The Great (and Risky) Melatonin Experiment on Children

Supplement use soars amid worries over long-term side effects on developing brains and bodies. Here’s what pediatricians and sleep experts advise.

Sometimes we parents will do almost anything to get our kids to sleep. The solution du jour is the supplement melatonin, whose potential long-term effects on developing child brains and bodies is unknown. American parents are conducting a huge, uncontrolled experiment on our children, loading them up with a hormone in tasty chewables and gummies of questionable quality and usefulness instead of addressing the underlying health, lifestyle and behavioral challenges that contribute to the genuine problem of inadequate sleep.

The fundamental problem is clear: More than one-third of children 14 and younger don’t get enough sleep, and for high-schoolers the figure is 78%.

The consequences are serious: Insufficient sleep causes daytime tiredness, reduces concentration and productivity, and packs numerous well-established long-term health risks, including type 2 diabetes and heart disease. Lack of sleep among children ages 6 to 12 — less than 9 hours a night — creates lasting deficiencies in areas of the brain that deal with memory, intelligence and overall well-being.

A dubious solution has emerged: A new survey of parents suggests melatonin use among children has soared from about 1.3% in 2018 to more than 6% of preschoolers, 18.5% in kids ages 5 to 9, and 19.4% among children ages 10 to 13. Preschoolers taking the supplement had been using it for a year, on average, parents said, and older children had been taking it for 18 months or more.

“All of a sudden, in 2022, we started noticing a lot of parents telling us that their healthy child was regularly taking melatonin,” said study leader Lauren Hartstein, PhD, a postdoctoral fellow in the Sleep and Development Lab at the University of Colorado Boulder. Hence the survey, conducted earlier this year and published this week in the journal JAMA Pediatrics.

Though the survey participants don’t fully reflect the entire US population, the conclusions mirror other research indicating a spike in melatonin sales and use in adults and children, and an increase in accidental ingestions and hospitalizations among children. Taken together, the research shows the nation’s children are struggling with a lot of underlying sleep problems, Hartstein said in a statement.

Below you’ll find healthy alternatives for promoting better sleep for kids. First, the scope of the problem and concerns over the great melatonin experiment…

Health advisory issued

Hartstein and other researchers, along with pediatricians and sleep doctors, express multiple concerns:

• Parents are treating symptoms instead of dealing with underlying problems.
• The effect of melatonin supplements on children and their developing brains has not been well studied, so possible long-term implications may not be understood for years to come.
• Melatonin supplements are notorious for containing much less, or much more, than what’s on the label. One brand of melatonin gummy was found to contain none of the hormone, but was loaded with CBD instead.

“Because melatonin is a hormone, it’s possible that melatonin supplements could affect hormonal development, including puberty, menstrual cycles, and overproduction of the hormone prolactin, but we don’t know for sure,” according to the National Center for Complimentary and Integrative Health. (Prolactin is involved in breast development, lactation and other functions.)

These concerns led the American Academy of Sleep Medicine to issue a health advisory last year, urging parents to treat melatonin supplements like any other medication and administer them only after discussion with a pediatric healthcare professional.

“The availability of melatonin as gummies or chewable tablets makes it more tempting to give to children and more likely for them to overdose,” said M. Adeel Rishi, MD, a sleep medicine and critical care specialist at Indiana University Health Physicians and safety spokesperson for the AASM. “Parents should talk directly with their child’s health care professional before giving their children melatonin products. Often, behavioral interventions other than medication are successful in addressing insomnia in children.”

Other experts are even more cautious.

Melatonin should be avoided in most cases, even if a pediatrician recommends it, says Suzanne Bertisch, MD, an assistant professor of medicine at Harvard Medical School, and director of behavioral sleep medicine at Brigham and Women’s Hospital.

“Melatonin is a hormone, and it may have effects on reproductive hormones, particularly at certain critical developmental windows,” Bertisch told me last year, when I first reported on the rising use among kids.

Risks unknown

Melatonin is produced naturally in the brain to help regulate the body’s internal clock that runs a daily cycle known as the circadian rhythm. The body clock keeps time primarily based on cues from light. Darkness triggers the production of the hormone, and daylight suppresses it.

Melatonin is not a sedative. It is not a sleeping pill (sleeping pills are decidedly unhealthy, by the way). Melatonin just lets the brain know that it’s nighttime. It doesn’t put a person to sleep, but nudges them in that direction, much like dimming the lights or switching from party music to a calming piano concerto (shown to help, by the way).

Pediatricians and other doctors and sleep experts say melatonin supplements may be appropriate for short-term use, perhaps to adjust a sleep schedule or deal with time-zone changes, under the supervision of a physician.

“But it is almost never a first-line treatment,” said Hartstein’s co-author, Julie Boergers, PhD, a Brown University psychologist and pediatric sleep specialist at Rhode Island Hospital. “Although it’s typically well-tolerated, whenever we’re using any kind of medication or supplement in a young, developing body we want to exercise caution.”

Boergers often suggests parents whose kid routinely struggles to fall asleep try to change the child’s daytime and evening behaviors before experimenting with melatonin, and then to use the supplement only temporarily.

