being, some kids just need less sleep than their peers. If your child isn’t falling asleep at night, melatonin may be a short-term solution, but it won’t necessarily solve the real problem. Instead, it’s best to focus on supporting long-term behaviors that help kids fall and stay asleep.

Copyright 2022, Consumer Reports Inc.

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