The sleep struggle in kids and the role of melatonin

The struggle is real when it comes to sleep. Tired, cranky children who do not sleep well disrupt household routines, including parents’ sleep, impacting school and work performance. More parents are turning to melatonin supplements as a way to resolve the sleep issue for their children.

Taking melatonin, a naturally occurring hormone and an unregulated supplement, is a growing trend with a lack of research to support daily use in kids. Pediatricians are starting to raise concerns about the safety of taking melatonin on a daily basis while being compassionate to parents’ household disruptions and the importance of sleep.  

Steven Kovar, MD, Chairman of Pediatrics at Endeavor Health Edward Hospital, said, “Poor sleep of kids affects the parents as well, and they’re looking for anything to help. Parents turn to melatonin in hopes that this will quickly resolve the issue. But with little to no regulation, it’s unsure what is safe and what isn’t. Like a lot of things, people look for the quick fix without often getting to the root of the issue, which is sleep hygiene and household routines.”

What is melatonin?

Melatonin is a hormone that is one of the players managing the body’s 24-hour circadian rhythm. The hormone is released from the endocrine system’s pineal gland in the brain. When darkness falls, the body is naturally triggered (by the amount of light hitting the retinas) to begin entering a sleep phase, with melatonin secretion noted to be at its highest level at night.

Because melatonin supplementation is a newer trend, researchers are still studying the hormone to fully understand its overall role. Research shows beyond sleep, melatonin regulates menstrual cycles and impacts neurodegeneration. Studies are looking into how melatonin supplements impact puberty development.

Melatonin is passed to babies via breastmilk until about 8 weeks of age when an infant begins producing its own melatonin. Melatonin production hits its highest levels before puberty, and then a decline in hormone production continues until it levels as a teenager. Melatonin production, which typically is higher in women than in men, begins to decline around age 40.

Supplement vs. habits

As a supplement, melatonin is typically made synthetically. Dietary supplements are not regulated by the U.S. Food and Drug Administration (FDA), and, therefore, the amount of melatonin in each product varies. Studies have found different amounts of serotonin in each capsule, including higher levels than listed on the label, as well as other additives, including cannabidiol (CBD), metals, bacteria, pesticides and other substances.

Carly Senescu, MD, MPH, FAAP, Endeavor Health Medical Group pediatrician and Endeavor Health Edward Hospital Pediatric Medical Director, said, “Not being FDA approved in the same way as prescription drugs is one of my concerns. You could be giving your child a supplement with ingredients you don't want them to have or a dose of melatonin higher or lower than desired. Also, most come in a tempting 'gummy' form without childproof caps, and they should be kept out of reach of children. There has been an increase in accidental melatonin overdoses.”

A 2022 study shows a 150% increase in melatonin sales of tablet, capsule, liquid and gummy formulations from 2016-20. With that, reports to poison control for ingesting melatonin in people 19 years old and younger jumped, with the Center for Disease Control and Prevention reporting a 530% increase with a total of 260,435 ingestions reported from 2012-2021.

Lifestyle changes to improve sleep

Both Dr. Senescu and Dr. Kovar talk to parents and patients about making lifestyle changes to benefit sleep health, with the following four tips:

1. Put down devices at least one hour before bedtime, as recommended by the American Academy of Pediatrics. The blue light emitted from phones, e-readers or tablets makes the brain think it is daytime. The brain is, therefore, not triggered to release melatonin and begin a sleep cycle.
2. Increase body movement during the day, with active play or sports activities, encourages better sleep at night.
3. Limit naps and increase natural sunlight exposure during the day to help maintain the body’s circadian rhythm. 
4. Create a quality sleep routine and environment with a warm bedtime shower or bath, a cool and dark bedroom, soothing scents, and a comfortable bed add to a family’s good night of sleep.

The short-term use of melatonin supplements can play a role in initially creating sleep habits in kids or resetting a sleep routine after a vacation. The daily use of melatonin in kids might be just a quick fix with some negative outcomes, not a long-term solution.

Talk to your pediatrician about dosing and the use of any supplementation before starting.