Melatonin For Sleep
Along with eating and pooping, sleep forms the trifecta that dominates most parents’ lives. Pooping and eating problems (hopefully) mellow out as your kid gets older, but sleep problems are common from 0-18. There are a bunch of potential issues, but I’m going to focus on kids who have a hard time getting to sleep at night. It’s a common problem – most surveys estimate that about 25% of kids have trouble sleeping, and that number is much higher for kids with other conditions such as ADHD or anxiety.
When parents tell me their kid can’t fall asleep, we always start with “sleep hygiene,” all the routines and habits that condition your mind and body to fall asleep. This is pretty obvious stuff, like having a consistent bedtime, turning off screens an hour before bedtime, keeping the room dark, and staying in your own bed. But when you’re already doing all these things and your kid is still taking hours to fall asleep, a lot of parents are turning to melatonin. But does it work? Is it safe? How much should you give?
Melatonin is not a “sleeping pill.” It’s a hormone our brain (specifically our pineal gland) uses to control our circadian rhythm, or 24-hour sleep-wake cycle. Normally, we secrete a lot of melatonin at night and only a little bit during the day. The theory is that by giving some extra melatonin, we can give your child’s body a stronger signal to get sleepy and reinforce a consistent sleeping time. There aren’t that many studies looking at kids, but there was a decent double-blinded, placebo-controlled study (so half the kids got a fake “placebo” instead of melatonin, and neither they nor the researchers knew who got what until the end) on 40 kids aged 6-12. (1) The kids who got the melatonin fell asleep about an hour earlier and got about 30 minutes more total sleep than the kids who got the placebo.
There aren’t a lot of good studies on the safety of melatonin for kids. One study in the Netherlands did follow 101 kids between the ages of 6 and 12 with ADHD and sleep problems. (2) Smaller kids got 3 mg and bigger kids got 6 mg. Two-thirds were still taking melatonin nearly four years later, and parents reported no side effects. In my practice, while it certainly does not work for all kids, I have not seen any side effects either. Melatonin can change the immune system in a very mild way, so kids with immune disorders or who take immunosuppressant drugs should avoid it.
Sleep is huge. I like melatonin and I trust it. If using it helps your kid to get one extra hour of sleep per night, that means better attention in school, better emotional regulation, and better overall health. Given that the medicine seems quite safe, that seems like a good trade off to me. For kids under 12, I would recommend starting at 1 mg and inching up to 3 mg if needed. I have used it down to age 2, but talk to your doctor if your kid is under 4. Kids 12 and older could go up to 6 mg if needed. Give it about 30 minutes before bedtime. It can also be used short-term for 1-2 weeks to adjust your child’s sleep schedule (if you’re trying to shift her bedtime to an hour earlier, for example).
Sweet dreams.
1. Melatonin for chronic sleep onset insomnia in children: a randomized placebo-controlled trial. Smits MG et al. J Child Neurol. 2001 Feb; 16(2):86-92.
2. Long-term follow-up of melatonin treatment in children with ADHD and chronic sleep onset insomnia. Hoebert M et al. J Pineal Res. 2009 Aug; 47(1):1-7.
