Melatonin is a sleep hormone which we all naturally produce and the body’s signal to release melatonin is being in the dark. When your child is anxious or stressed or even excited just before bedtime, it can be difficult or even impossible for them to fall asleep. Bright lights and screens or phone screens even a few hours before bedtime can delay the production of melatonin and therefore lead to sleep difficulties. In the morning try to get as much light as you can, at least 30 minutes. Open the curtain and let the light in and kick-start your circadian rhythms.

Circadian rhythms

The body has many circadian rhythms (24 hour cycles) and one of the most important is sleep cycle. Keeping the sleep/wake close is important and you can help by:

• Encouraging set sleep routines
• Encouraging exposure to daylight on waking
• Provide a dimly lit room in the evening a few hours before bed, as darkness tells our body to release the sleep hormone melatonin.

Virtually every animal has a body clock that governs their circadian rhythm –  Our body clocks are affected by external factors which, in turn, affect our internal rhythm, such as light, temperature, mealtimes and social activities.  These are all important for keeping our body clock in rhythm and letting our body know when it is time to do different functions such as sleep, eat or be alert and able to concentrate.  It is as a result of our circadian rhythm that we are most likely to want to sleep during the dark hours of the late evening and early morning. 

Melatonin and diet

Melatonin rich food are helpful for increasing melatonin levels naturally. Eating small amounts of food before bed can be helpful, for example, Toast or Weetabix which are slow release. Most children grow at night so a small amount of food can be helpful to avoid waking early in the morning.

Good sources of melatonin

Most food databases don’t list the amount of melatonin in foods, but according to available research, these foods are good sources of melatonin:

• Tart Cherries
• Goji Berries Produced by a plant native to China
• Eggs
• Warm milk
• Fish
• Cranberries and cranberry juice
• Nuts taking allergy precautions

Most fruits are poor in melatonin. Only cranberries, grapes, strawberries, cherries, apples, and bananas have decent amounts of melatonin.

Pistachios are among the richest foods in melatonin, containing 23.3 mcg of melatonin per 100g, or 6.5 mcg per 1oz.

https://www.webmd.com/diet/foods-high-in-melatonin

Prescribing melatonin

Preliminary research suggests that melatonin supplements may aid children who are prone to sleep disorders, but this research is limited. It is important to discuss melatonin supplements with a health care professional before administering them to a child.

Children with longer-term sleep problems can take melatonin if a specialist recommends it. Melatonin is not recommended for children younger than 5 years old.

Melatonin concentrations are naturally quite low in babies 3 months and younger, as their circadian systems are still developing. At this time, there are no long-term studies on melatonin use in infants.

In children 5 years and younger, sleep duration and quality can be affected by external factors such as teething, separation anxiety, or changes in routine. It may be useful for caregivers of 1- to 5-year-old children to pinpoint and treat these possible causes for sleep disruptions rather than opting for melatonin or other sedating over-the-counter medication such as allergy treatments.

For children over the age of 5, a doctor may recommend lower doses of melatonin to address sleep-onset insomnia. If your infant or toddler struggles to sleep, talk to your GP or health visitor. They can help you identify possible causes and you can develop a treatment plan.

Melatonin is a possible short-term strategy for helping children achieve quality sleep. Though research on the use of melatonin in children is limited, studies of select groups of children provide promising evidence of melatonin’s effectiveness in initiating sleep.

Side Effects of Melatonin

The use of melatonin in children has not been extensively studied, and the potential risks and side effects of using it are not fully known. Children who take melatonin supplements may experience symptoms like bedwetting, drowsiness, headaches, and agitation. Parents should also be aware of the risk of accidental overdose and work closely with their child’s doctor on the use of melatonin.

Currently, there is little research on the long-term effects of melatonin use in children. Some experts question if melatonin, because it is a hormone, can affect other hormonal development in adolescents. Further research is needed to more clearly understand the long-term side effects of melatonin on children.

www.sleepfoundation.org

Research The Lancet July 2023

Use of melatonin for children and adolescents with chronic insomnia attributable to disorders beyond indication: a systematic review, meta-analysis and clinical recommendation: Henriette Edemann-Callesen et al. 

Evidence before this study: Melatonin has gained popularity as a sleep aid within the past decade, yet there are currently no recommendations available to guide clinicians on use of melatonin in children and adolescents with disorders beyond autism spectrum disorders and attention deficits hyperactive disorder (ADHD). We aimed to develop the first clinical, evidence-based recommendation for use of melatonin in disorders that are beyond indication, and thus currently not included in existing guidelines.

Added value of this study:  To the best of our knowledge, this is the first evidence-based clinical recommendation on this topic in children and adolescents with disorders other than autism spectrum disorders and ADHD. We searched multiple databases, with the latest search performed in March 2023. We found 13 studies reporting on the use of melatonin in children and adolescents (aged 1–26 years) with various disorders beyond indication. Evidence of low certainty collectively supports a moderate reduction of sleep latency by 15 min and a moderate increase in total sleep time by 19 min. These improvements in sleep continuity parameters did not have an impact on daily functioning or the quality of sleep. Evidence on adverse events was scarce. Our recommendations, outlined below, were constructed by a multidisciplinary guideline panel based on the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

Implications of all the available evidence:  Based on our findings, we recommend careful use of melatonin to treat insomnia attributable to disorders ranging beyond indications in children and adolescents. Such off-label treatment with melatonin should only be considered by a medical specialist with knowledge of the underlying disorder and in those cases where non-pharmacological interventions have proven to be inadequate. It remains to be investigated whether melatonin may provide a differential magnitude of effect and adverse event profile across different disorders.

Discussion: 

We recommend that melatonin may be used in children and adolescents aged 2–20 years with chronic insomnia due to underlying disorders ranging beyond indication, granted that daytime functioning is affected and that sleep hygiene practices have been inadequate. We consider this to be one of the first evidence-based recommendations on the matter.

In all cases, chronic insomnia should initially be tried resolved by means of sleep hygiene practices and other non-pharmacological measures.

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00226-2/fulltext