Mark L. Splaingard, MD, director of the Sleep Disorders Center at Nationwide Children’s Hospital, answers a question often asked by primary care providers.
With some reports that insomnia symptoms are experienced by 20 percent or more of children, health care providers (and parents) often want to know if melatonin is appropriate to use in the pediatric population. I have a simple answer, and a more complicated one.
Simple: Melatonin in small doses is probably safe for children older than 3 years of age to use for a few months. Behavioral therapies and proper sleep hygiene, however, work well for most healthy children and should be tried first.
Complicated: Melatonin use for the treatment of insomnia in healthy children is hotly debated, because there are no long-term studies on its safety and efficacy. The exogenous hormone is considered a dietary supplement, meaning the U.S. Food and Drug Administration does not regulate its safety, purity or efficacy. But trials of up to two months have shown melatonin to improve sleep onset in all age groups.
Melatonin has been most extensively studied in children with blindness, attention-deficit/hyperactivity disorder and autism – populations that have a greater prevalence of insomnia symptoms than healthy children. Some studies report longer use in developmentally disabled children with no significant side effects.
There are a few concerns about melatonin to note, though:
Given these concerns, I reiterate part of my simple answer – behavioral techniques and good sleep hygiene should be the first-line treatments. A titrated trial of melatonin may be warranted if those fail, but like much else in the literature, dosage recommendations are lacking. My own practice is to:
We are in need of long-term studies on the effects of melatonin on children. Until then, we can consider using it cautiously, when other measures have fallen short.
Photo credit: Adobe Stock