children melatonin

Many parents have found that melatonin is a safe, natural way to help their children sleep. But some pediatricians worry that the supplement needs further study. 

My husband and I got new Fitbits earlier this year. They're standard models, able to track how many steps we take each day, our "active" minutes of movement and the number of hours we sleep each night.

I've abandoned mine because I resented the device showing me how poorly I sleep. I don't need a Fitbit to tell me that I'm tired.

At one point this summer, I turned to my primary care doctor for help. I showed him the sleep charts on the tracker's app. Night after night, I was tossing and turning. (My husband, on the other hand, enjoys many hours of deep sleep every night. I came to resent that, too.)

My physician told me he could prescribe a prescription sleep aid, but he suggested I first try melatonin, a hormone the body already naturally produces. A supplement, he advised, might help regulate my sleep cycles. Plus, it's cheap and available over-the-counter. 

I followed his advice, but after a week or two, I didn't find melatonin particularly helpful. I was still tossing and turning and felt like it made me groggy during the day, so I stopped taking it.

Many millions of other adults would disagree with me. 

The federal government estimates that the use of melatonin more than doubled between 2007 and 2012 and that last year 1.3 percent of all adults in the country took a melatonin supplement, nearly as many as took a probiotic. 

Melatonin intake among kids is up a lot, too. An estimated 419,000 U.S. children now use melatonin, almost five times as many as in 2007. 

By most accounts, the supplement appears to be safe with no side effects. It's not addictive and patients tend to respond to a small dose. But some pediatricians argue that the effects of long-term melatonin use haven't been studied among children. And the supplements aren't regulated as rigorously by the federal government as prescription drugs. 

"It is not 'FDA approved.' That’s the little red flag," Dr. Jacqi Angles, a sleep expert at the Medical University of South Carolina, told me. "We just don’t know enough about it long-term."

That doesn't mean Angles won't recommend melatonin for some children. But she does so with caveats: Parents need to consult their child's pediatrician to determine the appropriate brand, the correct dosage and to figure out when the child should take the supplement each day. Parents also need to work with a doctor to identify other factors that may be inhibiting their child's sleep, such as screen-time before bed or midday naps.

Angles said she's never recommended a melatonin regimen for a child younger than 4 or 5 years old or advised parents to give it to their children for more than a few weeks. Children are typically able to correct their sleep cycle within a month, she said. 

"I’m very comfortable giving children melatonin," she said. "Unfortunately, we just don’t know what those ... long-term effects are. We don’t want kids to be on medications for a long time."

Likewise, the National Institutes of Health warns that "important questions remain about (melatonin's) usefulness, how much to take, when to take it, and its long-term safety."

A report published in The Guardian earlier this month raised similar questions.

"(E)xperts have expressed concern that the hormone may be being overprescribed," the report explained, "due to the fact that there are few alternatives to support children with insomnia and other problems."

Unlike the United States, melatonin requires a doctor's prescription in the United Kingdom. In the U.S., the FDA has not approved any prescription sleep aid for pediatric use. American doctors may prescribe drugs such as Ambien and Lunesta to children "off-label," even though studies have found that they often don't work well for kids.

“(Melatonin) is a prescription of desperation really; doctors don’t know what to do about sleep and feel they have no alternatives,” Dr. Neil Stanley, a sleep expert, told The Guardian. “That is terrible as it affects all body clocks and it will affect children’s developmental clocks and we have no idea what that does.”

The key word there is "desperation." And it's not only doctors abroad who are grasping for answers. I know parents are equally invested when it comes to addressing problematic sleepers. My daughter, for example, has outgrown the need for a midday nap. But because she sleeps with the rest of her daycare class after lunch, she often won't fall asleep at night until 10 p.m. 

Speaking from experience, it's no wonder melatonin use has increased so substantially. On at least one occasion, my daughter's new sleep schedule has prompted a major meltdown — on my part, not hers. 

I've wondered lately: Is melatonin the magic pill she needs? 

Probably not. 

Dr. Jess Shatkin works at the Child Study Center at NYU Langone Medical Center in New York City and co-authored a 2016 review titled, "Insomnia: the Sleeping Giant of Pediatric Public Health." 

In most cases, Shatkin said, he wouldn’t recommend melatonin for kids under 7. But that doesn't mean it's not helpful for older children, particularly adolescents who can't seem to fall asleep until after midnight. The short-term use of melatonin is also good for managing jet lag, he said. 

But when it comes to chronic sleep disorders, behavioral therapy should be considered the first-line treatment before medication. Not to mention, Shatkin said, toddlers who delay their bedtime aren't good candidates for sleep aids. They just need some encouragement. 

Dr. Deborah Greenhouse, a pediatrician at Palmetto Pediatric and Adolescent Clinic in Columbia, agreed that children who resist bedtime or wake up in the middle of the night shouldn't be offered a pill to fall asleep. 

Greenhouse said she's found that older children, particularly those with an autism spectrum disorder, have responded well to short-term melatonin use. But she advised parents to discuss the supplement with their child's pediatrician before reaching for the medicine cabinet. There may be something else going on that's keeping the child from sleeping, she said. 

"Melatonin can be one of the tools in our tool box," she said. "It shouldn’t be the only tool, and it shouldn’t be the tool you use first."

Reach Lauren Sausser at 843-937-5598.