Is Melatonin Safe For Kids? Pediatric Sleep Doctors Explain
Melatonin is widely available, but is it safe for kids?
When you ask if a supplement that’s as widely available as melatonin is safe for kids, you might expect an answer a bit more cut-and-dry (and comforting) than “that’s the million-dollar question, isn’t it?” However, when I asked Dr. Alon Avidan, Professor of Neurology and Director of the UCLA Sleep Disorders Center, if melatonin is safe for kids, that was his first response. If you’ve been giving your preschooler melatonin gummies, rest assured there’s no need to freak out. Three pediatric sleep doctors generously shared their insight into melatonin and kids’ sleep habits, and, overall, the news is comforting. Here’s everything parents need to know about melatonin and kids.
What is melatonin?
Unlike other sleep aids that you might be familiar with in the supplement section at the grocery store — like passionflower or valerian — melatonin is not an herbal supplement. “Before we talk about whether or not we recommend melatonin, we just have to remind ourselves that melatonin is a hormone,” says Avidan. Melatonin is a neurohormone that is produced in the brain, and it is actually only available by prescription in the European Union, despite the fact that it’s available over-the-counter here in the United States, Avidan adds. It is often used to treat insomnia and circadian rhythm issues, as well as abnormal movements and behaviors at night. “It’s particularly relevant in pediatric patients because there aren't a lot of medications that are recommended in this patient population due to the lack of safety,” Avidan explains.
Is melatonin safe for kids?
Every kid has a tough night of sleep now and then, and the idea that there’s literally a magical candy that can help you say farewell to bumpy bedtimes is enticing. But are those little melatonin gummies safe for kids? Or should you just walk right on past the supplement aisle?
“The bottom line is that melatonin, overall, is relatively safe in pediatric patients over a short period of time,” Avidan says, adding a lot of important qualifiers to the general idea that yes, melatonin is probably safe for kids.
“Short-term use of melatonin (< 6 months) overall appears safe with minimal side effects,” agrees Dr. Judith Owens, Director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital. However, Owens also adds an important qualifier: “We don't have a lot of data regarding possible long term or possible delayed side effects.”
Although it may be tempting to give your child melatonin — every parent understands that when your kid isn’t sleeping well, no one is sleeping well — experts agree that you should talk with your child’s health care provider before offering melatonin. “Talking to your doctor and finding the right sleep solution for your child can be the best long term solution, and the safest solution,” advises Dr. Elizabeth Super, an Associate Professor of Pediatrics and Clinical Pediatric Sleep Physician at Oregon Health & Science University. “Your doctor can not only help you and your family work on behavioral approaches, but if melatonin is recommended, they can provide guidelines on when to give the melatonin, and how much to give.”
Is melatonin safe for babies?
The short answer is no, says Owens. “We don’t know how melatonin might affect the developing brain, and the vast majority of significant sleep issues in children under 3 years are due to behavioral issues, with a minority related to medically-based sleep disorders, neither of which are addressed by melatonin,” Owens explains. “Unfortunately, many parents and pediatricians think that melatonin is a cure-all for any sleep problem. It should not be used to simply ‘promote restful sleep’ in children who do not have a sleep problem, as often advertised.” There has been a 500%+ increase in melatonin-related calls to Poison Control Centers in the past 10 years, Owens reminds us, and a 40% increase between 2019 and 2020 alone, according to a Centers For Disease Control (CDC) report from 2022. Most of these involve very young children and often the gummy formulations of melatonin. So, if you do have melatonin gummies at home, it’s important to store them well out of reach of kids, just as you would any medication.
How much melatonin is safe for kids? Dosage matters
How much melatonin is too much? Well, the experts say that this depends a lot on your child’s age. The best way to determine the appropriate dose for your child is to work closely with your child’s health care provider.
On average, it’s typically recommended that you start with 1 milligram in preschoolers (which Avidan defines as 3 to 5-year-olds) and increase to 2 milligrams if needed, says Owens, adding that you should “always start at the lowest dose.” For 6 to 12-year-olds, both Owens and Avidan say they typically recommend 2 to 3 milligrams, and for adolescents over 13, they suggest 5 milligrams as a maximum dosage.
“There is no increased effect above 5 milligrams,” explains Owens. However, she adds the caveat that melatonin is poorly regulated in the United States, and the “actual content may be way below or way above the labeled amount.” Because of this, she recommends pharmaceutical-grade melatonin only.
Side effects of melatonin
While experts agree that melatonin side effects are typically mild, Super says, “There are no FDA approved medications for patients under 18 for insomnia. This includes over-the-counter medications and prescription medications.” Common side effects of melatonin for kids, according to Owens and Avidan, may include:
- nightmares or vivid dreams
- morning grogginess
“If those issues arise, parents should check with their primary pediatrician to see what may be going on,” Avidan urges. “Is it a hundred percent safe? I would say no. It does have undesirable side effects that are often unpredictable. Parents have to make sure that they read the labels very carefully to see exactly how much melatonin is included, and give children the melatonin only after talking with their pediatricians.”
In addition to the above, Owens suggests one “softer” side effect of melatonin that parents may want to consider: “The message to children that they need a pill to make them sleep can be damaging in the long term.”
Other ways to help your kid sleep well
Behavioral approaches are the first step in helping your kids sleep well, advises Super. She suggests that the “best way for your child’s brain to produce the appropriate amount of melatonin” is to do the following three steps each day in preparation for a smooth bedtime and night of sleep:
- Make sure your child has lots of exposure to bright light in the morning to help with alertness. “Getting your child outside in the morning can significantly help their night time sleep,” Super explains.
- Turn off all electronics 60 minutes prior to bed. This is “necessary for your brain to produce its maximum amount of melatonin.”
- Dim the lights for 30 to 60 minutes prior to sleep. “This could mean using a night light during bath time or a flashlight or headlamp while reading together in bed,” Super says. “Think about how sleepy you get while camping in the natural darkness, and try to mimic that as part of your sleep routine! Your brain is very sensitive to light prior to bed, and light can powerfully decrease your brain’s natural melatonin.”
There are, however, two pediatric populations that Super says may particularly benefit from melatonin. “The pediatric populations most well-studied with regard to melatonin use are children with ASD [Autism Spectrum Disorder] and ADHD [Attention Deficit/Hyperactivity Disorder],” Super explains. “As an alternative to other sleep medications for children with ASD, as well as the common need for long-term use, melatonin is often the best, safest medication choice, along with a behavioral program.”
In short, despite its wide availability, melatonin is not a supplement to approach lightly. When you think of a it as a neurohormone in gummy form, maybe it’s easier to understand why the E.U. and Canada have chosen to make it available by prescription only. However, used very occasionally and at the right doses, it may help your child with an occasional bumpy night. Just get the OK from your doctor or health care provider before you give your child a melatonin supplement.
Dr. Elizabeth Super, associate professor of pediatrics and clinical pediatric sleep physician at Oregon Health & Science University
Dr. Judith Owens, M.D., MPH, Director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital
Dr. Alon Avidan, Professor of Neurology and Director of the UCLA Sleep Disorders Center