For the Langstaff family, the bedtime routine had become more like a bedtime marathon.
“My son has struggled with sleep from the moment he was born,” Anna Langstaff, the head of a Montessori school in Portland, Ore., said of her 6-year-old son, Henry. “We used to joke that he was like a little knight fighting a dragon called sleep.”
When Henry was a toddler, dimming the lights and other bedtime cues simply sent him into “battle mode” she said. “He’d start yelling, ‘No bed! No bed!’”
After years of struggling with what had become a two-hour bedtime routine, the Langstaffs turned to their pediatrician, who recommended a chocolate containing melatonin, a hormone secreted by a pea-size organ in the brain called the pineal gland that helps regulate the body’s internal clock and induces sleepiness.
“It was like magic,” she said. Now Henry falls asleep at 7:30 p.m. and continues to wake up at the same time he always has, shortly before 6 a.m., Langstaff said.
“Magic” — “game changer” — these are words frequently used by parents describing how melatonin helps their children fall asleep.
An online survey of 933 parents with children under 18 conducted by YouGov for The New York Times in May found that only about a third had kids who were struggling with sleep issues in the past year. But among those parents, almost half had given melatonin to their children.
The study consisted of a small number of people self-reporting over a short time period, but it reflects a trend experts have observed about children’s melatonin supplements.
“It’s so widely used, it is astonishing to me,” said Dr. Judith Owens, M.D., M.P.H., the director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital. “Pediatricians have kind of glommed on to this as being the answer to children’s sleep problems.”
But melatonin use among young children isn’t well studied nor are there any universally agreed upon standards on how much should be taken or for how long. It’s sold as liquids, gummies, chewables, capsules and tablets, all with different dosage instructions, and is not regulated as strictly as over-the-counter or prescription drugs.
Supplement makers do not need to submit evidence that their products work, nor prove that their listed ingredients are accurate or pure. As a result, some experts are concerned about the popularity of melatonin supplements, particularly if they aren’t being used under a doctor’s supervision.
How many kids use melatonin, and does it help?
It is difficult to know how many children are taking melatonin supplements — in the United States they do not require a prescription, so there is no insurance data to track.
But the demand for melatonin appears to be growing. The technology company SPINS, which supports the wellness industry, found in March that sales of children’s melatonin supplements in retail stores grew 87 percent over the prior year.
“When the stay-home orders hit, the shelves were empty of them,” Kelly Porciello, a mother of two in San Diego, said of the children’s melatonin gummies her family typically buys for her 6-year-old son. “We stopped using them when our supply ran out.”
As many as 25 percent of children and adolescents have problems falling (and staying) asleep. While melatonin can help some children fall asleep, it doesn’t typically help a child who wakes up frequently in the middle of the night.
“It seems to be more effective among children and the elderly,” said Alcibiades Rodriguez, M.D., the medical director of the Comprehensive Epilepsy Center-Sleep Center at New York University.
A 2019 review of seven clinical trials studying the short-term use of melatonin for sleep onset insomnia in children and adolescents (most of whom suffered from attention disorders) found that the hormone was moderately effective in the short term and appeared to be safe, although the quality of the studies was patchy. Studies have also shown that melatonin is effective for insomnia in children with neurodevelopmental disorders including epilepsy and autism spectrum disorders.
Adelaide Mestre, who lives in Manhattan, confided that before giving her daughter melatonin, she and her husband hadn’t had an evening to themselves in two and a half years and “had practically forgotten how to relate to one another.” Their daughter, now 6, has been taking it every night for the last year.
And Craig Giesecke and his wife, who live in Denver, started giving a sliver of a melatonin gummy to their son when he was 1 year old — but didn’t initially tell the pediatrician for fear of judgment, he said.
When they eventually spoke up, the pediatrician was supportive, so they still give melatonin to their son, who is now 2, on a near-nightly basis and sometimes during the day before his naps.
“Almost inevitably, if we forget to give it to him in the evening it’ll be coming on 10 o’clock and he’s still sitting up in his crib,” Giesecke said. If they do give it to him, “he’s usually out in 15 minutes.”
How do you know if melatonin might be helpful?
Children on melatonin should meet some criteria for insomnia, and in particular for difficulty falling asleep. But they also should have other things ruled out, experts said.
