Bedtime just isn’t what it used to be. Two years into the COVID-19 pandemic, daily routines of old are still a distant dream, and nights are no better. For some kids – already notoriously finicky sleepers – the isolation, uncertainty, and restrictiveness of life during the pandemic has led to new or worsening sleep issues that mimic those now experienced by nearly half of adults. A June meta-analysis of 16 studies concluded that “The prevalence of sleep problems in children and adolescents during the COVID-19 pandemic is alarming” – 49% of the children surveyed failed to sleep for the number of hours recommended for their age groups. Sales data suggests that many adults have turned to over-the-counter melatonin in hopes of a quick fix for their own COVID-induced insomnia, and are likely slipping small doses to their kids too. But is melatonin safe for kids?
The popular and cheap pills have a reputation as an approachable and natural sleep aid because the active ingredient is a synthetic version of a hormone the body produces that causes us to feel drowsy and tired at night. But experts say that a melatonin tablet is not as close to a simple cup of chamomile as manufacturers would have you believe – and that parents should think twice before considering it for their kids.
Laura Sterni, MD, director of the Johns Hopkins Pediatric Sleep Center, says she sees “kid after kid” on melatonin. “But one of the things I always try and tell parents is we do not know,” she says. “We have not taken large groups of kids and given them melatonin and looked at what happened.”
One of Sterni’s main concerns with pharmaceutical melatonin writ large is how little it’s regulated. Because the pill is formally classified as a dietary supplement rather than a medication, FDA oversight is lax. One study from 2017 found that 71% of melatonin supplements contained an amount of active ingredient that mismatched the amount stated on the label by at least a 10% margin. Of the 31 supplements the research team looked at, the concentrations varied from 83% less to 478% more than the labeled amount. Even different lots by the same manufacturers could contain different concentrations of the hormone.
Luckily, you do not have to worry about your child taking too high of a dosage. An accidental melatonin “overdose” will make your child groggy at worst.
A large body of research on melatonin in adults has found little risk of side effects from taking it. But there is no guarantee that the same is true for children, who could be more affected by side effects such as residual drowsiness or bedwetting. It’s more likely that any unknown risks lurk in long-term usage.
“I mean, it’s a hormone,” Sterni says, “so people worry about the effect on the whole hormonal axis. But again, we do not have those studies. ” A few studies in adults, she says, have identified a potential link between large amounts of supplemental melatonin and slowed metabolisms.
So is it ever okay to give kids melatonin? Absolutely, Sterni says – if, and only if, a doctor has recommended it. It’s partly about safety, but it’s also about not slapping a hormonal band-aid on a bigger problem. “When you’re looking at children who are having difficulty falling asleep or staying asleep, the huge, huge majority of those children are having what we call behavioral insomnia: behavioral problems or sleep hygiene problems that lead to the difficulty with sleep. And giving them a medication is not solving the problem. ”
Instead of reaching for the melatonin bottle, she says, parents should think about why a child is having such a hard time sleeping. Are they winding down and putting away electronics an hour before bed? Is their room dark and cool? Are they getting enough movement in during the day? Although sleep hygiene concerns like these aren’t always the easiest to perfect, they’re a great place to start.
If your child shows patterns of sleep issues beyond a wired night here or there, ask their doctor about more specific strategies, which may include trying low doses of melatonin from a manufacturer that they recommend. Studies do show that melatonin can help some children with autism, ADHD, and circadian rhythm disorders (whose bodies may not naturally produce enough melatonin at the correct times of day), and there are a number of other conditions that doctors may suggest the use of melatonin to address. “I just can not stress enough that it’s worth talking to your doctor first,” Sterni says.