Nighty-Night or not quite right? Melatonin craze among young people

Nighty-Night or not quite right?  Melatonin craze among young people

Melatonin children's sleep

A study from the University of Colorado Boulder indicates that nearly one in five children and teens use melatonin for sleep, and use extends to preschoolers. Concerns arise due to limited safety data and the FDA’s lack of regulation. Experts stress caution, noting the importance of behavioral changes regarding nutritional supplements to treat sleep problems in children.

Research shows a significant increase in the use of melatonin among children and adolescents for sleep, raising concerns about safety, effectiveness and potential long-term health effects. Experts advise caution and recommend prioritizing behavioral solutions to sleep problems.

Nearly one in five school-age children and teens now take melatonin for sleep, and some parents routinely give the hormone to preschoolers, according to new research from the University of Colorado Boulder published November 13 in JAMA Pediatrics.

Concerns raised by researchers

This concerns the authors, who note that safety and effectiveness data surrounding the products are scant, and that these supplements lack full regulation by the Food and Drug Administration.

“We hope this paper will raise awareness among parents and clinicians, and sound the alarm to the scientific community,” said lead author Lauren Hartstein, Ph.D., a postdoctoral fellow in the Sleep and Development Laboratory at the University of Colorado Boulder. “We are not saying that melatonin is necessarily harmful to children. But more research needs to be done before we can confidently say that it is safe for children to take it long-term.

Researchers at the University of Colorado Boulder have noticed an increase in the use of melatonin to help children sleep. Postdoctoral fellow Lauren Hartstein describes what melatonin is and how high use can be a problem.

Melatonin usage trends and statistics

Melatonin is naturally produced in the pineal gland to signal the body that it is time to sleep and regulate its circadian rhythm – the 24-hour physiological cycle.

In many countries, the hormone is classified as a drug and is only available by prescription.

However, in the United States, chemically synthesized or animal-derived melatonin is available over-the-counter as a dietary supplement, and is increasingly available in child-friendly gummies.

“Suddenly, in 2022, we started to notice a lot of parents telling us that their healthy children were taking melatonin regularly,” said Hartstein, who studies how environmental cues, including light at night, affect children’s sleep quality and melatonin production.

During 2017-2018, only about 1.3% of American parents reported that their children used melatonin.

To get a sense of how widespread current use is, Hartstein and his colleagues surveyed about 1,000 parents in the first half of 2023.

Among children ages 5 to 9 years, melatonin had been administered in 18.5% of survey participants in the previous 30 days. For teens ages 10 to 13, that number rose to 19.4%. Nearly 6% of preschoolers ages 1 to 4 years had used melatonin in the previous month.

Preschool children who used melatonin had been taking it for an average of one year. It has been used by elementary school students and teens for an average of 18 and 21 months, respectively.

The older the child gets, the higher the dose, with preschoolers taking between 0.25 to 2 mg, and pre-teens taking up to 10 mg.

Risks and mislabeling issues

In a study published in April, researchers analyzed 25 melatonin gummy products and found that 22 of them contained different amounts of melatonin than stated on the label. One had more than three times the amount on the label. One had nothing at all. In addition, some melatonin supplements have been found to contain other substances of concern, such as serotonin.

“Parents may not actually know what they are giving their children when they give these supplements,” Hartstein said.

Some scientists have also raised concerns that giving melatonin to young people whose brains and bodies are still developing could affect the timing of the onset of puberty.

The few human studies that have looked at this have yielded inconsistent results.

Gummies, specifically, also carry another danger: They look and taste like candy.

From 2012 to 2021, the authors note that reports of melatonin ingestion to poison control centers increased by 530%, occurring largely among children under age 5. More than 94% were unintentional and 85% were asymptomatic.

Potential risks and recommendations

When used under the supervision of a health care provider, melatonin can be a useful short-term adjunct, said co-author Julie Borgers, Ph.D., a psychiatrist and pediatric sleep specialist at Rhode Island Hospital and Alpert Medical School of Brown University. Especially in young people with autism or severe sleep problems.

“But it’s hardly considered a first-line treatment,” she said, noting that she often recommends that families look at behavioral changes first and use melatonin only temporarily. “Although it is usually well tolerated, when we use any type of medication or supplement in a young, developing body, we want to be careful.”

Anecdotally, I have heard from parents that the supplement often works well at first but over time children may need higher doses to achieve the same effect.

Introducing melatonin early in life can also have another unintended consequence: It may send the message that if you have trouble sleeping, birth control pills are the answer, Hartstein said.

Study limitations and broader implications

The authors caution that the study was relatively small and is not necessarily representative of nationwide use. However, he says.

“If this many kids are taking melatonin, it suggests there are a lot of underlying sleep issues that need to be addressed,” Hartstein said. “Treating the symptoms does not necessarily treat the cause.”

Reference: “Characteristics of Melatonin Use Among American Children and Adolescents” by Lauren E. Hartstein, Michelle M. Garrison, Danielle Lewin, Julie Borgers, and Monique K. Le Bourgeois, November 13, 2023, JAMA Pediatrics.
DOI: 10.1001/jamapediatrics.2023.4749

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