Image Credit: yanadjana/EnvatoElements.com

By Mona Fahoum, ND and Kim Ross, DCN

Reviewed by Deanna Minich, Ph.D.

October 25, 2023

The use of melatonin for children and teens has been in the news, from the American Academy of Sleep Medicine to Consumer Reports to popular news feeds and social media outlets.

These reports were primarily a result of a recent Centers for Disease Control and Prevention (CDC) report that found that the annual number of calls to U.S. poison control centers for childhood ingestion of melatonin increased by 530% from 2012-2021 (1). While most of these reports were unintentional ingestion of melatonin, it did result in symptoms presenting in almost 16% of children. Sadly, melatonin became children's most frequently ingested substance in 2020, resulting in more than 4,000 hospitalizations (1). Further, a 2023 study reported that the number of emergency room visits for unsupervised medication exposure among children increased by 421% (1,440 visits) due to melatonin exposure (2).

These numbers might leave you wondering—why are children and teens using melatonin?

In 2020, the American Academy of Pediatrics reported that only 47.6% of children were getting sufficient sleep, which may be one reason parents seek melatonin use for their children (3).

However, many factors influence sleep quality and duration for children and teens, including (4):

• sleep habits (i.e., bedtime routine)
• the environment (i.e., dark, cool room)
• screen time (including TV, mobile phones, tablets, computers, and gaming stations)
• medical concerns (i.e., ADHD, autism spectrum disorders)
• parents/caregivers (i.e., their sleep habits)

This leads to 2 important questions:
Should children and teens take melatonin to assist in sleep?
Is there any reason why children and teens should take melatonin supplements?

To answer these questions, let’s first review the natural production of melatonin.

Natural melatonin production

The pineal gland in the brain is the primary source of melatonin production. Melatonin (a hormone) regulates our sleep/wake cycle. Its production or suppression responds to environmental cues, namely the exposure to light or darkness. When exposed to light, melatonin is suppressed. When exposed to darkness, melatonin is produced.

But did you know? Children and teens produce much more melatonin than adults, up to 5 times as much in their teens than 50-year-olds [Image 1] (5). As a result, it is unlikely that a lack or insufficiency of melatonin is the reason for sleep issues in younger people.

OK—but my kid isn’t sleeping—what should I do?

There appears to be a consensus among healthcare providers and medical organizations that supporting better sleep habits and sleep hygiene is an excellent first-line approach that somebody should consider for most children, teens, and their families (6–8).

Darkness deficiency and light excess might be the biggest enemies to supporting quality sleep. Take a moment to look around your present environment---you will likely notice an overabundance of light in your life – phones, computers, TV, alarm clocks, nightlights, and lights on at all hours. This excessive light inhibits melatonin from being produced due to the lack of darkness.

One of the most important things you can do for your family is to turn off the screens and the bright lights in the evening since this suppresses natural melatonin production (9).

A national survey conducted in the U.S. of almost 44,000 children (ages 0-17) showed that children who spent more time on screens (TV, gaming, tablets, mobile phones) experienced fewer hours of sleep, regardless of the time of day spent on these devices (10).

During the first decade or so of life, children are more photosensitive than adults due to normal childhood development, including larger pupils and clearer lenses, which transmit more light through the eyes. As a result, studies have shown that melatonin is suppressed twice as much when children (~9 years of age) are exposed to evening light at 580 lux, which is approximately the standard lighting you experience in your office. They also have melatonin suppression under lighting at ~140 lux, the average lighting in a home, compared to dim lighting of less than 30 lux (low nighttime lighting of a home). Further, pre-school-aged children exposed to 1,000 lux (outdoors when it is overcast) 1 hour before bedtime have a ~90% suppression in melatonin that lingers for another 50 minutes after the light exposure (11).

Here is a list of things to support a calm brain and good sleep cycles for your entire family:

• Create routines to turn off screens and dim the lights at least an hour before bed.
• In that hour, do calming activities like reading, puzzles, sipping on chamomile tea & cuddle time with the young ones—even the teens if they will let you! If not, consider this a great time to engage in conversation with your teens.
• Consider bath time for the younger kids with calming bath salts or a few drops of lavender essential oil.
• Remove nightlights and bright alarm clocks from the bedroom and surrounding areas.
• Get blackout curtains or blinds for bedrooms to reduce external light sources.
• Try to wake consistently every day – to sunlight or a dawn simulator if you live in a darker climate.
• Get consistency in sleep night to night --- our bodies crave routine, both for bedtime and wake-up time. A regular schedule is especially important for your teen, who may love sleeping longer on the weekends.
• Get outside – at least one hour of direct sunlight daily supports our natural sleep/wake cycles.
• Avoid sugar – It is important to note that sugar alone can impair sleep quality (12,13). Based on the body’s digestive and glucose regulation processes, consuming food, including sugar, 2-3 hours before bedtime can impair one’s ability to fall asleep. Neither children nor adults benefit from consuming sugar before sleep.

Can I give my child melatonin supplements?

Try to avoid being influenced by marketing. A staggering 65% of gummy-formulated supplements are marketed toward children (14). They are visually appealing to children and can be pleasing to eat because gummies look and taste like candy!

