Problems with falling and staying asleep happen to about 1 in 5 children and teenagers. One of the dietary supplements available for help with this issue is melatonin. We naturally have melatonin in our system that is produced in the pineal gland. It helps regulate sleep onset, meaning it is released to help us fall asleep. We are still discovering other things that melatonin does in our system.
By 3 months of age, melatonin in infants start to regularly be released in the evening. This helps the 3-6 month old infants sleep better at night. By the teen years, it is released later. This contributes to teens staying up later and sleeping in. By the senior adult years, it is released earlier. This contributes to senior citizens going to bed earlier and waking up early in the morning.
Some people naturally make plenty of melatonin. Other people's body does not make enough melatonin for them to easily fall asleep and stay asleep. For those children (and adults), taking melatonin about an hour before sleep can allow them to fall asleep faster, increase the total number of hours slept, and decrease the number of night time awakenings.
A number of studies have looked at otherwise healthy children, children with autism or autism spectrum, children with developmental disabilities, and children with mental retardation. All of these groups have shown improvement with melatonin if they had sleep issues. Side effects in the short term are limited. The most common feeling is a "fuzzy" or tired feeling in the morning and many people do not experience this side effect. Occasionally, people experience headaches, nausea, or dizziness after using the melatonin, but the chances of these symptoms is not greater than taking a placebo (sugar pill). Although long term side effects are still being studied, no alarming information is coming out of studies that have looked at 3+ years of use. Exceeding the maximum dose may increase the risk of heart arrythmias.
Because melatonin is available over the counter as a dietary supplement, it is not tightly regulated by the Federal Drug Administration. Many manufacturers make a melatonin product. Because these products are not tightly regulated by the FDA, some of the products may be better than others. One major manufacturer's melatonin product was found to contain no melatonin! If you are taking an appropriate dose of a melatonin product and it is not helping, consider trying a different company's melatonin. It is available in many forms, all over the counter: liquid, pills, dissolvable tablets, and gummies.
The usual dose range is from 1 mg to 10 mg. I recommend starting with the lowest dose. There are melatonin products that are 500 mcg (1/2 mg) -- although the dosage may be so low that it would not help with sleep, it is fine to try this lower dose first. Increase to a higher dosed if a lower dose is not adequately helping. It is fine to use the melatonin every night or just as needed. Give the melatonin 30-60 minutes before you want your child to fall asleep. Remember: not everyone will respond to melatonin. It may be a big success or you might not notice any difference at all.
A personal perspective: we have used melatonin in my house. I have taken it occasionally if I was struggling with insomnia on a particular night (which I am lucky enough to not have very often). It works very well for those nights. I might feel a little more "fuzzy" or drowsy the next day, but then I did not fall asleep at my normal time. I have also taken melatonin if we were taking an over-night flight. It has also helped me sleep during those nights also. On a humorous note, I took it once in an airport before a flight on a family vacation. My family was not pleased when the flight was delayed by about 45 minutes. Their worry was that the melatonin I had taken would kick in and they would have to help me on the flight. As the melatonin kicked in, I was so sleepy that they did indeed had to assist me into the plane. One of my three sons is not our best sleeper. We have often said that he is "not wired for sleep". He has tried melatonin on occasion and it has not helped him. Admittedly, we have not increased his dose past 6 mg, but he has not thought that melatonin made him any more sleepy. So our family's experience with melatonin has been mixed.
So who do I recommend try melatonin to help with sleep? Certainly a child with autism, ADHD/ADD, or developmental disabilities who struggles with falling or staying asleep may benefit from melatonin. Other children with difficulties with falling or staying asleep may also benefit from trying melatonin. If you start with a low dose and notice a nice improvement, you may continue the dose as needed. If you do not notice a difference, the dose may be increased to a maximum of 10 mg. If any dose causes side effects that bother you, decrease the dose or stop the melatonin. Call during regular office hours if you have questions or concerns.