Is melatonin safe for children?

Recent media coverage surrounding melatonin use in Australian children suggests it’s becoming more commonplace, with an upcoming study from Central Queensland University finding that among 255 parents, 70% used melatonin for their children.
 
According to Therapeutic Guidelines, more than a third of children and adolescents experience sleep problems and first-line therapy is sleep hygiene. They also state that although melatonin is widely used for sleep problems in children and adolescents, high-quality evidence of benefit and long-term safety data are lacking.
 
‘There is also little evidence to guide dosing, choice of formulation and timing of administration,’ they state.
 
‘Melatonin should only be used for sleep problems in children and adolescents with specialist advice [eg paediatrician, sleep specialist, child psychiatrist].’
 
Dr James Best, Chair of RACGP Specific Interests Child and Young Person’s Health, told newsGP he is increasingly seeing parents use melatonin for their children.
 
‘I’m seeing more and more. Use is widespread,’ he said.
 
‘It’s appropriate to use in autism, ADHD and in some developmental disabilities, but apart from those specific populations, it isn’t recommended.
 
‘Online sourcing is very common, or through supplement shops where they can get the gummies.
 
‘The evidence is very limited on its efficacy and safety and there can be problems associated with it, such as agitation, headache and accidental overdose.’
 
A June 2022 report published by the US Centers for Disease Control and Prevention showed that from 2012–21, the annual number of paediatric ingestions of melatonin reported to poison control centres increased by 530%.
 
More than 84% were asymptomatic, but those with symptoms included gastrointestinal, cardiovascular and central nervous system problems. Five children required mechanical ventilation and two died.
 
According to Professor Sarah Blunden, a clinical psychologist and sleep researcher, parents often tell her melatonin supplements are ‘natural’ – even though they are not.
 
‘We do have natural melatonin, but what you’re getting in a bottle is not natural. It’s a chemical,’ she told Nine Newspapers.
 
‘In Australia, it’s not TGA [Therapeutic Goods Administration] approved, and it is rampantly prescribed by doctors and paediatricians.
 
‘It staggers me.’
 
Dr Best has similar concerns and points out that melatonin is often sourced over the counter or online, which can lead to a different set of issues.
 
‘It’s unregulated and who knows what’s in it. What’s on the label and what’s in it isn’t always the same. For example, some were found to contain serotonin,’ he said.
 
‘We don’t know what we’re getting when we order something online.
 
‘It is a problem. Sleeping, in children, is a common problem but melatonin is a quick fix and we shouldn’t be using them willy-nilly.’
 
Instead, Dr Best says parents should be given support to help children self-settle.
 
‘Sleep in children is challenging, but there should be a behavioural approach,’ he said.
 
‘I advise parents all the time. It’s the GP’s role to have the skills to advise parents to do it or refer to other resources, such as the Raising Children Network.’
 
Their tips include:

• a regular bedtime routine
• consistent sleep and wake times
• reducing naps as children grow
• avoiding screens, particularly blue light from televisions, computers, iPads and phones, which suppress natural melatonin.

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