MELATONIN IN THE NEWS

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

 

A recent Centers for Disease Control and Prevention (CDC) report found that the annual number of calls to U.S. poison control centers for childhood ingestion of melatonin increased by 530% from 2012-2021. While most of these reports were unintentional ingestion of melatonin, it did result in symptoms presenting in almost 16% of children. Melatonin became children's most frequently ingested substance in 2020; unfortunately, more than 4000 of these reports led to hospitalizations (1).

 

Why is this? 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 (2). Sleep insufficiency has been reported to delay developmental milestones and increase the risk of type 2 diabetes, cardiovascular disease, and obesity in children. Factors influencing sleep quality and duration for children include (3):

• 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 an important question: Should children be taking melatonin to assist in sleep?

 

To answer this question, we will review the natural production of melatonin, concerns about supplement quality, and guidance on the best recommendations to help children sleep. 

 

Natural melatonin production

Melatonin is produced in the pineal gland to induce sleep. However, melatonin is also naturally produced throughout the body, including in the gastrointestinal tract, reproductive tissues, skin, and liver, to name a few, and is used in the body for more than regulating our circadian rhythm or sleep/wake cycle (4).

 

The pineal gland is the primary source of melatonin production for our sleep/wake cycle and responds to environmental cues, namely the lack of light or darkness, to increase production and prepare us for sleep. Less commonly known is that children and teens produce many times more melatonin than adults, up to 5 times as much in their teens compared to a 50-year-old [Image 1] (5). Making it an unlikely cause for sleep issues in younger people and less likely that kids need to take melatonin as a supplement.

 

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                                          Image 1: Modified from Grivas, T.B.; Savvidou, O.D. Melatonin the “light of night” in human biology and

                                                        adolescent idiopathic scoliosis. Scoliosis. 2007 Apr 4;2:6.

 

 

Melatonin Quality

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 from researchers in Ontario, Canada, showed that in testing 31 melatonin products, they ranged from 83% less to 478% more melatonin in a serving than the label claim. Worse, only a handful of products were within 10% of their label claims (6).

 

If any person, especially a child, 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. This may partly explain the increase in the number of calls the CDC reported for melatonin ingestion.

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My child isn’t sleeping; if not melatonin, what should I do?

 

While melatonin appears safe for most children, at present, clear guidelines on the dose, timing, or length of use of melatonin have not been established (7,8).

 

In agreement with the recommendations made by the American Academy of Sleep Medicine (AASM), we encourage parents to discuss melatonin supplementation with their healthcare professionals before giving it to children (9).

 

Conversely, there is a consensus that supporting better sleep habits and sleep hygiene is an excellent first-line approach that should be considered for most children, teens, and their families (7–9).

 

Darkness Deficiency is the biggest enemy in supporting quality sleep, and second to that is Light Insufficiency during the day. We have an overabundance of light in our lives – phones, computers, TV, alarm clocks, nightlights, and lights on at all hours.

 

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 – they suppress natural melatonin production (10). 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 (11).

 

Here is a list of things to support good sleep cycles for your 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, chamomile tea & cuddle time.

• Consider bath time for the kids with calming bath salts, chamomile tea, or a few drops of lavender essential oil.

• Try to remove nightlights and bright alarm clocks and get blackout curtains for bedrooms.

• Try to wake consistently every day – to sunlight or a dawn simulator if you live in a darker climate. 

• Get consistency night to night --- our bodies crave routine, both for bedtime and wake-up time. 

• Get outside – at least one hour of direct sunlight daily supports our natural sleep/wake cycles.

 

 

Is it ever appropriate for children to take melatonin?

 

There are some cases where melatonin may benefit younger people though more research is needed. Data is emerging around some genetic variants in which some people may not produce melatonin at the same levels as others. In particular, this may be the case for some who live with ADHD or are on the autism spectrum and often have delayed sleep phases and difficulty sleeping (12–14). Interestingly, the use of low doses of melatonin (0.2 - 0.5 mg) is promising, supporting a growing trend in melatonin research that more is not always better (14). 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.

 

Conclusions and Next Steps

 

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 first and foremost. There may be a time and place for melatonin for younger people, but a healthcare provider should be consulted if you consider it.

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While it may not be appropriate for all kids, when melatonin is needed, choosing a physiological-dose, plant-based phytomelatonin, may provide all the benefits for the sleep/wake cycle and several other uses for immune and cellular health support.

 

Authored by Mona Fahoum, ND and Kim Ross, DCN

Reviewed by Deanna Minich, Ph.D.

Last updated October 24, 2022

 

References

1. Lelak K, Vohra V, Neuman MI, Toce MS SU. Pediatric Melatonin Ingestions - United States, 2012-2021. Morb Mortal Wkly Rep. 71(22):725–9.

2. H.S. T, A. G, S.H. S. Sounding the Alarm on the Importance of Sleep: The Positive Impact of Sufficient Sleep on Childhood Flourishing. Pediatrics. 2020;146(1).

3. Fadzil A. Factors affecting the quality of sleep in children. Vol. 8, Children. 2021.

4. Minich DM, Henning M, Darley C, Fahoum M, Schuler CB, Frame J. Is Melatonin the “Next Vitamin D”?: A Review of Emerging Science, Clinical Uses, Safety, and Dietary Supplements. Nutrients [Internet]. 2022;14(19). Available from: https://www.mdpi.com/2072-6643/14/19/3934/htm

5. Grivas TB, Savvidou OD. Melatonin the “light of night” in human biology and adolescent idiopathic scoliosis. Vol. 2, Scoliosis. 2007.

6. Erland LAE, Saxena PK. Melatonin Natural Health Products and Supplements: Presence of serotonin and significant variability of melatonin content. Journal of Clinical Sleep Medicine. 2017;

7. Goldman RD, Bongiorno PB, Olcese JM, Witt-Enderby PA, Shatkin JP. Myths and evidence regarding melatonin supplementation for occasional sleeplessness in the pediatric population. Pediatr Ann. 2021;50(9).

8. Chan C. Is melatonin safe for children? Pharmacy Today. 2021;27(6).

9. American Academy of Sleep Medicine advises parents to seek medical advice before giving melatonin to children [Internet]. 2022 [cited 2022 Oct 11]. Available from: https://aasm.org/american-academy-of-sleep-medicine-advises-parents-seek-medical-advice-before-giving-melatonin-children/

10. Tähkämö L, Partonen T, Pesonen AK. Systematic review of light exposure impact on human circadian rhythm. Vol. 36, Chronobiology International. 2019.

11. Twenge JM, Hisler GC, Krizan Z. Associations between screen time and sleep duration are primarily driven by portable electronic devices: evidence from a population-based study of U.S. children ages 0–17. Sleep Med. 2019;56.

12. Melke J, Goubran Botros H, Chaste P, Betancur C, Nygren G, Anckarsäter H, et al. Abnormal melatonin synthesis in autism spectrum disorders. Mol Psychiatry. 2008;13(1).

13. Rana M, Kothare S, Debassio W. The assessment and treatment of sleep abnormalities in children and adolescents with autism spectrum disorder: A review. Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2021;30(1).

14. Sletten TL, Magee M, Murray JM, Gordon CJ, Lovato N, Kennaway DJ, et al. Efficacy of melatonin with behavioural sleep-wake scheduling for delayed sleep-wake phase disorder: A double-blind, randomised clinical trial. PLoS Med. 2018;15(6).