Are Melatonin Supplements Safe for Children?

When a child has trouble falling asleep — whether it’s from fear of the dark, separation anxiety, worries about school, or adjusting to time changes — parents understandably want a solution so everyone in the house can have a good night’s rest. Using melatonin supplements for sleep is increasingly popular, according to research. A JAMA study published last year reported that nearly one in five school-aged children and adolescents are now using the supplement on a regular basis. But does melatonin work and is it safe for kids?

Melatonin is a natural hormone that is produced by our brains. When it gets dark outside, melatonin increases and sends a signal to our bodies that it’s time to sleep. The supplements are synthetic versions of the hormone.

Dr. Katharina Graw-Panzer, the director of the Pediatric Sleep and Breathing Disorders Center at NewYork-Presbyterian/Weill Cornell Medical Center says that melatonin supplements can make kids sleepy and help regulate sleep-wake pattern, but she advises that they be used sparingly.

“If a child has insomnia, the first line of therapy should not be melatonin, but instead to find out why a child has difficulties falling or staying asleep,” she says. “Usually there are circumstances causing the sleep problem, whether it’s unrecognized anxiety, difficulties winding down at night, or being used to a parent’s presence to fall asleep. The goal is to teach children self-reliance, so they can fall asleep by themselves, without their parent’s presence or medications.”

Health Matters spoke to Dr. Graw-Panzer to learn more about melatonin, when to consider taking it, and healthy sleep habits.

How effective is a melatonin supplement?
Melatonin is a mild supplement. It can help you fall asleep faster in the right circumstances, but it doesn’t work like other sedatives or anesthetics, which just knock you out and induce sleep. Because it has a mild effect, it’s important to have a calm environment that is conducive to sleep. Melatonin won’t be as effective if it’s still bright outside, loud, or if there are other distractors.

Who should consider taking melatonin?
Parents should give it very sparingly, but there are certain situations where melatonin can be helpful. We usually use it in combination with behavioral interventions in children who have chronic insomnia when, despite an excellent sleep environment and setting, the child has difficulties falling asleep. Melatonin can also be helpful in children with neurodevelopmental differences, in whom melatonin has shown a greater effect. Melatonin has also been shown to be effective for the treatment of jet lag or delayed sleep phase syndrome, which is when kids preferred sleep phase is delayed and needs to be adjusted to the time zone they have to function in socially.

What dosage of melatonin is safe for children to take?
Usually, we recommend the smallest dose possible. The exact amount depends on the age and brand, but the starting dose is usually between 0.5 to 1 milligram. Even for teenagers and older children, I limit the dose to 1-5 milligrams.

Is it OK to take melatonin every night?
We don’t have enough research on the effects of taking melatonin over the long term. But because it’s a hormone replacement, I recommend using it only for short periods of time.

Is melatonin habit-forming?
No, children won’t become dependent on melatonin. Also, the same dose should remain effective over time.

What are the side effects?
The common side effects are dizziness or sleepiness. Children also may develop a little bit more anxiety. In my experience, some children respond to melatonin, and some do not. I think that’s when it’s important to start with a small dose and observe your child to see if any of these side effects appear.

How do you pick a brand of melatonin supplement? Are there certain ingredients to look for that could be dangerous?
Because melatonin is a supplement, it is not regulated by the Food and Drug Administration. There are many different products on the market now, and the amount of melatonin and other active ingredients are not always displayed correctly on the label. If you are going to choose one, my recommendation is to look for a seal on the package from U.S. Pharmacopeia (USP), which is an independent, nonprofit organization that sets drug quality standards.

What is a melatonin emergency?
Melatonin emergencies often happen when a child takes too big of a dose. Many brands come in the form of gummies, and kids mistake them for sweets. We recommend that parents treat melatonin supplements in the house like any other medication; they should be stored away safely so a child cannot reach it because they are curious.

The other risk is some brands of melatonin are not pure and contain other substances that have depressive effects on a child — for example serotonin, tryptophan, or antihistamines.

There are some medications that should not be taken in combination with melatonin. Before you give it your child, it’s important to ask for guidance from your pediatrician or health care provider.

You should always be able to wake up your child when you give them melatonin because it’s a mild medication. So if a child is experiencing extreme dizziness, drowsiness, slurred speech, not being able to woken up easily, these are all concerning signs and you should call the doctor.

Does melatonin help with jet lag?
I don’t think it’s harmful to take a small dose of melatonin for jet lag, but it is not necessary. It’s more important to focus on the behavioral adjustments to help you adjust to a sleep schedule in a different time zone.

What are alternatives to melatonin if your child is having trouble falling asleep?
If your child is really struggling with chronic insomnia, it helps to speak with a doctor. Here at NewYork-Presbyterian/Weill Cornell Medical Center we have a unique sleep clinic, where children are evaluated by a sleep physician and a sleep psychiatrist. We start with a comprehensive evaluation of the child’s medical history, the bedtime routine, and setting. Is the sleep calm? Are there any breathing concerns? Are there any sleep interruptions due to nightmares or night terrors? Also, we look at the quantity of sleep and daytime sleep, and especially how the sleep affects the daytime function. How is the child’s behavior in the daytime? Is there any tiredness, or is the child falling asleep?

In the end, we make an individualized recommendation for each child, and we provide ideas for families to be reassured and empower them to help their child sleep better.