Q: My ten year old son finds it hard to fall asleep at night. We have tried a number of methods to help him, but nothing seems to work. Is it safe to use melatonin in a ten year old?
A: The use of melatonin in the pediatric population has become more and more common. It appears to be safe and effective for the most part, but there are still a number of unresolved questions that require further research
When it gets dark at night, the body’s natural response is to produce melatonin which is a hormone synthesized by the pineal gland in the head. The presence of light inhibits the production of melatonin.
Up to 25% of children experience difficulties in falling asleep. Normally, most individuals will fall asleep within 15-20 minutes after lying down.
In adults the main uses of melatonin have been for the management of jet lag and delayed sleep onset disorders. However some have suggested that it may also help to delay aging and prevent certain cancers. Data on the uses of melatonin in adults cannot be extrapolated to children.
Because synthetically made melatonin supplements in Canada are sold as natural health products, medical claims are carefully scrutinized and authorities require proper research to confirm both the safety and efficiency of melatonin. This is where the current research is in a Swiss cheese state—there are a number of papers available, but also large gaps here and there which must still be sorted out.
Most of the research which has had favorable outcomes was done in children with neurodevelopmental abnormalities such as Attention Deficit Disorder, Autism and Cerebral Palsy. Dosages used varied from between 2.5 mg per day to as high as 10 mg per day.
Melatonin is given 20 to 30 minutes prior to bedtime. This over-the-counter product comes in three forms: pill, liquid and sublingually. According the website of the BC Children’s Hospital the brand used by experts in that setting is Twinlab.
Melatonin seems to work equally well in both male and female patients and is not addictive. It does not lose its efficiency over time.
According to a survey of US pediatricians, 15-20 of pediatricians have recommended the use of melatonin to patients who have trouble falling asleep. It is not recommended for patients who have no trouble falling asleep but who wakes up later and then fails to fall asleep again.
In Australia and the UK melatonin use in children is not a common practise and authorities there have not allowed its official use.
Side effects of synthetic melatonin include vivid dreams, nightmares, a rise in blood glucose and if the dose is too high, drowsiness the next day. It may also interact with caffeine (contained in some energy drinks consumed by teenagers for example), antidepressants and the birth control pill. For these reasons it is important to mention it to your doctor when you have decided to use over the counter products such as melatonin.
At this point it is unclear if melatonin has an effect on the onset of puberty—some studies tell us it has no effect while others have been inconclusive. It is also unclear if melatonin may aggravate asthma.
Because of the above controversies, the Canadian Pediatric Society is currently working on a position paper regarding the use of melatonin in children. Position papers are usually based on scientific studies which look at all the evidence thus far. Most consider Cochrane reviews the gold standard. The bottom line is that we have more evidence on the use of melatonin in children with neuro developmental issues than the normal pediatric population.
The American Academy of Pediatrics has a section for Holistic, Complimentary and Integrative Medicine. This section published their stand in Pediatrics in Review (2009) An abstract can be found at www.pedsinreview.aappublications.org
It is important to remember a few basic principles when a child finds it hard to fall asleep. For example the use of television prior to sleep must be reduced or eliminated; exercise close to bedtime can delay the onset of sleep and big meals may also lead to insomnia. The light emitted from hand held electronic devices used prior to bedtime may also delay the natural production of melatonin.
A useful resource for sleep issues in children can be found at www.kidzzzsleep.org
Dr Peter Nieman is a member of the Canadian Pediatric Society and the American Academy of Pediatrics. He hosts www.healthykids.ca and www.lifebyexample.ca. He can be followed on Twitter at @DrPeterNieman
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