WHAT IS MELATONIN?

Melatonin is a hormone secreted by the pineal gland. Since the human body produces it, people generally think it's safe. But that doesn't mean you can use it without restrictions. In many cases, it's better to work on developing healthy sleep practices.

Melatonin is cheap and easy to acquire in the United States. However, in much of the rest of the world, it's not. Why not? Well, no one has adequately studied the long-term effects of melatonin supplementation. Also, the human body is used to cyclical production of this hormone. Putting it into your body at unexpected intervals may cause unexpected consequences.

Melatonin is a is both a chronobiotic agent and a hypnotic. This means it regulates your body clock as well as inducing sleep. These effects may vary from person to person. Melatonin rises naturally in the body one to three hours before the onset of sleep, and signals your body that sleep is coming. This means that if your doctor has prescribed melatonin for your child, your child will need to begin to prepare for bed almost three hours ahead of expected sleep onset. If you've wondered, "is melatonin safe for kids," it's important to keep this natural cycle in mind.

Sometimes doctors prescribe melatonin for children with insomnia to take after their scheduled bedtime. Clinical doses of melatonin can be much higher than what the body produces.

DLMO stands for Dim Light Melatonin Onset. It refers to the clock-time at which melatonin levels begin to rise. Certain kinds of light signal your body to release melatonin. Other kinds, though, can tamper with the body's natural DLMO phase. Blue-white light is one of these, which is why many recommend eliminating screen time two hours before bedtime.

If your doctor has prescribed melatonin, your child needs to take it a few hours before bedtime, not just before. A sleep physician can help you determine the best time for dosing. Some also recommend using synthetic melatonin instead of the natural preparation.

A recent review of studies has shown that melatonin is an effective sleep aid. However, information is still fairly limited.

The FDA doesn't regulate melatonin as a pharmaceutical, but rather as a supplement. This means that there have been no large-scale studies conducted by pharmaceutical companies. Certain reviews on melatonin by pediatric neurologists have advised dosing schedules and treatment guidelines in children.

IS MELATONIN SAFE FOR KIDS? IT'S COMPLICATED 

Although studies confirm melatonin's short-term safety, there are several issues to consider.

Delayed sleep phase syndrome (DSPS) is a disorder common among teens. It happens when commitments to school shift their natural sleep period significantly later. As a result, they can’t sleep before 2 a.m. or even later. Melatonin doses three hours earlier, along with better sleep practices and limited light exposure, are very effective in managing this.

Children with different causes of neurodevelopmental delay may experience significant insomnia. In such children, melatonin may help. However, in some children, its use caused persistently high daytime blood levels of melatonin and the ensuing daytime sleepiness.

Some children with blindness may experience problems with the sleep-wake time. This is because they do not have light regulating their body clock. Small trials have reported benefits, but the data isn’t very broad to generalize its benefits for all.

Melatonin has side effects. These may include daytime sleepiness, headaches, dizziness, stomach discomfort, anxiety, and crankiness. Mild bedwetting, diarrhea, and nausea are also common.

This study has found melatonin to be safe and effective for kids under certain circumstances. However, studies of melatonin have no biochemical basis since doctors view it as a supplement. Researchers have not studied melatonin's long-term effects at a biochemical level.

As a parent, you should know that authorities have not officially registered melatonin for use in children. Likewise, no long-term safety trials have been conducted for children. In fact, this alone should make any parent think a hundred times before administering melatonin. It is registered as a veterinary drug to alter reproduction cycles in sheep and other animals.

Moreover, since melatonin is a supplement, the dosage and concentration can vary from package to package. Some formulations may have as much as four times the amount of the drug in a drop as others. So, you may get as little as 0.5 mg or as much as 13 mg of the drug in one dose.

The most serious issue is purity. Some researchers found the drug mixed with serotonin, a neurotransmitter. Doctors usually prescribe seratonin to people with mood disorders and depression. So be very careful what supplement you choose, which company you buy from, and how much of the supplement you give your child.

ALTERNATIVES FOR SLEEP DISTURBANCES 

For most children, behavioral interventions can effectively treat insomnia. Before starting melatonin, consult your physician about sleep training. Melatonin cannot replace good sleeping techniques. Limit light exposure, cut out all screen time for at least an hour before bedtime and keep a regular sleep schedule.

Create a series of predictable events leading to bedtime. This includes wearing pajamas, brushing teeth, and reading stories from a book and not a screen. Avoid any boisterous activity before sleeping. Play calm music, read a story or sing a lullaby.

Stick to the same bedtime and wake up every day at the same time, even on weekends. Force them to use beds only for sleeping. Make sure the child’s room is comfortable, quiet and cool. Use an alarm clock to wake them up. Face it away from their bed so they don’t stare at it.

When your child wakes, encourage them to exercise to make them feel more refreshed. Avoid caffeine, chocolate, soda, and teas before bed. If they are still not asleep after twenty minutes, have them get out of bed and read from a school textbook, then when they’re sleepy have them return to bed. Keep a sleep diary to track naps, bedtimes, wake times, and behaviors.

SAFE MELATONIN USE 

• Don't use routinely

• Select a USP-verified preparation

• Verify the dose with pediatrician

• Couple with sleep hygiene

If you want to use melatonin, don’t use it routinely. Try using it only as needed and select a USP-verified preparation to ensure it's manufactured according to the U.S. Pharmacopeial Convention.

Dosing is critical. Start low and verify the dose with your pediatrician. Melatonin can be a tricky medication to dose. Maybe a few general rules can help. If you want to shift sleep schedules, administer the dose three to six hours before bedtime. It may take a while to get it right. This study started with 0.5 to 1.0 mg. If it doesn’t have the desired effect after a week or so, talk to your physician about increasing the dose. At the heart of it, melatonin is still a hormone. A little can go a long way.

But remember the only way this supplement can be effective is if you’ve coupled it with sleep hygiene.

COMING OFF OF MELATONIN 

If you've already started melatonin and want to wean your child off of it, gradually reduce the dose, then slowly use it every other night. Then try using it only as needed.

WHEN SHOULD MELATONIN NOT BE USED? 

Avoid melatonin if your child's insomnia is situational or psychological. Children may be anxious before a new day of school or for a debate or an event. Don't use melatonin if the insomnia is short-term, or if symptoms are only a few days or weeks old. Don't use it if the insomnia is due to an underlying physical cause like sleep apnea, restless legs syndrome or other physical issues. If your child is less than 3 years old then you can't use this.

SHOULD MY CHILD TAKE MELATONIN? 

No parent is eager to medicate their child. Safe treatment options for insomnia are limited. Often parents turn to melatonin if they have attempted to address the sleep and behavioral issue without success. So, first work with your doctor; investigate the cause for insomnia or other sleep issues. Then develop a sleep routine to address sleep hygiene problems.

The goal is always to help a child sleep without becoming dependent on medications. Melatonin may be a good treatment if behavioral changes alone haven’t helped and your doctor has ruled out other medical causes. If your physician agrees melatonin is a good option, they can work with you to monitor your child's insomnia.

THE BOTTOM LINE 

Melatonin is not a substitute for healthy sleep hygiene. As much as possible, try to have your child sleep without medications. Is melatonin safe for kids? Yes, it is in the short term. But it's not something they should take forever.

Develop good sleep hygiene. If this doesn't work, consult your pediatrician to discuss the options. Investigate the medical causes. If there aren’t any, consider melatonin. Make sure you continue to use it with sleep techniques. And, once started, always look for a way to reduce or wean your child off it.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding any medical condition.