Melatonin use has skyrocketed in recent years — and so have accidental overdoses.
A version of the same sleep-regulating hormone produced by your own body, easily and inexpensively available over the counter, that might help you — or your child — fall sleep: If you’re thinking, “Sounds worth a try,” your thoughts are in alignment with the millions of people who have been purchasing melatonin in recent years.
Unlike sleeping pills, which require a prescription, can be habit-forming and aren’t recommended for children, melatonin appears to offer a safer alternative.
Its popularity has surged, going from $285 million in U.S. sales in 2016 to $821 million in 2020.
Melatonin, which, like many substances, can be toxic when consumed in large doses, has become such a common item in people’s homes that by 2020 it was the No. 1 substance ingested by children reported to poison control centers, according to the U.S. Centers for Disease Control and Prevention (CDC). From 2012 to 2021, the number of pediatric melatonin ingestions reported to poison control centers rose 530%.
Most of these overdoses were unintentional and occurred at home in children younger than 5. Though most of the children didn’t have symptoms, 14.7% were hospitalized, 1% required intensive care and two children died.
The CDC analysis notes that the biggest uptick in accidental ingestions occurred from 2019 to 2020, coinciding with the onset of the coronavirus pandemic. This might be related to children spending more time at home or to more adults purchasing melatonin to treat sleep problems — both for themselves and their kids. It’s now the most common supplement, after multivitamins, that parents give their children, according to the American Academy of Sleep Medicine.
Melatonin has been widely studied as a remedy for jet lag, according to the Mayo Clinic. It seems to help people sleep at an unaccustomed time. There is also evidence to support the use of melatonin in children with autism who have sleep disturbances.
Yet melatonin is not exactly the safe, sure-fire sleep solution that its surging popularity suggests.
On Sept. 20, the American Academy of Sleep Medicine issued an advisory, counseling parents to store melatonin supplements just as carefully as any other medication and to consult with a pediatrician before giving melatonin to their children.
What is melatonin, and how does it work?
Melatonin is a hormone produced by the pineal gland in your brain in response to a decrease in light, such as nightfall.
“Your brain starts to release melatonin two hours before you fall asleep and signals your body and other brain sleep chemicals to get ready to sleep,” Dr. Carol Rosen, a pediatrician and member of the board of directors of the American Academy of Sleep Medicine, told HuffPost.
“Melatonin that comes in a bottle basically supplements the hormone that already exists in your brain,” explained Dr. Janine Zee-Cheng, a pediatrician practicing in Indiana. “The plasma levels of melatonin supplements peak about an hour after you take it, which is why it’s recommended to take it close to bedtime.”
What could be dangerous about a hormone your body produces?
Though melatonin is not as dangerous as other medications you might have in your house, accidental ingestion can cause symptoms such as headache, stomach upset and sleepiness.
“Doctors don’t know the exact danger dose,” Rosen said.
The number of children who had to be hospitalized after ingesting melatonin was small, but you can eliminate this risk by storing all medications and supplements safely so that children cannot access them.
When can melatonin be helpful for kids?
There are safe levels that can be helpful for children in certain circumstances, but, as the advisory notes, you should discuss all of this with your doctor before giving a child melatonin.
“For children with primary sleep-onset insomnia, melatonin can be helpful. It can also be beneficial for children on the spectrum of neurodiversity, or with neurodevelopment differences, who may have difficulty initiating sleep,” Zee-Cheng said. She added that she takes a detailed sleep history before considering melatonin for a patient.
Pediatric doses generally range from 0.5 milligram to 6 mg, said Rosen. “Doctors will recommend doses that best fit the child’s needs and size.”
It also appears that more isn’t necessarily better. Zee-Cheng pointed to research indicating that very small doses of melatonin can work well.
“One-milligram doses have been shown to be as effective as larger doses,” she said.
What should parents know before giving kids supplements?
First, parents should understand that something classified as a dietary supplement, which is the case for melatonin in the U.S., is not regulated by the Food and Drug Administration the way a prescription or over-the-counter medicine is.
In Canada, over-the-counter melatonin supplements are banned.
It’s up to companies to represent their own products truthfully, and research shows that, when it comes to melatonin, the manufacturers shouldn’t necessarily be trusted.
One study showed that the amount of melatonin varied by as much as 465% from one lot to another of the same supplement. In addition, more than a quarter of the melatonin supplements studied contained serotonin, another substance produced naturally by the body that affects many biological processes.
“This is important because serotonin syndrome is a well-described and extremely serious condition,” Zee-Cheng said.
Don’t make assumptions based on a product being labeled “all-natural,” she added. “‘All natural’ doesn’t mean benign.”
In addition, melatonin supplements are frequently sold as sweet gummies or chewable tablets that, to a child, are indistinguishable from candy, increasing the odds of accidental ingestion in potentially large quantities.
How else can parents encourage children to get a good night’s sleep?
If you’re struggling with sleep in your household, you’re not alone. It can be tricky to find a sleep routine that works for your family, particularly when children’s sleep needs change as they grow and develop.
Zee-Cheng suggests knowing how many hours of sleep your child needs at their age, maintaining a consistent bedtime and decreasing light levels in the bedroom.
Blue light, like we get from our electronic devices, actually suppresses the body’s natural production of melatonin, so it makes sense to limit screen time before bed for anyone in your family who’s having trouble getting to sleep.
“Melatonin is just one of many tools to optimize sleep, and it is only appropriate in certain people,” Zee-Cheng said.
If you’re considering giving your child melatonin or any other dietary supplement, talk to your doctor first.
“My wife and I are parents to a first-grader and a preschooler, and they both have different sleep needs, and we have very different sleep expectations for each of them,” Zee-Cheng said.
She added that pediatricians understand that getting kids to sleep can be hard, and they are there to help you problem-solve, not to pass judgment.
“We just want to be able to equip families with all the tools they need for successful sleep for everyone.”
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