When searching specifically for melatonin supplements for kids on Amazon, 76 products were available, with most containing imagery or wording appealing to children. For example, many bottles or boxes use primary colors often associated with kid-friendly items, images including cartoon-like animals such as sheep and teddy bears, and wording such as “nighty-night.” Additionally, like most supplements, melatonin supplements are not packaged to be child-proof.

While melatonin supplements appear safe for most children and teens, at present, clear guidelines on the dose, timing, or length of use of melatonin have not been established for this population, with a few exceptions, as noted later in this blog (6,7).

Supplements, generally, are unregulated by the Food and Drug Administration (FDA) in the U.S., leaving much room for varying degrees of quality. For example, a recent analysis that made headline news came from researchers in Ontario, Canada. This analysis showed that after testing 31 melatonin products, melatonin was anywhere from 83% less to 478% more per serving than the label claimed. More frighteningly, only a handful of products were within 10% of their label claims (15). Additionally, eight of the melatonin supplements tested contained serotonin, which can create severe health concerns, including the development of serotonin syndrome. Further, up to 13 different contaminants have been identified in synthetic melatonin. For more information, read our blog post: Even if Your Melatonin Says “Natural” it May Not Come From a Plant.

If any person, especially a child or adolescent, uses a product with more melatonin than they think they are taking, we run the risk of misuse or overdose. Additionally, melatonin is available in gummies and chewable forms that can make it more appealing to children, further increasing the risk of misuse or overdose. The appeal of gummies may partly explain the increased number of calls the CDC reported for melatonin ingestion.

In agreement with the recommendations made by the American Academy of Sleep Medicine (AASM), we encourage parents to employ the lifestyle modifications listed above and to always discuss melatonin supplementation with their healthcare professionals before giving it to children for general sleep support (8).

Is it ever appropriate for children and teens to take melatonin?

There are some cases where melatonin may benefit younger people.

Melatonin has been studied extensively in children with Attention Deficit Disorder (ADD), Attention Deficit and Hyperactivity Disorder (ADHD), as well as with children with Autism Spectrum Disorders (ASD). These groups have been shown to have decreased melatonin production and are known to have many circadian rhythm and sleep disorders that likely contribute to daytime behavioral symptoms (16–18).

Most studies focus on short-term, low-dose (0.3-1.0 mg) use for pediatrics with these medical conditions, with a maximum dose of 3 mg for children and 5 mg for adolescents (19).

Another consideration would be jet lag. Just like adults, the circadian rhythm of kids will need to adjust when traveling across one or more time zones. Presently, studies are lacking on this specific topic for children, though melatonin’s use for jet lag is commonly known, utilized, and well-studied and therefore you may see blogs, social posts, or online recommendations from pediatricians and parents alike. While the recommendations include a variation of doses, Symphony Natural Health suggests using a lighter dose in children than would be used in adults, sometimes even opening a capsule and using half or a third of the capsule Herbatonin 0.3 mg. Don’t forget to get the clearance from your child’s pediatrician first!

Interestingly, using low doses of melatonin (0.2 - 0.5 mg) is promising, supporting a growing trend in melatonin research that more is not always better (20). It remains essential to discuss the use of melatonin with your child’s doctor if they are experiencing sleep disturbances due to one of the conditions.

Is melatonin safe?

Despite the reported increased ingestion rates and hospitalizations, a literature review conducted in 2020 showed that long-term use (up to 2 years) in children and adolescents was safe (21).

The pediatric population has a low side effect profile, though occasional increased nighttime involuntary urination and morning grogginess have been reported and resolved by adjusting the dose. In rare instances, headache, dizziness, and diarrhea have been reported with use and resolved upon discontinuation.

One safety hesitation in children is due to the findings of three small studies showing that melatonin supplementation may delay pubertal onset. However, these studies had incomplete follow-up and poor measures of pubertal onset that have not been repeated subsequently (22). Among the studies that refute this point is a longer-term study showing no pubertal delay and safety in use at an average of 2.69 mg daily for three years (23). Additional studies have found no impact on pubertal development when melatonin was used short-term (3 months) or long-term (up to 2 years) in children and adolescents with autism, ADHD, or insomnia at doses of up to 6 mg per day (24–27).

Despite its safety profile, we do not recommend melatonin supplementation in children or teens unless advised by your child’s healthcare provider.

Conclusions and Next Steps

While nothing is more frustrating than a child who can’t go to sleep, the first line of defense should be to explore sleep habits and sleep hygiene. There may be a time and place for melatonin for younger people, but parents should consult a healthcare provider to ensure proper use and dose.

While it may not be appropriate for all children and teens, IF melatonin is needed and approved for use by your child’s healthcare provider, choosing a high-quality low-dose melatonin is critical to ensure the dose in the product matches the label, there are no contaminants, allergens or unwanted petrochemicals or compounds like serotonin, which can remain if the manufacturing process has not been done correctly.

Herbatonin has not only been independently tested by consumer watchdogs such as Consumerlab.com for 13 years verifying every time that the amount of melatonin in our vegan capsules matches the label claim, but also Herbatonin does not include any excipients, binders, solvents, petrochemicals, gelling or coating agents, preservatives, colors, dyes, flavors, sweeteners, or allergens such as gluten, yeast, wheat, corn, dairy or soy.

References

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