“If you are worried about your kid’s sleep, talk to your pediatrician,” said Craig Canapari, M.D., an associate professor of pediatrics at Yale University, director of the Pediatric Sleep Center at Yale-New Haven Hospital. “Melatonin certainly may be on the table for a finite period of time, but you have to look and see is there an underlying problem that is causing your child’s insomnia.”
For example, melatonin is not appropriate for restless leg syndrome. Both the American Academy of Pediatrics and the National Institutes of Health say that children should not take melatonin long-term, but neither organization defines what long-term means. Some children naturally fall asleep later than parents might like, but that doesn’t mean they need melatonin.
If you use melatonin, how much and what type should you give your child?
This is an important discussion to have with your pediatrician because there are no hard and fast rules. A 2014 paper in the European Journal of Pediatric Neurology recommended doses of one milligram for children and adolescents. The maximum dosage for children less than 88 pounds is three milligrams, the study said, and children who weigh more than 88 pounds should not take more than five milligrams.
Dr. Owens and Dr. Rodriguez both said they would not recommend more than five milligrams of melatonin for a child.
Dr. Canapari said he generally starts with half a milligram and goes up to a maximum dosage of around three milligrams.
“My experience is that higher doses don’t tend to give you a lot of benefit,” and can even bring unwanted side effects like headaches, morning grogginess or vivid dreams, he said.
As for which type, check your melatonin packaging to see if it has a logo from either UL, United States Pharmacopeia (U.S.P.) or ConsumerLab.com. These companies test dietary supplements to ensure that they meet their standards for purity.
Families who are using melatonin should always combine it with behavioral interventions like a consistent bedtime routine, sleep experts said.
What should parents be concerned about?
The parenting website of the A.A.P. has warned of concerns that melatonin might affect puberty, but so far there isn’t any solid evidence of this.
In a 2019 review of recent studies about melatonin and puberty, the authors found it difficult to draw strong conclusions. Only a few studies have examined the topic on a long-term basis, and these had small sample sizes, incomplete follow-up and poor measures of pubertal timing, the authors said.
There are other concerns, too. Side effects can include morning sleepiness, nightmares, agitation, headaches and increased urination at night. And melatonin could interact with certain medications. But in general, Dr. Owens said, “it’s pretty well tolerated” among her patients.
More worrisome is the lack of strict regulation of melatonin products. A 2017 study tested 31 different melatonin supplements and found most of the supplements did not have the same amount of melatonin listed on their labels. In addition, 26 percent of the supplements contained serotonin, a hormone that can have harmful effects even at relatively low levels.
“I was so shocked by that, and it completely changed my recommendations to families,” Dr. Owens said. She now recommends the brand Natrol because it has been used in clinical trials that evaluated its purity. (She said she has no financial ties to the company.)
We don’t have evidence as to whether taking artificial melatonin will suppress the body’s own production of melatonin. At least one study has indicated that this was not true among adults but it does not appear to have been studied in children.
Are there other ways to help your child sleep better?
Melatonin has often been called the “hormone of darkness” because darkness triggers its release. It is suppressed by light, including the blue light emitted by digital screens. So one of the best ways to help a child’s brain get sleepy is to dim the lights in your home and turn off those omnipresent screens an hour before bedtime.
It’s also helpful to get exposure to bright light during the day, since sunlight helps regulate our sleeping patterns. When people are exposed to light in the morning, regardless of whether it’s sunlight or very bright artificial light, it helps nighttime melatonin production.
Try to keep a structured, consistent bedtime routine to preserve your child’s sleep-wake schedule. For children 6 and under, difficulty sleeping is often a behavioral issue, experts said, and behavioral solutions might work.
To help your child fall asleep earlier, Dr. Canapari recommends making sure your child doesn’t nap too late in the day. To get to sleep by 8 p.m., for example, make sure your child’s nap ends before 4 p.m.
Also, match your child’s bedtime to when they naturally fall asleep. Then try shifting bedtime earlier by 10 to 15 minute increments. Eventually, you will find a “sweet spot,” Dr. Owens said, that works for you and your child.
Dr. Canapari suggested thinking about ways to incentivize a child’s time in bed and offering rewards as opposed to punishments.
And if your child is using melatonin, he added, continually reassess your need for it while also making sure your child has the best possible sleep hygiene, the habits that help prepare the body for sleep