In general, at least for adults, short-term melatonin use is considered safe. The immediate side effects in children are mostly minor (a relative term, to be sure): headaches, bedwetting, nightmares, dizziness, moodiness and, in a dose of irony: morning grogginess.

While there can be benefits to physician-supervised melatonin use — such as treating specific, diagnosed sleep disorders or mental health disorders like ADHD and autism — much remains unknown, including whether the supplement continues working with repeated use. Some parents have told Boergers that while the supplement seems to help kids initially, over time they need higher doses to have the same effect.

Watch out for unknown ingredients and overdosing

Adding to the headache of parenting sleepless children, melatonin supplements are not formally regulated by the FDA, so you need to be careful what your child is actually ingesting. Studies have revealed that ingredients can vary significantly from what’s stated on a label.

The amount of melatonin ranged from 83% less than what the label said to 478% more than advertised, according to a 2017 analysis of 30 melatonin supplement brands. Amounts varied dramatically even among different lots of the same brand. Adding hormonal insult to injury, eight of the brands contained serotonin, a hormone used to treat neurological disorders, though serotonin was not mentioned on the labels.

Separately, a 2023 analysis of melatonin gummies found the quantity of the hormone ranged from 74% to 347% of what the label claimed. One brand had zero melatonin but packed 31 mg of CBD.

If you purchase melatonin — or any supplement, for that matter — check the label for extra, unwanted ingredients, and more importantly look for the USP verification symbol. It shows that a product has been tested, albeit by the manufacturer, but with oversight by a nonprofit.

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

What about dosage?

There are no medical guidelines for melatonin dosage, for adults or kids. Under the supervision of a doctor, the hormone should be taken about an hour before bedtime, or sooner, experts say.

Craig Canapari, MD, director of the Yale Pediatric Sleep Center and an attending physician at Yale New Haven Hospital, suggests starting with a dosage of 1 mg. That will probably involve breaking a pill or gummy into pieces, given common dosages on the market, which are often 5 mg or higher.

Never give a kid melatonin during the night, after bedtime. That will only delay their ability to wake up in the morning, furthering a vicious cycle.

And really young kids should never take melatonin.

“In general, melatonin should not be given to healthy, typically developing children under age 3, as difficulties falling and staying asleep in these children are almost always behavioral in nature,” say experts at Boston Children’s Hospital.

Better sleep strategy for kids

Kids younger than 6 need anywhere from 10 to 13 hours of sleep. Those ages 6 to 12 require 9 to 12 hours. Thanks to early school start times, loads of homework and packed activity schedules, many children simply run out of hours in the day and don’t have an opportunity to get enough sleep. Melatonin cannot make up for an inadequate sleep window.

Many parents also don’t realize that when kids hit puberty, their body clocks naturally shift later, so bedtimes that worked previously will now leave them staring at the ceiling (or reaching for their phones). The forced awakenings for school become an even bigger problem.

For serious sleep issues, whether you suspect insomnia or aren’t sure what’s going on, seek medical advice before giving your kids a supplemental hormone, experts say. And don’t assume it’s safe.

“Melatonin is an important tool in the treatment of sleep disorders in children, and because it is naturally derived, there is a widespread perception that it is safe,” writes Canapari, author of the book It’s Never Too Late To Sleep Train. “However, I have become concerned by the frequency of its use, especially in an unsupervised way.”

If your child struggles to fall asleep at a reasonable hour, the first recourse should be to improve sleep hygiene in multiple ways:

• Encourage more physical activity, which is crucial for good sleep.
• Encourage more time outside in natural daylight, which has the strongest effect on the body clock and timely melatonin production.
• Turn lights down or off in the evening, and discourage stressful activities like homework, social media, or violent video games after a certain hour. Human brains and bodies need time to wind down before sleep is possible.
• Make the bedroom as dark as a kid will tolerate. Even modest light during the night is known to ruin sleep.
• Try to carve out a sufficient time window for adequate sleep, and enforce consistent wake times during the week and on weekends.

As a parent myself, I know: Easier said than done. But we’re in the midst of a great melatonin experiment, and nobody knows how it’s going to turn out. Do we want our children to be the guinea pigs?

Important note from the author: In the comments, Medium member Elanor Rice took issue with this article’s characterization of autism and ADHD as mental health disorders. So I did some research. In the mental health profession, conditions like autism, depression and ADHD are often referred to as illnesses, diseases or disorders. But many people—not just Elanor—dislike using those diagnostic labels to describe their mental states. So as editor of Wise & Well, I asked psychiatrist John Kruse what terms we writers should use, and which to avoid. He responded with a thoughtful and informative essay. Terms that can be helpful for patients and mental health professionals are not always welcome, Kruse writes. He then offers superb advice that we can all lean into in writing or discussing mental health conditions in a way that respects the evolution of language and patient preferences. Moving forward, Kruse’s essay will inform my writing and my editing, and therefore all future articles on Wise & Well. I’ve left this article as originally published so readers can learn from it, as I have.

For comprehensive advice on how to sleep, and why it matters, check out my book: Make Sleep Your Superpower. And thanks for your support, which makes my reporting and writing possible.