Should I Give My Child Melatonin for Better Sleep?

Picture this:

It's 2 AM when you once again get awoken by your child's complainant that they cannot get back to sleep. You’ve had a long day, are exhausted, know that tomorrow is likely going to be another busy day -  and you're not at your wit's end, given that this has been happening more often than you care to admit. You do your best to be supportive and comforting to your sleep deprived child but what you really need is for this child to go back to sleep. Sound familiar?

In addition, you're worried that your child's lack of sleep has had a significant negative impact on her school performance. You've done all you can to help: Established a consistent bedtime, no TV or electronics of any kind 2 hours before sleeping, no sugar or caffeinated drinks, roughhousing, to no avail. 

Then another parent at your child's school tells you about Melatonin and  how it has saved their lives. You've heard of Melatonin before but do not know it is safe for children. You call your pediatrician, who tells you, well, maybe it is safe, but he doesn’t know much about it. You're stuck. What's next?

What is Melatonin?

Used by adults and children worldwide when they need help falling asleep, Melatonin is a hormone produced by our brain to induce sleep and manage the timing of our circadian rhythms, our 24-hour internal clock. Melatonin is induced by darkness, and hence it is typically released at night and turned off in the morning. 

But research suggests that Melatonin plays other vital roles in the body beyond sleep. It is also involved in managing immune function, blood pressure and cortisol levels. And research has shown that because it is an antioxidant, it can significantly improve many health conditions.

Melatonin supplements can be made from animals or microorganisms, but they're often made synthetically. Synthetic Melatonin is formulated to mimic the effects of the naturally-produced Melatonin to induce sleep. In addition to improving sleep, melatonin is also involved in managing immune function, blood pressure and cortisol levels. Plus, it acts as an antioxidant, with some research finding that it can significantly affect many health conditions.

"Studies suggest that synthetic Melatonin does not suppress the body's natural hormone production."

But not all Melatonin is equal. A recently published study measured the amount of Melatonin in 31 different brands and found a considerable variation on the amount listed on the label. Some formulas had significantly less amount than stated while others had significantly more. I strongly recommend using a pharmaceutical graded melatonin formula for consistent effects and safety, such as Akasha Naturals.

In addition, it has been found that many non-sleep products contain Melatonin as a secondary ingredient. Children's "nighttime cough syrup" and "relaxation" drinks are only two of likely an array of misguided formulas out there.

Can Melatonin Help my Child Fall and Stay asleep; Is it Safe?

The internet is filled with contradictions regarding the safety of Melatonin in children:

• "Australian experts called the increase in use among children alarming' and warned in 2015 that parents shouldn't give it to their children." WebMD

• "Melatonin, according to more than 24 studies, is safe for children and has been used with little to no side effects." NaturalSleep.org

• "Currently, we don't have any evidence that taking melatonin daily in that sense is harmful, although there are no large-scale multicenter clinical trials to test that." Medscape

The last quote most correctly addresses the current reality of the use of Melatonin in children.

But why the sudden increase in interest in Melatonin use in Children? Anxiety, COVID-19, more  screen time, more negative news, less effective parenting? 

Observational as well as clinically relevant research has clearly demonstrated a significant increase in the use of Melatonin in children in the past five to 10 years. In England, for example, where Melatonin is only available by prescription, research has shown a 25 percent increase in melatonin prescriptions in children under 18 between 2015-16 and 2017-18, and a 40 percent increase in the extended-release forms during the same period. 

Unfortunately, given that Melatonin is widely available over the counter in the United States, there are no similar statistics in the U.S pertaining to how much it is used.. Still, pediatricians have repeatedly stated that it is rare for a child with a sleep disorder to present at a pediatrician's office not to be already on Melatonin.

Studies have,  however, shown that Melatonin has relatively few side effects in children. When there are, most are minor, such as headaches, increased bedwetting, nightmares, dizziness, mood changes, and morning grogginess, all disappear with discontinuation. But, there are ongoing concerns based on animal studies showing Melatonin can affect puberty-related hormones.

Studies have also demonstrated that Melatonin may induce faster sleep in children with insomnia, ADHD, autism, and other neurodevelopment disorders. While Melatonin is an effective short-term solution to address bedtime problems, after a thorough assessment by a well-knowledge neuro-developmental pediatrician, children with neurodevelopment disorders may benefit from long-term use. 

