Remember when you brought your newborn baby home from the hospital and she slept during the day but was awake all night? One of the first things we do as new parents is to start trying to help our babies shift their sleep and wake times (circadian rhythms) to match our own. Baby sleep is challenging and the battle continues into toddlerhood and even adolescence. In my family medicine practice, I often get asked by parents about using melatonin for sleep. “What is melatonin,” “is melatonin safe in children” and “what about melatonin for sleep in children.”
What is melatonin?
There is an internal clock in our bodies, also called the circadian rhythm, or the sleep-wake cycle. A hormone called melatonin (produced by the pineal gland in the brain) regulates our internal clock. AKA it helps tell us when its day and night. When to go to sleep, and when to stay awake.
Melatonin is a chemical naturally produced in our body, that helps us fall asleep at night. After birth, melatonin within the pineal gland is not fully functional. It takes time before the pineal gland can produce enough melatonin at nighttime to start having “regular” sleep cycles. At 3 months old melatonin begins to regulate, so this is when 3 month old babies will begin to have more regular sleep patterns.
Melatonin is sold in supermarkets, drugstores and health food stores and marketed as a “natural sleep aide”. In fact – Melatonin is actually a prescription product in Europe! Health Canada actually recommends melatonin only be used for adults and is not marketed specifically for use in children.
Does melatonin for sleep help promote sleep, improve insomnia, or treat sleep difficulties?
Melatonin may be effective for management of “circadian rhythm disturbances.” This is most commonly found in people who suffer from sleep issues due to shift work, or from jet lag. In fact, I use melatonin when I struggle with sleep after being on call or when I am jet lagged.
The data surrounding melatonin use in children that have difficulty falling asleep, or staying asleep – is conflicted. One meta-analysis of 226 children did find a reduction in sleep latency (how fast you fall asleep) by 0.67 hours. In adults, the data is inconsistent and if the results are believable only modest improvement (melatonin may help people fall asleep faster by ~ 10 minutes and spend more time asleep ~ 15 minutes).
There is very little evidence for use of melatonin supplements in healthy children, and most studies are very short term. The population of children where melatonin has shown benefit includes those with autism and attention deficit hyperactivity disorder (ADHD).
The fact is that children’s bodies can normally produce enough melatonin to sleep at night time, provided we have a regular sleep routine. They don’t necessarily need melatonin supplements as well.
So what about giving melatonin pills to my child to help them fall asleep, or stay asleep?
The short answer is melatonin is not recommended as a first step treatment for sleep issues in children. Generally speaking, recommendation from your pediatrician or family physician is recommended before using melatonin for sleep in children.
The first and most important step in helping your child get a restful night sleep is to have healthy sleep habits leading up to bedtime. This should include:
- Consistent bed time and wake up time
- Dark and quiet place to sleep (white noise can be helpful to drown out house noises)
- Avoiding screen time within an hour of bedtime
- Reading books and other relaxing activities in the evening before bedtime
- Consistent and predictable bed time routine
Changes to your child’s bedtime routine can take time and consistency for them to be effective. Generally speaking – Children with sleep deprivation or insomnia should first have an established bedtime routine that may require changing pre-bedtime behaviors, before considering medications or melatonin for sleep.
Keep a sleep diary to help track your pre-sleep habits
If you are struggling with your child’s sleep, a good idea is to keep a sleep diary for your child over at least a two-week period. Keep track of exactly what is happening at home leading up to bedtime, and overnight. This information is helpful at your child’s pediatrician or family doctor when assessing your child for sleep related issues.
A Sleep diary can include:
- When do they stop watching tv or playing on their phone?
- Any self-care activities before bed? (relaxation, mindfulness, showers/baths)
- Are they going to bed hungry?
- Any heated conversations before bed?
- When do they turn out the lights? How long do they toss and turn?
- How many night-time awakenings?
- What do they do when they wake up mid-night? Do they get up or stay in bed?
- What time do they wake up?
- Do they drink coffee or soft drinks with caffeine throughout the day? If so, how much?
- What time do they take their medications?
Are there side effects to melatonin?
Yes – melatonin is a medication, and all medications have side effects. Some side effects of melatonin may include: relapse of poor sleep upon discontinuation of melatonin, increased urination at night, daytime drowsiness or sleepiness.
The bottom Line, is that melatonin should not be used as a replacement for healthy sleep hygiene!
This post was co-authored by Erin Manchuk, BScPharm, BCGP and Stephanie Liu, MD, MSc, CCFP, BHSc.
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Owens JA, Babcock D, Blumer J, Chervin R, Ferber R, Goetting M, Glaze D, Ivanenko A, Mindell J, Rappley M, Rosen C, Sheldon S. The use of pharmacotherapy in the treatment of pediatric insomnia in primary care: rational approaches. A consensus meeting summ
https://www.cps.ca/en/documents/position/melatonin-sleep-disorders-children-adolescents – Accessed April 12, 2019
van Geijlswijk IM, Korzilius HP, Smits MG. The use of exogenous melatonin in delayed sleep phase disorder: a meta-analysis. Sleep 2010; 33:1605.