The problems with using melantonin for your child's sleep

Melatonin is a hormone naturally produced by the body in response to light/dark information that induces the onset of sleep.
In people with certain sleep disorders, often in the presence of neurological disorders, administration of melatonin has been shown to help advance the time of sleep onset and improve sleep overall 5 . Unfortunately, this has led to it being recommended for use inappropriately and often with children. As melatonin is a naturally occurring hormone, this has led to even more inappropriate use as it is marketed as 'natural' and sold by health industries without diagnosis or prescription and with exaggerated claims as to its effectiveness.

Problem 1: Lack of evidence
Melatonin is not registered for use in children anywhere in the world 1. Clinical studies have shown effectiveness for melatonin use in children however in most of those cases the children had neurological impairments and often visual impairments 5. There have been some studies on children with less severe impairments such as  ADHD 2 and with sleeping disorders unrelated to neurological impairments  3 4 but these studies were quite small and showed only small increases n sleep amounts. In spite of an absence of well-designed, controlled and long term studies there appears to be a consensus that melatonin is effective in the treatment of paediatric sleep problems.

Problem 2: Inappropriate usage
Melatonin is not effective for all sleep disorders. In fact if sleep disorders are due to non-circadan reasons it is shown to be completely ineffective 5. Up to 20% of  children with experience problems with sleeping - most often a reluctance to go to bed and waking during the night. This is usually related to age, mild and naturally transient. The issue can be resolved more quickly by the use of behavioural training techniques as I have previously discussed. Melatonin in these cases would be inappropriate and most likely ineffective.
Children with ongoing sleep disorders, in particular a problem with going to sleep and staying asleep, may respond to melatonin treatment but require assessment by a professional first.
To be effective, melatonin must be administered at a time that coincides with the onset of natural melatonin secretion so advancing an already existing sleep phase. It should also be used alongside the use of behavioural training techniques in order to establish healthy sleeping techniques. If used appropriately, melatonin should only be needed for a short period of time before sleep issues are resolved.

Problem 3: Safety
Melatonin has not undergone the formal safety testing expected for a new drug, with no studies showing safety from long term usage for more than 10 years.
Melatonin receptors are present all over the body, indicating it has wider effects than just inducing sleep 5. Animal studies have shown effects on the reproductive system, cardiovascular, immune and metabolic systems 1.  There is no evidence that these effects exist in humans 5 however melatonin has not undergone the formal safety testing expected for a new drug and no studies have shown long term safety in children.
What there is evidence of however is that melatonin can have unpredictable effects on mood disorders. Some people with mood disorders improve after treatment with melatonin, however others deteriorate 5. This is concerning since 75% of depressed children and adolescents complain of insomnia and may be treated with melatonin without appropriate monitoring.
Additionally, melatonin is known to interact negatively with many medications 1. If prescribed by a doctor, following appropriate assessment these effects should have been carefully examined prior to the prescription 5. However when bought without a prescription, no such assurances can be made.

Problem 4: Inappropriate administration
Pure melatonin has no reported side effects and as such the most frequently reported side effects of melatonin (headache, restlessness, confusion, nausea, irregular heart beat and purititis) are considered to be likely due to impurities in the melatonin 5. This is particularly concerning as the majority of melatonin available as 'troches' which are made by compounding pharmacists. There is no assurance of purity in these preparations and they are not approved by regulatory bodies 6.
Studies have shown that melatonin should be given alone and should not have other additives such as added vitamins 5 as is frequently the case in 'sleep preparations'.

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