There was once a time when taking melatonin was exclusively the preserve of international travellers trying to reset their body clock after crossing timezones. But over the years, its use has crept from jet lag cure to mainstream sleep aid – and it’s increasingly being given to kids.
There’s no parent-shaming here; a child who can’t or won’t sleep is the one thing guaranteed to tip even the most sanguine of caregivers to the brink of sanity. Yet I’ve been struck by the number of friends who now regularly rely on melatonin gummies to give their little ones an extra push into the land of nod, something that was nigh-on unheard of a decade ago.
Dr Lindsay Browning, a sleep expert at TroubleSleeping.co.uk, says that social media has led to an increased level of interest in sleep aids like melatonin, and online pharmacies offer a way to bypass the fact that it is only available on prescription in the UK.
“Although in the UK, melatonin is not available to buy without prescription, I have seen a lot of parents getting hold of melatonin over the internet or when travelling abroad, to use with their children. With social media being so vocal about improving sleep, there has been an increased interest in sleep aids like melatonin, which has probably led to this increase in use.”
Melatonin, otherwise known as the “sleep hormone”, is a naturally occurring hormone in the body that regulates our circadian rhythm, and therefore our wake/sleep cycle. More melatonin tells our brain and body that it’s time to unwind, slowing our blood pressure and lowering body temperature to prepare us for sleep. Its production increases in darkness, which helps us to drop off, and decreases when it gets light, giving us the signal to wake up.
In the US, it’s sold as a supplement over the counter for kids and adults alike. In the UK and elsewhere, melatonin is only available on prescription.
Questions around safety came to the fore last year when US-based online store iHerb suspended sales of melatonin gummies to Australia, following a rise in reports of children experiencing non-fatal overdoses. Australia’s drug regulator issued a safety warning about imported, unregistered melatonin gummies; testing by the TGA, Australia’s drug regulator, identified eight brands that were advertised as containing 1-10 mg of the hormone but had anywhere from 112 to 417 per cent of the stated dose.
“This variability in melatonin content raises serious safety concerns for consumers, including the risk of hospitalisation and accidental overdose, especially in children,” the TGA said. The issue is only exacerbated further by the fact that the gummies in question are appealing to children, with the same look and taste as sweets.
This is one of the major concerns, says Mandy Gurney, founder of Millpond Children’s Sleep Clinic. “My worry for parents is, where’s the melatonin coming from in the first place?” she says. “Is it prescribed? Are they buying it online? Are they these gummies? We’ve got absolutely no idea how much melatonin is in those because it’s not regulated.”
In the UK, prescription is largely limited to children with visual impairment, autism, ADHD or other neurodevelopmental conditions, as these can impact natural melatonin production. This means that the majority of parents using melatonin are buying it over the internet or bringing it over from the US. Any use should be carefully monitored, with low doses to start with and hormone “holidays” factored in, as recommended by Professor Paul Gringras, a consultant in paediatric neurodisability and sleep medicine. “But who is monitoring what these children are having?” asks Gurney. “It’s a bit concerning from that point of view.”
Gurney has observed a similar worrying trend of magnesium spray being recommended as a sleep aid for babies on TikTok. “It’s a minefield for parents to know what they can trust,” she says.
There’s little evidence that prolonged use of melatonin has any negative health impacts on children or adolescents. Then again, there is worryingly limited data on the topic at all. “More research is definitely needed,” says Dr Browning. “Studies that have looked at melatonin use in children generally report only mild side effects [like grogginess and headaches], but uncertainties and important questions remain about how melatonin may affect hormone development and timing of puberty in children.” In the adult realm, one large-scale study published last year found that patients who used melatonin for 12 months or more had about a 90 per cent higher chance of heart failure over five years compared to non-users.
The experts I spoke to remain concerned and sceptical about its use, in part because administering melatonin avoids getting to the crux of why a child is having trouble sleeping in the first place. There could be an underlying medical issue at play such as restless leg syndrome, reflux, pain, snoring or even sleep apnoea. Gurney highlights the fact that several recent child clients have been identified as having low ferritin levels. “They’ve now been prescribed iron supplements from the GP, and their sleep is so much better,” she explains, “So there are lots of other factors we need to consider, and giving melatonin may be masking some of those other issues.”
Most children are producing enough natural melatonin as it is, but there are ways to boost production that don’t involve supplements. Andrea Grace, a Harley Street child and baby sleep consultant, recommends giving children lots of light exposure, particularly in the morning, and keeping lighting levels low at bedtime; “if a child needs a night light on, have a red night light, because that doesn’t interfere with melatonin production in the same way that white or blue light does,” she advises. Screens should be turned off an hour before bedtime and even meal choices can make a difference: “Eat food that’s high in tryptophan, which is a precursor to melatonin,” adds Grace. This includes chicken, turkey, pork, tofu, fish, milk, eggs and nuts and seeds.
Melatonin doesn’t create a physical dependence in the same way that some other medications do, such as prescription sleeping pills like zopiclone. And yet another potential issue is that it can create psychological dependence if taken regularly by children. “They may not develop skills for how to fall asleep independently without it,” argues Dr Browning, “or worry that they will be unable to fall asleep without melatonin and become anxious at bedtime.”
The most compelling argument against melatonin, though, is that there are simply better long-term solutions that take into account the root cause of the difficulty.
Grace often sees families blighted by anxiety: “Because it takes the child a long time to fall asleep, parents will either get melatonin or they’ll put them to bed early to give them lots of time to fall asleep. All that happens when they do the earlier bedtime is that the child starts to associate bed with wakefulness, and it becomes a bit of a vicious cycle.”
It may seem counterintuitive, but Grace recommends avoiding an early bedtime initially to strengthen the connection between bed and sleep. “Maybe do some temporary sleep restriction so they have a much later bedtime than perhaps they should, but it’s easier for them to fall asleep,” she says. “Then just inch bedtime gradually forward – that’s a much better way to approach a delayed sleep onset problem than giving a supplement.”
Another important factor to consider is your child’s genetically inherited sleep pattern, known as their “chronotype”: are they a morning lark or a night owl? “A bit of a personal bug bear of mine is that there are these very prescriptive sleep schedules that people are putting out on various platforms,” says Gurney. “There may be some children who fit that criteria, but we now know that genetics plays a big role in terms of sleep.”
How much shut-eye children need is very individual, as is the timing of their sleep. Gurney talks to a lot of parents who have tried to follow strict patterns, with zero success. “It might be that their child’s chronotype means that they’re not set up to go to sleep ’til later,” she says. There isn’t necessarily anything wrong at all – just a mismatch between “normal” expectations of sleep patterns and a child’s own natural rhythms.
Gurney recommends keeping a sleep diary and logging when your child feels sleepy to build a better idea of their natural body clock.
A calming routine, characterised by a series of steps leading up to bedtime, is also key. Grace’s other top tips include mindful exercises, such as counting or word games (naming animals beginning with each letter of the alphabet, for example), plus a warm bath before bed. “We know that when the core temperature rises, the process of cooling down helps sleep to come,” she explains.
And one of the most simple things you can do as a parent? Carve out quality time to spend with your kid, especially if you’ve been at work all day.
“Sometimes it’s worth building in an extra 15 minutes of focused time on your child, to talk about their day, talk about your day, do a bit of colouring, have cuddles,” says Gurney. “Start the bedtime routine after that. Sometimes bedtime resistance can be because they simply want to spend time with you – and they’re going to resist sleep if that hasn’t happened.”
