I can't get my child to sleep. Does melatonin work?
The Doc Smitty addresses melatonin use in children
“I’m just not sleepy!”
“I’m too thirsty to sleep!”
Yep, I heard both of those in the past week.
Some kids have a hard time going to sleep. No matter what time you set bed time, even with the perfect routine, they toss and turn and get out of bed for hours.
What is a family to do?
First of all, you have to make sure that you are doing everything you can to help the child go to sleep.
This information is great for making sure you are not doing anything that would prevent your child from going to sleep.
Here are some highlights and some of the most common mistakes I see parents make:
1. Keep consistent bedtimes and wake times
2. Keep a consistent bedtime routine
3. Avoid high stimulating activities before bed (especially activities with a screen)
Despite taking care of all the items on this list, some children may continue to have difficulty sleeping. So, what next? Several different treatments have been used over the years, but the liquor cabinet is no longer considered a safe option and some kids go absolutely crazy with Benadryl. Today, many people turn to a supplement called melatonin.
What is melatonin?
Melatonin is a naturally occurring chemical that is produced in the brain when it is dark. It helps your body distinguish between day and night. Infants as young as 3 months have regular increases in melatonin during dark hours. Maybe this is why 99.999 percent of parents at two month check-ups complain that their baby “has their days and night mixed up.” It also explains why having a bright iPad screen in your face in bed is probably not the best idea because it confuses the brain into thinking that it is day time.
Melatonin is available over the counter in pill, tablet and even liquid forms (although this used to be harder to find, I suspect it will continue to get easier). Many adults take it and give it to their children to help them get to sleep. But does it work? Is it safe?
How many people are using it?
Because melatonin is available over the counter and many parents use it outside the recommendations of their pediatrician, it is difficult to truly quantify how many children have been given melatonin as a sleep aid. A 2013 survey of pediatricians in Australia showed that about 50 percent of pediatricians recommend melatonin use in children with difficulty sleeping. Older studies (2003) from the United States showed that more pediatricians were recommending antihistamines for help with sleep but no recent studies had been done. I suspect that our numbers more closely resemble Australia’s at this time. How many people are using it? It’s hard to say from studies but I suspect there are many families out there who do with or without their pediatrician’s blessing.
Does melatonin work?
Several studies have looked at the use of melatonin in children. Studies have been done in children with delayed sleep onset for no apparent reason and in children with developmental and medical causes. This study from the journal Pharmacology administered melatonin to 72 children over one week and showed about that children fell asleep about 1 hour earlier than they had prior to starting the melatonin. One study in "Sleep and Biological Rhythms" journal reviewed charts of 192 patients from a sleep study center and reported improvement in about 75 percent of patients in both children with normal development and those with developmental issues. Melatonin use has been studied in children with ADHD and also shown to be effective.
One of the best studies which was done as a randomized controlled trial (where some children were given melatonin and others given placebo) was done in 146 children with neurodevelopmental disorders (autism and similar conditions) and showed that children went to sleep earlier, but did not gain any extra sleep because wake times were earlier. It’s important because I could find no other studies that looked at this issue. Even given this, it’s use might be helpful to start sleep earlier, especially in children who are having trouble waking up in time for school or other daily activities due to not being able to fall asleep quickly. They also looked at family functioning outcomes and child behavior and showed improvements in those that received melatonin.
Is melatonin safe?
Melatonin does have some side effects that we need to be on the lookout for. The Pharmacology study referenced above lists red face, cheeks and ear lobes, and fewer reported pale looks, dizziness and cold feelings. Other studies have reported mild side effects but no long term side effects. The long term use of melatonin has been studied in 51 Dutch children who used melatonin over an average of three years and showed no changes in sleep quality, pubertal development or mental health scores as related to the general population.
It appears that melatonin use is safe and effective for treating children who have difficulty falling asleep. This is true for children with neurodevelopmental problems, ADHD and typically developing children.
I recommend that parents attempt all non-medical options to maintain sleep hygiene, and then discuss with their pediatrician their recommendations prior to starting any medication for helping a child to sleep.
Get to know Justin Smith, M.D.
Justin Smith, M.D., is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles.Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in 2017.