Is melatonin safe to give to kids?

It’s common for adults to take a supplement like melatonin to help when they’re having trouble falling asleep, or just need a really good night of rest. 

Melatonin has been shown in numerous studies to help people fall asleep, and in some cases, improve the quality of their sleep. Plus, it’s sold over the counter at many kinds of stores. 

But when it comes to kids, some questions come up. On this episode of Parenting Behavior, host Dr. Andy Kahn gets some advice from Dr. Liz Harstad. 

Liz is a developmental behavioral pediatrician at Boston Children’s Hospital and an associate professor at Harvard Medical School. She has more than 15 years of experience caring for children with learning and attention differences and developmental conditions.

Is it OK to give your child melatonin? What about other supplements or medications? What does a sleep problem look like in a child, anyway? 

Listen or watch to get Liz’s answers. 

We’d love to hear from you. You can email us at ParentingBehavior@understood.org.

• How ADHD can affect your sleep

• 4 ways lack of sleep affects how kids learn

• Child can’t wind down at night? Why some kids struggle to go to sleep   

(1:20) How can you tell if there is a sleep problem?

(3:42) What are the benefits of melatonin?

(6:38) What are the risks of taking it?

(8:37) Are there alternatives?

Andy: For many adults, it's really common to take a supplement like melatonin to help you when you're having trouble falling asleep, or when you're just wanting to make sure you get a good night's sleep. Melatonin has been shown in numerous studies to help people fall asleep, and, in some cases, improve the quality of their sleep. Plus, it's sold over the counter at many kinds of stores.

One look at the shelves of your local drugstore or big box pharmacy, and you'll see there are a variety of melatonin brands and other options all promising the same thing: a good night's sleep. But for kids, naturally, more questions arise. Is it OK to give your child melatonin? What about other supplements or medications? And can I or should I use this every night with my child?

This is "Parenting Behavior," and I'm your host, Dr. Andy Kahn. I'm a parent and licensed psychologist with over 20 years experience working with kids and families. And today, I'm getting some help from a friend of the show, Dr. Liz Harstad.

Liz is a developmental behavioral pediatrician at Boston Children's Hospital and an associate professor at Harvard Medical School. And she has more than 15 years of experience caring for children with learning and attention differences in developmental conditions. And Liz is here to talk about something she knows well, kids' health, specifically as it relates to the use of melatonin and other sleep supplements.

Now, before we jump into any specifics on melatonin or other supplements, I want to start with some more general questions on sleep. Liz, can you tell me a little bit about what's a normal night of sleep and what differentiates that from a problem?

Liz: Sure, that's a great place to start. Sometimes parents' expectations are a mismatch with what we should really expect. So, I think about a normal night of sleep as a night of sleep in which the child falls asleep without too much difficulty, so not taking too long or not needing too much parental support to fall asleep. And then once they fall asleep, they stay asleep through the night and wake up in the morning.

Generally, we're also ideally looking for fairly consistent fall asleep and wake up times. And ideally, we're looking for fairly restful sleep during the night, like no significant snoring during the night.

Andy: Gotcha, gotcha. So, if we're thinking about the time to fall asleep, are we thinking about like ten, 15 minutes and what kind of window? I know a lot of parents would ask me this. And when I'm working with them in my practice.

Liz:] Well, part of it relates back to the prior question, "What makes a good night's sleep?" And it relates to what's our expectation of how long our child is going to stay in bed. If we expect our child to fall asleep at, say, 7 p.m., and then we also expect them to sleep until 7 a.m. and they are not requiring 12 hours of sleep, they may not fall asleep readily at 7 p.m.. So, if they are put to a time of bed at which they're kind of feeling more tired or kind of the right time for them, I would expect they fall asleep within 15, 30 minutes or so.

Andy: All right. So, our kids with learning and thinking differences like ADHD and dyslexia, more likely to need support for sleep than neurotypical kids.

Liz: Well, definitely. There's a lot of research showing that in general, children with developmental challenges, whether that is attention difficulties, a lot of literature looking at autism spectrum disorders, children with these types of challenges are at higher likelihood of having difficulties falling asleep and staying asleep throughout the night.

