The Current24:25Concerns about melatonin use in children
Bedtimes became a hassle for Lorien’s neurodivergent son about a year after moving out of Vancouver to B.C.’s Kootenays. The lack of sleep that came with it was having an effect on his behaviour, his relationships and his happiness.
That’s why, after hearing a conversation in a health store that melatonin can be used for sleep, including with children, she thought she would give some to her son.
“One of the things that they had really emphasized in that conversation … [was] low dose is key,” she said. “What you want to do is give your child just that little tiny nudge towards sleepiness, not knock them off the cliff.”
Lorien, whose last name we’re not using to protect her child’s privacy, said it’s been working as expected so far.
“I started with just literal drops, and all of a sudden it was enough that at 20 minutes after taking them, we’d be all tucked in with our bedtime story and he would just feel sleepy,” she told The Current’s Matt Galloway.
Melatonin is a hormone that humans produce naturally through the brain’s pineal gland, and supplements can be bought over the counter as a sleep aid. And according to research in the U.S., it’s growing in popularity.
One study, published in the Journal of the American Medical Association last year, found that melatonin use “significantly increased” from 1999 to 2018 across all demographics.
Dr. Michael Rieder, a pediatrics professor at Western University in London, Ont., says melatonin helps regulate a brain’s circadian rhythm — a system of physical, mental and behavioural changes that follow a 24-hour cycle.
“It’s been shown quite clearly, for instance, that if you have a disturbance in circadian rhythm … melatonin can help reset the circadian rhythm back to where it’s supposed to be,” he told Galloway.
Different effects on different kids
Dr. Suresh Kotagal, a professor emeritus in the department of neurology at the Mayo Clinic in Rochester, Minn., said it’s understandable why parents like Lorien turn to melatonin to help with their child’s sleep issues.
“Sleep is so important for children because it’s only when they have good, sound sleep at night that restorative functions in the brain start clicking,” he told Galloway.
“And the next day, after a good night of sleep, children are able to stay more alert and be happier and learn better.”
But he says that doesn’t mean melatonin is a suitable supplement for every child.
“In typically developing children who don’t have autism, I think I would look elsewhere for an answer to improving sleep rather than melatonin first,” he said.
According to a 2019 study published in the National Library of Medicine, 50 to 80 per cent of children with Autism Spectrum Disorder experience sleep disorders, compared to nine to 50 per cent of neurotypical children.
Kotagal, who’s also the chair of the World Sleep Society’s task force, said there are studies that show the enzyme Acetylserotonin O-methyltransferase (ASMT), which is important for the body to make melatonin, is deficient in children with autism.
“So indeed, when we give melatonin to children with autism or other neurodevelopmental disabilities, we are improving or increasing the levels of melatonin in them,” he said.
He and his peers are doing their own rigorous analysis of published data on melatonin use in children with autism and other neurodevelopmental disabilities between 2012 and 2022. They’re trying to learn more by studying roughly 850 neurodivergent children.
Still, he said evidence shows melatonin is helping children with autism and neurodevelopmental disabilities sleep better. But he says the evidence isn’t as clear with other children who just have difficulty sleeping.
Lorien’s son hadn’t yet been diagnosed with inattentive-type ADHD when she first got melatonin for him. But she said that at that point, “the risk of doing nothing was that my child was having a really, really hard time with sleep” and other aspects of daily life.
“So to me, the very small risk of the unknown was offset by the need to not just do nothing,” she added.
The use of melatonin as a sleep aid has significantly increased over the past two decades, but experts say it isn’t a cure-all, and taking too much can cause health problems.
Understanding the risks
Although the evidence for melatonin use in neurotypical children is soft, the supplement is widely used regardless.
That’s concerning to doctors such as Rieder, because he says there’s a risk of parents giving too much melatonin to their children.
“Melatonin doses that work in kids are very small. You don’t have to give a lot of melatonin to work,” he said. “The problem was if you give it [and] it doesn’t work, there’s a natural tendency to think, ‘Maybe they just need to go a little bit more.'”
Rieder said melatonin can be bought in a 10-milligram tablet, which is the right dose for an adult, but too much for a child.
But because it’s usually sold as an over-the-counter supplement in Canada, there’s no intermediary that can prevent parents from giving their children unnecessarily large tablets.
“You can go into your into your pharmacy and use a self-check and not even speak to a human person at all to get this dose,” he said.
According to data provided to The Current by SickKids, which operates the Ontario Poison Centre, the number of melatonin-related calls from Ontario, Manitoba and Nunavut for children five and under increased every year from 2017 (160 calls) to 2021 (438 calls.)
Lorien, who has started taking melatonin supplements along with her other child, understands this risk. That’s why she’s taking precautions such as breaks in usage to prevent overdose.
“We literally use scissors and we cut them into quarters in order to keep that dose low where we want the kids to be taking it,” she said.
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Nevertheless, Kotagal suggests looking at other solutions to help tackle sleep issues.
He said if a child is below the age of two, nearby noise or medical issues may be the problem and those should be looked at first.
“When we come to older children, I would try behavioural sleep measures first. Go, if possible, discuss that with the primary care provider or sleep specialist.”
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