Although there is limited evidence that extended-release Melatonin formulas may help with night awakenings in children, more research is needed to support this use. Studies have also demonstrated that the immediate release formula is misleading in that immediate-release formulas do not help with difficulty staying asleep because it takes 2 hours for melatonin levels to peak in the blood.  

Before reaching out to the melatonin bottle, other reasons for insomnia in your child must be assessed. For example, it has been well-documented that COVID-19 has contributed to anxiety disorders in children and adults. Anxiety disorder, restless legs symptoms, or parental marital issues must be part of the assessment.

 After assessing other possible causes of insomnia  in your child, if melatonin use still seems appropriate, it should never be a "stand-alone" solution and should always be accompanied by behavioral interventions. These include temporarily delaying the bedtime to match the actual fall asleep time, using "check-ins" at bedtime, and positive reinforcement for staying in bed.

Paying attention to healthy sleep practices like having a regular bedtime and wake time seven days a week and having a regular bedtime routine is also crucial. For example, if your child or teen is using light-emitting devices before bed, insomnia delayed sleep is likely to occur because sunlight suppresses the body's natural release of Melatonin.

So, who will benefit from it? 

The consensus among expert pediatricians is that Melatonin should not be given to healthy, typically developing children under age 3 because difficulties falling and staying asleep in these children are, in most cases, behaviorally induced. 

Also, Melatonin can be effective as part of treating teens with a "delayed sleep phase, a circadian rhythm disorder. In this disorder, the natural fall asleep and wake times are much later than usual, usually by three hours or more, significantly interfering with regular sleep and daily activities. Management of this sleep disorder usually includes gradually adjusting the sleep schedule to avoid light exposure before bed.

When should Melatonin be avoided?

As mentioned above, children lose sleep for many reasons. Avoid Melatonin:

• if the insomnia is situational (stemming from anxiety about a new school year, for example)
• if the insomnia is short-term (caused by an ear infection, for example)
• if the insomnia is due to an underlying physical cause (like sleep apnea or restless legs)
• if your child is younger than 3

Melatonin should never  be used first before healthy sleep hygiene is implemented:

• A regular, age-appropriate, and consistent bedtime and bedtime routine
• No caffeine
• No electronics or screens before bedtime

Take-Home Message:

• Consider Melatonin for your child only in consultation with a health care provider, and make sure you study the label carefully before. 

• Melatonin is likely to have the least risk and the most benefit if your child has significant difficulty falling asleep and when it is used in combination with behavioral interventions and healthy sleep practices.

We stand behind Akasha Naturals’ formula safety and efficacy for both children and adults.

By Dr. Edison de Mello -  Founder and Chief Medical Officer of the Akasha Center for integrative Medicine is a board-certified integrative physician with over 25 years of experience in the field of Integrative Medicine.

His recent book, BLOATED? Outlines Dr. de Mello's approach to medical care. With his signature approach: "I meet my patients before I meet their diseases." Dr. de Mello has helped thousands of patients across the globe. 

Sources:

• Shane-McWhorter, L. (2020, July). Melatonin. Merck Manual Consumer Version. Retrieved June 15, 2021, https://www.merckmanuals.com/home/special-subjects/dietary-supplements/melatonin
• Masters, A., Pandi-Perumal, S. R., Seixas, A., Girardin, J. L., & McFarlane, S. I. (2014). Melatonin, the hormone of darkness: From sleep promotion to ebola treatment. Brain Disorders & Therapy, 4(1), 1000151.https://pubmed.ncbi.nlm.nih.gov/25705578/
• Savage, R. A., Zafar, N., Yohannan, S., & Miller, J. (2020). Melatonin. In StatPearls. StatPearls Publishing.https://pubmed.ncbi.nlm.nih.gov/30521244/

• National Center for Complementary and Integrative Health. (2021, January). Melatonin: What you need to know. Retrieved June 15, 2021, fromhttps://www.nccih.nih.gov/health/melatonin-what-you-need-to-know
• Esposito, S., Laino, D., D'Alonzo, R., Mencarelli, A., Di Genova, L., Fattorusso, A., Argentiero, A., & Mencaroni, E. (2019). Pediatric sleep disturbances and treatment with melatonin. Journal of Translational Medicine, 17(1), 77.https://pubmed.ncbi.nlm.nih.gov/30871585/