By Taylor Knopf

Nearly every new parent has felt the pain of sleep deprivation. Those sleepless nights can be brutal. The longer they drag on, the more desperate caregivers become, scouring the internet for any solution that might allow them a night of rest.

An increasing number of parents are giving their children melatonin supplements, according to the Centers for Disease Control and Prevention. Many people consider the widely available sleep aid to be safe because it also occurs naturally in the body. Melatonin is a hormone the body releases when it’s dark and helps regulate a person’s sleep.

In response to the supplement’s increased popularity, health organizations are urging caution when considering the use of melatonin for small children, citing increased emergency room visits and calls to poison control centers. Additionally, sleep experts say that, in most cases, melatonin is not necessary or helpful for children.

And in North Carolina, the medical examiner’s office says there have been several deaths of children who had high levels of melatonin in their bodies at the time of death over the past seven years. 

‘Not entirely understood’

Earlier this year, the North Carolina Office of the Chief Medical Examiner released a unique report examining seven pediatric cases going back as far as 2015 where cause of death was undetermined. However, notable levels of melatonin were found in the postmortem toxicology reports. Five of the seven deaths occurred in children younger than 1 year old.

“These cases from the NC OCME system raise awareness regarding the administration of melatonin to toddlers and infants who have died from undetermined/unknown causes,” the report concludes. “Melatonin is not known to be acutely toxic; however, it causes a multitude of systemic effects by way of mechanisms of action that are not entirely understood, especially in developing infants.”

The NC medical examiner report notes that infants’ bodies do not process substances the way or in the same amount of time as adults and melatonin can stay in their systems longer. The supplement has also been known to disrupt an infant’s natural body temperature control cycle in some cases. 

“More guidance is critical for parents and pediatricians who use melatonin as a routine sleep aid for young children,” the report said.

Increased melatonin use

The American Academy of Sleep Medicine has warned that the contents of melatonin supplements can vary. Because melatonin is a dietary supplement, it’s not regulated by the Food and Drug Administration in the same way as prescription medications. This means that the additives and quantities may vary greatly from product to product. 

The Academy’s health advisory noted one study that found the amount of melatonin in products tested ranged from “less than one-half to more than four times the amount stated on the label.”

Nonetheless, melatonin sales spiked, during the pandemic, as people looked for ways to get a good night’s sleep during a time of heightened uncertainty.

“With this increased use, there are growing reports of melatonin overdose, calls to poison control centers, and emergency room visits for children, even more so during the COVID-19 pandemic,” according to a health advisory from the American Academy of Sleep Medicine

From 2012 to 2021, the CDC reported a 530 percent increase in the annual number of pediatric ingestions of melatonin that resulted in calls to poison control centers. Hospitalizations and more serious consequences mostly occurred in children 5 years or younger who accidentally ingested too much of the supplement. 

Melatonin can come in the form of gummies, which are appealing to children. In 2020, melatonin was “the most frequently ingested substance among children reported to national poison control centers,” according to the CDC.

Not helpful for children

In addition to safety and regulatory questions regarding melatonin, the supplements aren’t proven to be helpful in addressing most sleep issues among children, according to Sujay Kansagra, Duke Health pediatric neurologist and sleep specialist.

“As far as melatonin use in kids, if a child is otherwise healthy, there’s almost no indication to use melatonin,” Kansagra said. 

The supplement is most effective for adults who need to shift their circadian rhythm, the body’s internal clock.

“If you’re having to work the night shift two weeks and having to work the day shift the next week, there is data that sort of shows that melatonin use can help with that adjustment,” Kansagra said. “It can also be helpful for the effects of jetlag because you’re doing the same thing, you’re having to adjust your body’s clock or to readjust a new time zone.”

The most prevalent behavioral sleep disorders in children are Sleep-Onset Association Disorder and Limit Setting Disorder. Both are very common and treatable, he said. Treatment often includes following the tenets of good sleep hygiene and implementing routine.

“Because most of the sleep challenges that children experience are usually in the behavioral realm and they have a behavioral solution,” Kansagra said, noting that there may only be one or two lectures in pediatric residency dedicated to the topic. “The challenge here is that most pediatricians are just not trained, unfortunately, in treating sleep issues in children. It’s just a flaw in our training.”

Kansagra helps parents of young children by explaining these disorders and sharing tips and helpful sleep information across all social media platforms, using the handle @ThatSleepDoc.  

Practicing good sleep hygiene

“The tenants of good sleep hygiene, they’re pretty consistent across any age,” Kansagra said, outlining the following.

  • Have a nighttime routine. About 20 to 30 minutes before bed, have a few calm, relaxing activities that are done in the same way every night. 
  • Create a comfortable sleeping environment. People sleep best in dark, cool and quiet spaces. 
  • Avoid activities and substances that disrupt sleep. Bright lights before bed, especially from LED devices such as computer and phone screens, can disrupt sleep. Caffeine consumption later in the day, as well as alcohol and nicotine can cause sleep disruptions. 
  • Keep a consistent schedule. Going to sleep and waking at roughly the same time each day, including weekends, helps the body get into a good sleep rhythm. 

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Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...