For three grueling years, Lauren Lockwood tried to get her son Rex to sleep through the night. When he was a baby, he couldn’t sleep without a blanket covering him completely to isolate him from the outside world. At age 2, he sometimes took hours to fall asleep—and so did his mom—and then woke up with a start, terrified by nightmares that made him scream in panic.
For years, Lockwood, a A nurse midwife who works with a group of new mothers at her home in Oakland, California, experimented with a variety of approaches to bedtime.
As a baby, I let him cry so he would learn to fall asleep alone As she grew older, she lay next to her for hours each night. Ultimately, she hired a sleep consultant who came up with another plan that didn’t solve the problem. When Rex turned 3, Lockwood, with another baby on the way, was exhausted and desperate.
Then she read about melatonin, a hormone released by the pineal gland which helps regulate the sleep cycle. Melatonin is sold as a dietary supplement in pharmacies and is marketed to children in the form of chewable tablets, flavored liquids, and gummies. “I thought maybe I just needed a little help,” Lockwood said.
Lockwood recounted that from the first night her son, “became a boy totally different”. She gave her a melatonin pill and read her a story, and she fell asleep almost immediately. “Our plan was to use melatonin for two weeks and stop.”
Six years later, she is still taking it every night.
Throughout history, parents have sought the secret to calm bedtime: sleeping together, sleeping apart, the “Ferber Method” war of wills, offering stuffed animals and pacifiers and hot milk, even spending $1 ,400 in a “smart” bassinet that responds to the baby’s cries with white noise (quiet) and movement.
In the In recent years, melatonin supplements have become an increasingly common infant sleep aid, which in the United States do not require a prescription and are only lightly regulated by the Food and Drug Administration (FDA).
In 2021, Americans spent $1,090 million on melatonin supplements , an increase of almost 150% with respect to the sales of 2018, based on data provided by NielsenIQ. Meanwhile, the number of reports of melatonin poisoning involving young children—meaning they ingested excessive doses—more than doubled from 2017 to 2021, according to the American Association of Poison Control Centers.
There were some 46,300 reports of intoxication in children 5 years of age or younger in 2021, compared to almost 19,400 in 2017. Potential symptoms of an overdose include headaches, dizziness, and irritability. Only a handful of the reported incidents led to major medical problems.
“This speaks to the widespread use of melatonin. It has spread to younger and younger children,” said Dr. Judith Owens, co-director of the Sleep Center at Children’s Hospital Boston and a professor of neurology at Harvard Medical School. “What I find especially alarming is that pediatricians recommend it as a quick fix. It sends the message to parents, and then to older children, that if you can’t sleep, you have to take a pill.”
The American Academy of Sleep Medicine advises against the use of melatonin for chronic insomnia, both in adults and children, and will soon issue a public health advisory stating that melatonin should not be used in children without medical supervision, said Dr. Muhammad Adeel Rishi, co-chair of the committee of public security of the academy and specialist in sleep of the University of Indiana.
“Most of the time insomnia in children is a behavioral problem, and it’s related to their bedtime routine, access to electronics at bedtime, and other activities they focus on instead of sleeping,” Rishi said. “It can often be treated without medication, with behavioral interventions.”
Rishi attributes the recent increase in melatonin use in children, in part, to the marketing efforts of supplement manufacturers, including products like gummies targeted specifically at kids. But he also believes that the pandemic has generated a “growing epidemic of insomnia.”
“We are going through a very stressful time as a society. And this is available on the shelf, so it’s easy to access. Parents usually take it. And it’s supposed to be safe,” Rishi added. “It’s kind of a perfect storm.”
But despite concerns about melatonin, it also has staunch supporters among specialists of sleep and pediatricians, which creates a confusing message for parents seeking a solution for the sleep problem that their homes suffer.
Dr. Rafael Pelayo, professor of the medicine division of the Stanford Medicine, stated that he considers melatonin to be a useful tool for treating sleep disorders in the very young. “It just tells the brain that night is coming,” he said. “I think the real problem is not that it is used in excess, but the large number of sleep problems that children suffer.”
“A small improvement in the child’s sleep”, he added, “it can have a dramatic impact on the family.”
Pelayo said that sometimes he recommends melatonin for the little ones, while the family implements behavioral changes to address an underlying problem. Many kids get by without it once they learn to sleep on their own, he said, but some end up taking it for a long time. He said it works better for kids who have trouble falling asleep, rather than those who wake up frequently during the night.
Melatonin is a hot topic of conversation on Facebook groups like The Mamahood-SF Bay Area, of which Jill Kunishima is a member. Kunishima first tried melatonin for her son at the suggestion of her pediatrician. She had slept well until she started preschool at age 3. The nap schedule at school disrupted her sleep routine, and she stayed up until almost 10 night
“The next day was a disaster. We went into his room in the morning and he was all grumpy,” said Kunishima, who lives in Oakland.
The pediatrician recommended a pill of one milligram of melatonin for a week or two, and her son’s bedtime was back to 8: 30 pm. “She got his body to calm down,” she said. “It was just what he needed.” But when she withdrew the pill, the problem started again.
When Kunishima returned to the doctor with her child, the pediatrician told her not to worry. “’If that’s what’s going to help you with your life, go ahead,’” he recalled the doctor’s words. “But now she’s 6 years old, she’s in first grade, and she’s still on the pill.”
Studies suggest that melatonin appears to be safe for short-term use in children, but there is little information on long-term effects, according to the National Institutes of Health. Since melatonin is a hormone, some experts are concerned that its use may delay puberty, although the evidence is scant. Other potential side effects include drowsiness, bedwetting, and restlessness.
Because melatonin is considered a supplement in the United States —and not a drug— quality and dosage levels can vary widely. A study by 2017, looking at 31 melatonin supplements, found that actual melatonin levels ranged from less than one-fifth to almost five times the dose indicated on their labels.
One in four products tested also contained serotonin, a hormone that can have serious side effects even at low doses.
Owens said he is concerned about adolescents and young adults who have been taking melatonin for a decade or more, the effects of which are still unknown. “Whenever a sleep medication is recommended or prescribed, you have to have an exit strategy. What is your reference point to decide that we are going to stop this medication?”, he asked himself.
“I have patients who ask for their pill to sleep every night, and that gives me chills.”
She is also concerned that the American Academy of Pediatrics has not published official guidelines on the use of melatonin in children, given that pediatricians strongly recommend Melatonin is frequently used as a sleep aid and in increasingly younger patients, sometimes as young as 6 months.
Lockwood stated that his son, now 9, is still taking a quarter of milligram of melatonin every night before bed. It’s such a small dose that, he wonders, maybe he’s experiencing a placebo effect, but efforts to withdraw it reignite his insomnia.
At Lockwood’s group for new moms in Oakland, sleep is often the main topic of conversation. “It’s something that consumes us as mothers,” she said. “What happened to me was that nobody helped me and nobody gave me a solution”
“Sometimes I wonder if he will have to continue doing this throughout his life”, she added . “But I no longer torment myself. It works, and he’s happy.”
Phillip Reese, Associate Professor of Journalism at California State University-Sacramento, contributed to this article.
KHN (Kaiser Health News) is the editorial office of KFF (Kaiser Family Foundation), which produces in-depth health journalism. It is one of three major programs of KFF, a nonprofit organization that analyzes the nation’s health and public health issues.