Andy: Gotcha. Super important for parents to be aware of that, because obviously when our kids have differences, there are a lot of aspects of their daily lives that are different for them. And when we think about restful, restorative sleep, this is something that I think parents also desperately want their kids to get to. I'm sure that's going to be helpful for them.

OK. On to melatonin. Now, maybe you can tell me about what melatonin is and what's the benefit of taking it for sleep.

Liz: So, we all make melatonin ourselves. It's secreted by the pineal gland in the brain. And it really is increased in its amount in response to decreased light. So, in the evening times, our bodies tend to make melatonin that makes us get sleepy. Supplemental melatonin is very similar to the melatonin in our body, and when given as a supplement, it's supposed to help bring on sleep.

Andy: Gotcha, gotcha. So, I guess one of the things that comes into play here too, is that particularly now, like if you think about wintertime, the sun goes down fairly early. Our body I would imagine is secreting melatonin when the sun goes down. So, is it, is part of this difficulty in terms of sun goes down early, your child starts to get sleepy, and then they're up for 3 or 4 more hours?

Liz: That may be one part of it. I mean, it's been that way for centuries, and people have adjusted their sleep. So, I think there also can be other components that may be at play. So, we're talking about natural light, but there's other ways that light interacts with us. An example recently is the use of screen time really can often complicate bringing on sleep, in part because of, you know, the light and feedback from the screen. Also in part related to the engagement that the screen can have for a lot of us, including children.

Andy: So, ultimately, should kids be taking melatonin? And if so, how should parents go about finding the right products and doses for their kids?

Liz: Well, obviously for each child, this has a, you know, different answer. Anytime a family is worried about their child's sleep, I would always encourage them to talk about this with their doctor or their health care provider. There are many different reasons that a child may struggle with sleep, and melatonin is not the answer to all of those reasons.

If a child has a good bedtime routine, has a consistent time at which they go to bed and wake up most days or all days of the week, and if they have reasonable expectations about how long the child is supposed to stay in bed through the night and the child sleeps through the night — that one problem is falling asleep at night — that might be a good time to think about use of melatonin if other behavioral strategies have been tried first.

Andy: Gotcha. So, sort of to summarize that, it's sort of part of the bigger picture, right? So, we're thinking about having appropriate rituals and expectations and using melatonin, perhaps as a way to start that sleep process for a child who might otherwise be struggling.

Liz: And we want to be reasonable at what we expect melatonin could help with. So, if a child falls asleep without too much difficulty, but they wake up every few hours throughout the night, or if they're waking up with night terrors or wandering in the middle of the night, those things will not necessarily, actually will not be benefited by melatonin. Melatonin really helps with bringing on sleep onset at nighttime.

Andy: Gotcha. That's super important. OK. So, you know, are there any risks of taking melatonin that we know of?

Liz: That's a great question. The melatonin is not FDA approved. So, it is considered a dietary supplement at this point in the United States. Perhaps in part because of that, there is not that much long-term evidence looking at the use of melatonin. The studies that exist do suggest that melatonin is relatively safe. But I think we want to always only use a supplement if it is truly indicated. And again, talk with our child's health care provider if using it just to make sure we can get kind of individualized counseling about risk and benefit for our child.

Andy: Awesome, awesome. So, thinking about melatonin, does taking melatonin reduce or change how our bodies naturally produce it? Because you were saying melatonin is this hormone in the body we naturally produce. So, is taking supplemental melatonin going to impact how our body reacts and produces it?

Liz: Yeah, that's a great question. Also something that could benefit from a little bit more research. The little bit of research that has been done does suggest that that's not the case. It suggests that no, it does not significantly or does not disrupt our body's ability to make melatonin.

Andy: I'm curious about how often it is safe to take melatonin. Should you take it nightly, or would you recommend just for rough patches?

