Melatonin has been studied in various populations including children, adults, and the elderly. It has also been studied among individuals with mood disorders, schizophrenia, Alzheimer’s dementia, and in children with neurodevelopmental problems. Melatonin has few side effects and is secreted in breast milk. It is not addictive and there is no rebound insomnia associated with it, so it is a good alternative for those suffering from insomnia.
Melatonin is synthesized from serotonin and is produced in the pineal gland, the retina, and the intestinal tract. It is widely used to promote sleep and to regulate circadian rhythms. It is rapidly absorbed and peaks in about 20 to 30 minutes with a half-life of about 40 to 60 minutes, so there is usually no morning grogginess associated with its use. The only major side effect that patients may experience is a headache.
The use of melatonin in children has been debated by medical professionals. It is often used by parents who are frustrated with children who do not want to go to sleep. However, there are children who benefit from taking the supplement including those with ADHD and neurodevelopmental illnesses.
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Sleep disorders in children are particularly difficult because both the child and the parent are affected, and neither get the sleep that they need. A recent article in the Journal of Clinical Sleep Medicine notes the recent findings of a parents’ perspective study. Interviews were conducted with parents of children with a neurodevelopmental illness. Parents were particularly happy with the ‘naturalness’ of melatonin vs a prescribed sleep aid. Parents did express a desire for practitioners to have a greater knowledge of how to use melatonin in a pediatric population. In Australia, where this study was conducted, parents were concerned about the price and availability of melatonin, as it is a prescription treatment and can be costly. For Americans, it is an over-the-counter supplement found readily in most grocery and vitamin stores.
In school-aged children, sleep disorders affect about 10% of the population. In children with neurodevelopmental disorders that number rises to about 80%. The children in this study ranged from 5 to 13 years of age and suffered from autism, Tourette syndrome, ADHD, or developmental delays. Parents were asked to describe their lives before melatonin use, with melatonin use, and what they felt their future of melatonin use would be. All of the parents had tried other alternatives and all felt they were unable to handle their situation any longer. Many of the parents said their children had experienced sleep difficulties since birth.
Most of the parents did not think that the melatonin was going to work given their history of trying other treatments that had proved to be ineffective. Later, on nights when they either ran out of the medication or when parents wanted to see how the children slept without the melatonin, parents in all cases said their children did not sleep as well. When asked at the end of the study if they would continue melatonin use, the opinions varied. Some were concerned about keeping their children on melatonin indefinitely while others were happy to continue long term. The greater the children’s sleep issues, the higher the probability was that the parents would continue long-term use of melatonin. Parents did note that they wished their family doctors would be more knowledgeable about melatonin and would be more sensitive to the impact of poor sleep on the child and the family. Most children in this study had autism and the parents noted that when the children slept better, their autism symptoms also improved.
We continue to learn more about exogenous melatonin and its use in promoting sleep. It appears to be safe in children, but caution should always be advised. Dosing is also a concern as there are no clear cut parameters on strength, but the lowest possible dose is always advised. Most dosing schedules range from 0.3 mg to 5.0 mg. In the United Sates, caution is particularly advised as melatonin is not a prescription and supplements are not FDA regulated. Therefore, what is advertised on the bottle may not always be what is inside the bottle.
Sharon M. O’Brien, MPAS, PA-C, is a practicing physician assistant and health coach in Asheville, NC.
References
- Waldron AY, Spark MJ, Dennis CM. The Use of Melatonin by Children: Parents’ Perspectives. J Clin Sleep Med. 2016; 12(10):1395-1401.
- Kryger MH, Roth T, Dement WC. Principles and Practice of Sleep Medicine. 4th ed. Elsevier Health Sciences. 2005.
