New advice on melatonin use in children

.

When it's bedtime, what parents really, really want is for their kids to go to sleep. Not only do parents want their children to get the rest they need, but parents want to get some rest themselves! So it's understandable that when children have trouble falling asleep, many parents reach for melatonin. Recent warnings about melatonin call this into question.

What is melatonin?

Melatonin is a hormone that the body makes to regulate sleep. Commercially, it is sold without a prescription as a sleep aid. If you give your body more of a hormone that helps you sleep, you are more likely to fall asleep, right? This isn't always true, of course; for many people, taking extra melatonin does little or nothing. But for some people it does help — including some children.

Over the past couple of decades, use of melatonin supplements has increased significantly. It's the second most popular "natural" product parents give to their children after multivitamins.

A health advisory on melatonin supplements for children

Whenever a lot of people do something, things can go wrong. And indeed, there have been many reports of melatonin overdoses in children. While overdoses can lead to excessive sleepiness, headaches, nausea, or agitation, luckily they aren't dangerous most of the time. That doesn't mean that over-the-counter melatonin is completely safe, however. In fact, the American Academy of Sleep Medicine (AASM) recently issued a health advisory with warnings about its use.

Over-the-counter melatonin is classified as a dietary supplement. This means it's not regulated by the FDA the way over-the-counter medicines like ibuprofen, acetaminophen, or diphenhydramine are regulated. There is no oversight on what companies put in the melatonin that parents buy.

And what they put in it is exactly the issue. The AASM warns that the amount of actual melatonin in tablets or liquid can vary, from less than what the label says to much more. The greatest variation is found in the chewable tablets, which are unfortunately the ones children are most likely to take. It's also hard — impossible, even — to know what else might be in the supplement. The AASM reports that some melatonin products also contain serotonin, a hormone and neurotransmitter that requires a prescription.

Helping children sleep well

The thing is, while some children really do benefit from melatonin, such as children with neurologic or neurodevelopmental problems, most don't need it to get a good night's sleep. Before buying a sleep aid — especially one that may not contain what you think it does — there are some strategies parents should try first.

• Keep your child or teen on a regular sleep schedule. For teens, that sleep schedule should preferably include sleep at night, not during the day. It's okay if your child stays up a little later on a weekend or during vacation, but try not to vary too much. Our bodies are more likely to drift off to sleep when we're used to falling asleep at a particular time.
• Make sure your child gets exercise during the day; it helps them be more tired at bedtime.
• Once your child has given up naps, don't do naps. If they come home from school exhausted because they stayed up too late, don't let them nap — it will just make it harder to go to sleep that night.
• Have a calming bedtime routine. This can be hard for high school students who have sports practices and homework, but to the extent that you can limit the stimulating stuff right before bedtime, please do. Think bathing, reading, and generally being quieter as bedtime approaches.
• Shut off the screens. The blue light emitted by screens can wake up the brain, and it's easy to get sucked into whatever you are doing on that screen. Ideally, screens should be off two hours before bedtime. For teens, it's best to charge phones somewhere else besides the bedroom. If teens say they need the phone as their morning alarm, buy them an alarm clock.
• Create a sleep environment conducive to sleep. Not having a TV or other device helps. For some kids, room-darkening curtains are great; for others, a night light is important. A white noise machine can help if there is ambient noise. Make the space inviting and comfortable — for sleep. It's best if kids don't hang out in their bed during the day or do homework there; bed should be for sleep.

If you have tried all this and your child is still having trouble falling asleep, talk to your doctor before giving them melatonin. There may be other issues at play. By brainstorming together you may come up with ideas.

If you decide to use melatonin:

• Select a product with the USP Verified mark, as it's more likely to be of higher quality.
• Start at a low dose.
• Don't give it every night. If you do, your child's body gets used to it and you end up having to increase the dose.

Bottom line: if your child is having trouble falling asleep, there's lots to try before trying melatonin. Talk to your doctor before you buy — or try — it.

Follow me on Twitter @drClaire