Kids, sleep and melatonin

We call our 2-year-old “the sleep bandit.”  Every night we get our kids through the bath, in pajamas, and finally, after multiple stories and lots of kisses and snuggles, we close the last bedroom door.  About 5 minutes later we hear her little feet… and we start the game of putting her back to bed, many, many times.  She just won’t sleep.  Out of desperation we tried giving her a little melatonin… it worked.

Lots of adults regulate their sleep with melatonin supplements, but what about kids?  Is melatonin safe for children?  Does it work?

About 25% of children take a long time to fall asleep—getting out of their bed and infamously asking for one more drink of water, one more story.  In medical terms we call this “sleep-onset delay,” “settling difficulties,” or (my favorite) “bedtime resistance.”  Bedtime resistance is more than just annoying to tired parents—kids who don’t sleep well can have behavioral, attentional and emotional problems.  Many kids diagnosed with ADHD really just have poor sleep.  Kids who sleep well do better academically, and are less likely to be overweight, get sports injuries, and get sick.  We know melatonin is key to regulating the body’s natural clock, or circadian rhythms.  To fix bedtime resistance we need to fix melatonin regulation.

Melatonin is a naturally occurring hormone that our bodies make.  Healthy adults and children get a surge of melatonin about 30 minutes before they get sleepy.  This melatonin surge seems to be trigged by a reduction of light.  This is why we get sleepy when it gets dark.  The trouble comes when our brain doesn’t release the hormone at the right times, and our sleep cycles get out of whack, such as when we are jet-lagged.  The same thing happens to toddlers who miss naps, get sick, or just grow out of their regular sleep routines.  This is where I think melatonin supplements may help kids—when they need to re-program their circadian rhythms. 

But there’s not a lot of research about melatonin, especially in kids.  So I was excited to read about a recent study that measured natural melatonin levels in 2.5-3 year-olds.  It was a small study—only 14 children were involved.  Much more research will have to be done before we can say these findings apply to most children.  But the research showed that kids who were put to bed about 30 minutes after their melatonin surge fell asleep faster.  Kids whose bedtimes were not in sync with their melatonin surge had bedtime resistance.

This research measured natural melatonin surges, the kind that occur when it gets dark (or lights are dimmed).  Researchers actually showed up at these children’s homes, covered windows, dimmed lights, and took saliva samples.  There is very limited research about melatonin supplements in kids.  The data we do have mostly looks at children with developmental abnormalities.

Lots of parents give their children melatonin.  You can buy the liquid kind with a dropper at any pharmacy for about five to ten dollars.  It’s a cheap fix for desperate parents, like myself, who don’t have another hour to commit to bedtime.  But here’s the scary part—we just don’t know the long term effects of melatonin in children.  We do know that melatonin affects sexual maturation.  If we give melatonin to children on a regular basis, will it provoke early puberty?  We don’t know—this research has never been done.  But it is a reasonable hypothesis based on what we know about melatonin.  We also don’t know if the body down-regulates natural melatonin production if you take supplements, meaning that your child could become dependent on melatonin supplementation to fall asleep.  Even if there is no physical dependence on melatonin supplements, children can become psychologically depending on their “magic medicine” to fall asleep.

I think it is fine to use low-dose melatonin supplements for children on a short-term basis (1-5 days) to help re-program their body’s clock if they’ve gotten off their regular sleep schedule.  I would only do this in consultation with your own pediatrician, and after trying the above suggestions to get a child’s sleep schedule back on track.

Melatonin is not useful for kids who are waking up in the middle of the night.  In these situations you need to do some trouble-shooting about what’s going wrong—is it illness?  Anxiety?  Too much napping?  Is there a TV on in another room that is preventing them from sleeping soundly?

I would never use melatonin in an infant.  If you’re struggling with a sleepless newborn, Dr. Kathryn Bucklen has some solid advice to get you through the night.  If you have an infant or toddler over six months of age with sleep troubles, I recommend sleep training techniques.  See my article, “Stress, Cortisol, and Getting your Baby to Sleep.”

The sad reality is that there is no magic sleeping pill for kids.  The good news is that kids don’t need melatonin supplements—their bodies make it naturally.  A melatonin surge about 30 minutes before bedtime means toddlers stay in bed and sleep well.  We can trick their bodies into producing a melatonin surge when we want it.  Here’s how:

  • Dim your house lights about 30 minutes before bedtime.  Don’t wait until bedtime to shut off the lights.  If necessary, cover windows to reduce natural light.
  • During the 30 minutes between light dimming and bedtime do quite activities together.  Tell stories, sing lullabies, rock or snuggle with your children.  Many families say prayers.  If you need to read a book, use a small clip-on LED reading light.
  • Make sure natural light enters your child’s room in the morning.  Natural light exposure during wake-up time is important for melatonin regulation.  If you’ve pulled down shades before bed, open them after your child falls asleep to allow the morning light to shine in.
  • Never use screens, such as iPads, TVs, or smart phones during bedtime.  There is good research to show that screen time before bed makes it take longer for kids to sleep.  Kids should not have screen access for a full 2 hours before bed.
  • Make sure you’re not over-doing it with naps.  If your toddler takes a nap from 1-3, they might not be ready for at 8 pm.  Before considering a supplement, consider setting a later bedtime or shortening nap time.  How much napping does your toddler need?  See this article by Dr. Sarah Lenhardt.  How much sleep does your child need?  See this article by Dr. Kelly Ross.
  • Find a bedtime routine that you, as a parent enjoy.  Stick to it.  Make sure that all caregivers are using the same bedtime routine.
  • Kids need a regular bedtime and a regular wake time to keep their melatonin surges synchronized.  This is the hardest part for parents—getting kids to bed on time means sacrifices on our part, like not staying out too late at another child’s activity.  Sorry, no sleeping in on the weekends, either.
  • Address anxiety, nutrition, illness, and anything else that is preventing your child from falling asleep.  Kids can have anxiety over things we never imagined.  They won’t tell you unless you ask.  

Sleep is a life skill that we, as parents, need to teach our children.  When we teach our children healthy sleep routines, we give them so much more than a schedule.  We give them health, energy, attention, and cheerfulness that will last a lifetime.  We get a more peaceful home.  And we get to sleep more, too.

Are you too tired?  Here’s what sleep deprivation does to parents.

 

Kathleen Berchelmann, M.D. About Kathleen Berchelmann, M.D.

Kathleen M. Berchelmann, M.D., is a pediatrician at St. Louis Children's Hospital and Washington University School of Medicine, director of the St. Louis Children's Hospital Social Media Team, and co-founder of the ChildrensMD hospital physician blog. Her work has been featured in print and online publications including the St. Louis Post-Dispatch, the Chicago Tribune, and TIME magazine. She is a frequent contributor to Fox2 News STL Moms. Kathleen and her husband are raising five children.

Follow Dr. Kathleen Berchelmann on Facebook: ChildrensMomDocs Twitter: @MomDocKathleen and connect with her on .

Comments

  1. Great article! However, I’d sugest not opening the shades until morning unless you live in a neighborhood that is absolutely dark all night long. Ambient light from outside can disrupt sleep cycles, too.

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