Liz: That's a great question. Stepping back from melatonin, I think about, when we think about sleep, I think many parents would probably agree that every few months, sleep patterns may change. It may change in terms of what time a child is going to bed, how well they're sleeping through the night, what time they're waking up. Many factors influence that. So, if melatonin is indicated, it may make sense to try it for a period of time and then to consider trying without it for a few days, a few weeks to see if it's still needed. But generally, I recommend consistent use when it's used rather than just using it as needed.

Andy: Well, let's talk about some other supplements or sleep aids. You know, some people will take NyQuil or ZzzQuill or other generic versions. Can you talk a little bit about that?

Liz: Yes, I'm familiar with that, and I talk with families that I see about trying different things, which I get, when kids aren't sleeping, parents aren't sleeping. And it's hard for anyone to function during the day when no one is sleeping. I don't feel comfortable medically recommending those things. They don't have many studies suggesting both benefits as well as safety.

So, again, I would say if a family's feeling as though they really want to try something medication wise for sleep, I think that warrants a conversation with our own clinician to talk about, you know, exactly what parts of sleep they want to improve upon and what's safe and reasonable to try for their child.

Andy: Gotcha, gotcha. You know, and I also know that other people will use Benadryl or generics of of Benadryl in sort of an off-label manner. When we talk about off label, it's, you know, what we're talking about, my understanding is that Benadryl is is a medication we used for blocking histamine or for allergic reactions. But what do we know , is that it often makes people drowsy. So, because it causes drowsiness, it can sort of help starting people to sleep. Maybe, what can you tell us about this and your thought on the use of it in this way?

Liz: Well, again, this is using a medicine not for what it's indicated for. And so I would encourage families to make sure that they are doing things that have stronger indications. There is good evidence that having a solid bedtime routine, making sure that we're avoiding things like sleep associations, meaning helping our kids soothe to sleep and then not being there when they wake up in the middle of the night, are ideal things to do. I would prioritize doing those things, and then if still there are difficulties talking with the provider.

I don't feel comfortable, you know, generally recommending something like longer-term use of Benadryl to help with sleep.

Andy: Gotcha. Any other supplements or medications available that are safe or recommended for kids around sleep?

Liz: That's a great question. And it really comes down to what is the problem related to sleep? For some children who are really having a hard time falling asleep and staying asleep through the night, a doctor may think or other health care provider may think about prescribing a medication that can help with really getting them to sleep more solidly through the night, but it's an individual case-by-case basis. For many children, emphasizing the sleep hygiene, consistency with sleep, wake, and going to bed times is really helpful for improving sleep.

Andy: Gotcha, gotcha. So, before we go, Liz, is there anything we missed or final advice you'd like to leave us with?

Liz: Well, I keep coming back to the point of talking about your child's health care provider, but it is really important because there are some medical things that can impact sleep. So, if a child is snoring at night, we may have concerns about sleep apnea. That should be discussed with the health care provider. If a child is waking in the middle of the night, that is possibly related to having something like fluid in their ears or discomfort, you know, somewhere in their body.

So, if we see a sudden change in our child's sleep, or if sleep difficulties are causing the whole family to suffer, the child to struggle, and how they're doing during the day, it makes sense to schedule an appointment just to talk about that sleep concern.

Andy: Well, that's super helpful. So, important advice for parents: Let's not rely on Dr. Google. Let's talk to our health care providers before we make decisions on our own, especially when we're talking about supplementation and medication. One other piece of advice is working on sleep hygiene. What's happening before bedtime? What are the rituals and routines? Because these are all factors in getting our kids to sleep.

And ultimately, let's be honest, as parents, getting ourselves to sleep. And we parent our best when we're rested, so. Listen, Liz, thank you so much for joining us today and sharing this super-useful guidance with us. Thanks for being here.

Liz: Sure. Thanks for having me.

Andy: And folks, thanks for joining us today on "Parenting Behavior." Don't forget to check out the show notes for the resources and links on topics shared in today's episode.

Thanks for listening to this episode of "Parenting Behavior with Dr. Andy Kahn." We'd love to hear from you. If you have any thoughts on the show. You can email us at ParentingBehavior@understood.org. I'll put the email in the show notes, too, where you can also find more resources and links to anything we mentioned.

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