April 2015 Bulletin

Use of Melatonin as a Sleep Aid in Children: Q&A with Dr. Maida Chen

Maida Chen Bulletin

Dr. Maida Chen, who leads the Pediatric Sleep Center at Seattle Children’s, addresses questions about using melatonin as a sleep aid for children. Thank you to Dr. Wendy Sue Swanson, a pediatrician at The Everett Clinic in Mill Creek, a member of Seattle Children’s medical staff and executive director of Digital Health, and author of the Seattle Mama Doc blog, for submitting these questions.

Q: Melatonin is widely available, and parents sometimes reach for it early in their child’s life. What does the data show about safety in toddlers and young children?

A: Only a few long-term studies have looked at prolonged use and associated effects,1 but most sleep specialists consider melatonin safe, particularly for occasional short-term use. The bigger question is why parents feel the need to give their child melatonin.

Often the child has a chronic sleep disorder and melatonin is masking the symptoms. It can be a slippery slope for families because continuing use of melatonin can delay obtaining more appropriate treatment for the underlying sleep disorder.

Q: What does the data show about melatonin and children with attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorders (ASDs)?

A: More trials of melatonin for sleep difficulties have been done in children with ADHD2,3 or ASD4 than studies for typically developing children. Evidence from these trials suggests that melatonin is safe and does shorten the length of time it takes to fall asleep. However, the effects are generally modest and not every child who takes melatonin benefits. The studies mostly evaluate short-term use only.

Q: Is melatonin a good medication to use in concert with good sleep habits and sleep hygiene for young children who aren’t diagnosed with ADHD or ASD?

A: Generally, melatonin is not tremendously effective in children who aren’t diagnosed with underlying ADHD or ASD, though some individual kids get significant benefit. Most young children whose parents feel melatonin is needed would likely experience greater benefit from improved sleep habits and sleep hygiene.

Although combining short-term melatonin with behavioral interventions may, in theory, be synergistic, most families end up relying exclusively on melatonin and not addressing underlying sleep issues.

Q: What is the best way to advise parents and teens about melatonin dosing recommendations?

A: There are no clear-cut dosage guidelines because neither melatonin nor any other medication or supplement is approved by the Food and Drug Administration (FDA) for the purpose of treating insomnia in children. If parents or teens are considering using melatonin, you should advise them about overall appropriateness, timing of the medication and dosage.

Most children who benefit from melatonin – even those with a diagnosis of ADHD or ASD – don’t need more than 3 to 6 mg of melatonin. Some children benefit from as little as 0.5 mg. Younger children tend to be given 1 to 3 mg and older children/teens a little more.

Q: Do you find inconsistencies in potencies between brands?

A: Yes. Potency varies by brand and even between different batches from the same manufacturer. It’s important to note that many studies evaluating melatonin have been done using pharmaceutical-grade melatonin in other countries, which is not commercially available in the United States.

Q: What other sleep medications do you recommend for toddlers and school-age children?

A: I may sound like a broken record, but there are no FDA-approved medications or supplements for the purpose of treating insomnia in children. It’s not that the readily available over-the-counter medications (e.g., melatonin or antihistamines) are overtly dangerous when used appropriately. Most are safe for occasional use – although potential adverse side effects may occur. My concern about making any recommendations is more about why parents feel sleep medications are needed.

Q: What are your thoughts about use of Benadryl at night or on the plane?

A: If a family is traveling across time zones and the child is generally healthy, occasional use of Benadryl is probably fine. However, I recommend that parents test the dosage at home first because some kids have a reaction to Benadryl that makes them wound up rather than sleepy. Discovering this on a red-eye flight is not good for anyone. Chronic use of Benadryl for sleep difficulties, unless prescribed for something like allergies, is probably not beneficial.

References

  1. Van Geijlswijk IM, Korzilius HP, Smits MG. The use of exogenous melatonin in delayed sleep phase disorder: a meta-analysis. Sleep 2010;33(12):1605–14.
  2. Van der Heijden KB, Smits MG, Van Someren EJ, et al. Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. J Am Acad Child Adolesc Psychiatr 2007;46(2):233–41.
  3. Weiss MD, Wasdell MB, Bomben MM, et al. Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia. J Am Acad Child Adolesc Psychiatr 2006;45(5):509–12.
  4. Guenole F, Godbout R, Nicolas A, et al. Melatonin for disordered sleep in individuals with autism spectrum disorders; systematic review and discussion. Sleep Med Rev 2011;15(6):379–87.

Upcoming CME Events for April 2015

Everett CME: Common Pediatric Dermatoses

  • Presented by Dr. Deepti Gupta
  • Thursday, April 16 from 6 to 7 p.m. at the Snohomish PUD Training Center, 2320 California St., Everett, WA, Room TC-2A
  • Free Category 2 CME credit
  • Light dinner will be served.
  • RSVP to Emily Rice or 206-422-5668


Grand Rounds for April 2015 (CME Credit Available)

Upcoming Grand Rounds

  • April 9: What Every Pediatrician Should Know About Pedophiles
  • April 16: Oh by the Way… Integrated Behavioral Health in Family Medicine
  • April 23: Food Allergy Therapy: Past, Present, Future
  • April 30: Accountable Care: The Path to Optimizing Value
  • May 7: Congenital Diaphragmatic Hernia – The Past 25 (or So) Years
  • See all upcoming Grand Rounds.

Watch Past Grand Rounds Online

  • Paradigm Shifts in Childhood Arthritis: Changing Times, Changing Terms, Changing Treatments
  • Altering the Trajectory: Screening for Mental Health Problems in the Emergency Department
  • Affecting the Intestinal Microbiome: Using Knowledge on Managing Enteric Bacteria
  • Revolution in Rheumatology: New Insights, Therapies, Definitions and Outcomes
  • See all online Grand Rounds.

New Medical Staff and Allied Health Professionals for April 2015

Medical Staff

  • Maryse Bouchard, MD, Seattle Children’s, Orthopedics and Sports Medicine
  • Cyril Engmann, MD, University of Washington, Neonatology
  • Gary Fudem, MD, Harborview Medical Center, Plastic Surgery
  • Rani Sunder, MD, Seattle Children’s, Anesthesiology and Pain Medicine
  • Yanyun Wu, MD, PhD, Puget Sound Blood Center, Pathology

Allied Health Professionals

  • Patricia Endicott, PA-C, Seattle Children’s, Anesthesiology and Pain Medicine
  • Lara Kroepsch, PA-C, Seattle Children’s, Orthopedics and Sports Medicine