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Dear Melissa,
My 3 ½ year old daughter has no other medical diagnoses but has the hardest time falling asleep at night! We minimize TV and other electronic devices in the evenings, and we have consistent bedtime and wake-up times throughout the week. We have also tried “reward charts” and other behavior modification techniques. Even when she is “being good,” I can watch her on the video monitor just tossing and turning for an hour, even though her head is on the pillow. I have friends who use Melatonin to help their children fall asleep. Is this a good idea for my daughter?
Confession…this is actually a question about my own child that I really struggle with! Some commentators praise Melatonin as the greatest thing since sliced bread. It not only helps children and adults fall asleep with minimal/no side effects, but its efficacy is being studied for treating and preventing certain cancers. Others say the complete opposite. Critics accuse parents of taking the “easy way out” and drugging their children to induce sleep, claiming that Melatonin has long-term side effects ranging from dependency to decreased sexual development. What is the truth?
What is Melatonin?
Melatonin is a hormone found naturally in the body. It is produced in our brain’s pineal gland. Melatonin appears to be linked to the body’s sleep/wake cycle or circadian rhythm. The release of Melatonin is stimulated by darkness and suppressed by light. The levels of Melatonin in your blood are highest just before you go to sleep. Melatonin used in medicine is usually made synthetically in a laboratory. It is most commonly available over the counter in pill form, but Melatonin is also available in forms that can be placed on the cheek or under the tongue. This allows the Melatonin to be absorbed quickly into the body.
Effective…Yes!
There are many quality research studies which have deemed Melatonin to be quite effective in helping children fall sleep. Not only children with various disabilities such as ADD/ADHD, Autism, Cerebral Palsy, Cognitive Impairments, and Blindness, but typically developing children as well. In most cases, it is recommended that you administer Melatonin 30-60 minutes before bedtime. It helps a child to fall asleep but is much less effective at helping a child stay asleep. As a whole, I can find little question that Melatonin works.
It is sold over the counter…but is it safe?
Many people have commented to me that melatonin (and other supplements) are “all natural” and therefore are safe. To that I reply “Marijuana and psychedelic mushrooms are ‘all natural’ but I would hope that you would not deem THOSE products safe to give to your child!” The problem with “all natural” products is that they are not regulated by the FDA. I like the FDA. I know that there are many conspiracy theorists out there, but it is the job of the FDA to keep us safe. The FDA is in charge of making sure that all drugs are both safe and effective. This includes regulating potency and ensuring there are no added/unreported ingredients. One of the major known problems of taking melatonin is that one can never be completely sure of the dosage. As with all non-FDA approved supplements, there is little outside regulation. Therefore, the consistency, potency and outside contaminants can vary from company to company and from bottle to bottle within the same brand.
My Recommendations
- Start with good sleep practices.This includes consistency of bedtime routine, sleep/wake time, minimizing electronics, etc.
- Assess your child’s individual sleep needs. Each child is unique. Ifyour child goes to bed later but wakes up on time and thrives during the day, she may need less sleep than her peers. Though annoying, this is OK and causes no need for further intervention.
- Add behavior modification techniques when necessary.Think about your personality, your child’s reasons for not sleeping well, and the personality of your child in order to find the best technique for your family.
- Use an infant video monitor. This can help you assess what might be contributing to your child’s sleep difficulties. I have found this information to be tremendously valuable as a mama when working with my own children on sleep. Is the child getting up and playing, or is she tossing and turning with her head on the pillow? These two scenarios require different interventions.
- Talk to your pediatrician. When you have tried all of the recommendations above and your child is still having sleep difficulties, it is time to take the next step. In my opinion, a “wait and see” approach is not good enough. Work with your pediatrician, teachers, occupational therapist, child psychologist, and other professionals who might be involved in your child’s care to determine the best approach.
Parent detective work
Don’t forget to be a detective first! This will allow you and your pediatrician to have an informed discussion about the problem. Your doctor’s recommendations will rely heavily on your day-to-day observations. Go to your pediatrician equipped with knowledge gleaned from your own observations. For example, be able to answer questions such as the following:
- Does your child have a problem with falling asleep or staying asleep?
- Does your child appear restless?
- Does your child have problems with naps (if they are still necessary) or just at bedtime?
- Does your child snore?
- Does your child have nightmares?
- Does your child have specific fears with falling asleep?
My final word on Meletonin
Yes many of the sleep medications and supplements have potential negative side effects. However, we KNOW that a sleep-deprived child will have the negative side effects of irritability and decreased attention. In addition, many studies have also linked a lack of sleep with decreased academic performance, obesity, depression, and behavior problems. In general, I tend to embrace non-pharmaceutical approaches first, but don’t hesitate to do what is necessary to help your child achieve the quantity and quality of sleep she needs.
What are your thoughts on Melatonin? Have you found it to be a wonder-drug for your family? Did you or your child have negative side effects? I would love for you to weigh in! In addition, I have posted a TON of resources this week due to the complexity of this issue. Sweet dreams!
Also, if you have a question you would like me to address in my Weekly Blog,
send it to share@ChildrensTherapyTEAM.com
Resources:
Safety and Efficacy of Melatonin in Children, The Natural Medicine Journal
The Use of Melatonin in Children with SleepDisturbances, MedScape
Melatonin, American Cancer Society
Melatonin, National Institutes of Health
Bedtime Routines for School Aged Children, Healthychildren.org
Melatonin: A ‘Magic’ Sleeping Pill for Children? Wall Street Journal
Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences, American Academy of Pediatrics
A Practice Pathway for the Identification, Evaluation, and Management of Insomnia in Children and Adolescents With Autism Spectrum Disorders, American Academy of Pediatrics