Is Melatonin Safe for Kids? What Experts Want Parents to Know
A lot of parents were no doubt alarmed when they heard recent news that the number of calls to poison control centers for melatonin overdoses in kids rose by 530% from 2012 to 2021, according to a report by the CDC. Even scarier? Pediatric hospitalizations from melatonin overdoses also increased during the study period, mainly because kids under the age of 5 were unintentionally ingesting it, stated the CDC.
Over a 10-year period, melatonin ingestion among kids was associated with almost 28,000 visits to ERs and emergency clinics, over 4000 hospitalizations and 287 admissions to an intensive care unit, according to research published in the Journal of the American Medical Association (JAMA). Five kids had to be put on mechanical ventilators, and two died.
By 2020, these centers were getting more calls about melatonin ingestions in kids than any other substances, research showed. “I am a big believer that melatonin is often overused, and that there’s little evidence that melatonin is effective as an insomnia medication for kids,” says Raj Dasgupta, M.D., a certified sleep medicine specialist and spokesperson for the American Academy of Sleep Medicine. “Overdoses aren’t common, but it’s scary.”
Dr. Dasgupta emphasizes this point: “Sleep is important not only for the child to function, but for the parents to function. One feeds the other.” But, he adds, “Every parent has a different situation, with a unique kid — and there are parents with kids who are on the autism spectrum, or kids who have ADHD,” which can make sleep issues especially hard. “I don’t want parents to feel shamed if they’ve grabbed melatonin from the shelf in the past to deal with it,” he says.
Instead, with his help, we're looking at what parents need to know about the safety around melatonin for kids.
Why unintentional overdoses are happening
When the sun sets, our brains are wired to produce melatonin, a natural hormone secreted by the brain's pineal gland, and that sends a message to our bodies that it’s time to sleep. Melatonin supplements are intended to give a boost to that process. There's a lot of good evidence that these supplements can help in terms of shifting one's circadian rhythm, says Dr. Dasgupta, but he adds, “There really isn’t an abundance of evidence in regard to helping chronic insomnia, especially in kids.”
There are a few reasons why overdoses may have become a problem, experts say: For one thing, more parents are relying on melatonin these days to ease their kids into slumber. A study found that melatonin is the second most popular "natural" product used by children in the U.S., and market research done in 2020 showed that the sale of children’s melatonin supplements had spiked by 87% over the previous year. Also, the form that melatonin supplements come in may well be an issue: They’re available in gummies, which look (and taste!) a lot like candy, as well as cherry-flavored chewable pills.
“Why are more parents grabbing melatonin? Because of the way it’s marketed,” says Dr. Dasgupta. “It’s right there in the supermarket or the drugstore, next to the multivitamins. People don’t realize that taking melatonin is something that should be taken seriously, and for kids, you should run it by the pediatrician first. And it’s important to realize that it’s not an FDA-approved drug since it’s a dietary supplement. So it’s not as strictly regulated as a prescription medication.” Supplements are not evaluated by the FDA for safety and effectiveness; companies don’t have to submit proof that their supplements work or that the ingredients listed are accurate.
Another concern — for adults taking melatonin as well — is that the dosage listed on the label of the bottle may be totally different from what’s actually in the supplements, according to a 2017 Canadian study published in the Journal of Clinical Sleep Medicine. The researchers looked at 31 different brands, and the amount of melatonin was found to range from 83% less than the label indicated to 478% more. For example, the chewable sample tested had almost 9 mg of melatonin when it was supposed to contain 1.5 mg. “And in the form of gummy bears, this probably isn’t the most accurate way to dose melatonin,” says Dr. Dasgupta.
Another alarming finding: In the 2017 study, eight of the 31 brands studied contained up to 75mcg of serotonin, which is a controlled substance used to treat neurological disorders. “There’s something called serotonin syndrome,” says Dr. Dasgupta, which is particularly an issue if a child is on depression medication. "Serotonin syndrome can be life-threatening. It presents with very high fevers, a lot of muscle rigidity and neurological manifestations. But it’s not the parent’s job to identify serotonin syndrome — it’s to know, the minute something isn’t right and they feel it’s possibly related to any type of ingestion or medication, to call Poison Control right away and get to an emergency department very quickly.”
An important reason for adults to keep their own melatonin supplements stashed way out of reach: The JAMA report pointed out that some brands of melatonin gummies for adults include CBD, which isn’t approved by the FDA for use by healthy kids. And here again, the amounts declared on the label were incorrect: All the samples had more CBD than was indicated on the bottle.
Signs of a melatonin overdose
It can manifest in different ways, says Dr. Dasgupta. “It’s important to let your healthcare provider know that your child is on melatonin, because the symptoms [of an overdose] may not only be excessive sleepiness. It could be nausea or diarrhea. And sometimes it could be melatonin reacting with another substance or another medication. So there isn’t a classic way of how it would present — but it’s not a parent’s job to memorize the signs and symptoms of early toxicity of melatonin. The important take-home message is that if you even suspect that your child has a melatonin overdose, call Poison Control right away.”
According to Poison Control, some symptoms include:
Sleepiness
Headache
Nausea
Agitation
Is melatonin actually safe for kids to use?
No guidelines have been set about safe dosages for kids or how long it’s okay for them to use it. The American Academy of Pediatrics says it shouldn’t be taken “long-term,” but doesn’t define what time period that is. "While studies have shown that short-term use is relatively safe, less is known about longer uses of melatonin," the AAP's website states.
But Dr. Dasgupta says he would never recommend it for infants or children under age 5, since their sleep circadian rhythm is still developing.
There's also a theory that, if a child who hasn’t gone through puberty yet uses melatonin over an extended period of time, it could delay puberty’s onset. Because the brain’s natural melatonin levels go down during puberty, the theory suggests that artificially keeping kids’ levels higher than normal could delay puberty. So far, this hasn’t been sufficiently studied; in 2019, a research review published in the journal Natural Science Sleep stated that the studies done to date were very small and not sufficient to determine whether there is an impact, and that more research is needed.
What to do when a child is having sleep issues
“As a doctor, when I think of parents grabbing melatonin for their child, my first question is why? Why are you grabbing it?” says Dr. Dasgupta. “If your child isn’t sleeping well, that opens up other questions. Does the child have a medical issue? Is there some kind of undiagnosed sleep breathing disorder, like obstructive apnea, which can happen even if you’re a kid? Is the child having a circadian rhythm problem — is the child a night owl? This is where your health care provider or a sleep specialist can help you figure out why, and address the underlying cause.”
Dr. Dasgupta points out that the pediatrician can help parents figure out the cause of insomnia, whether it's, say, behaviorally induced (like when a child relies on being rocked to sleep), or a case of limit-setting insomnia, where the parents need to work on a bedtime routine with the child. “Or maybe the child is on the autism spectrum, which makes it so hard to get good sleep." Same with a child with ADHD who’s getting medications such as stimulants. "I want to acknowledge the hard work of parents and what they’re going through.”
Bottom line: Dr. Dasgupta emphasizes that melatonin should be kept out of the reach of children, in a childproof bottle. Then, he says, “It's important with kids, the same with any medication, that melatonin is taken under the supervision of their health care provider. The rule of thumb is always, start low and go slow. When using any medication, you definitely want to use the lowest effective dose." Dr. Dasgupta adds, "It’s not going to be a long term solution — you always have to have an endpoint. And you always want to encourage children to have good sleep habits, like a regular bedtime and wake time routine, and limiting screen time — these are always going to be the first step before initiating melatonin. And letting a healthcare provider supervise your journey.”
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