Melatonin for sleep problems in children

By Dr Tommy TranGeneral08 Sep 2015

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Sleep difficulties are very common in children. Poor sleep at night can result in many problems during the day, including behavioural problems, learning problems and poor attention. For parents, it can be extremely frustrating trying to help their children fall asleep at night. In most cases though, sleep can be improved with an improvement in sleep hygiene.

Simple measures such as having a structured routine, limiting light exposure at least an hour before bedtime, reducing screen time and having a set waking up time every day are often very effective. This is the first line management, and even if your child starts medication, they will need to continue with these strategies. More information can be found here.

Melatonin is a light sensitive hormone that helps the body prepare for sleep at night. In a bright environment, the levels of melatonin decrease. In a dark environment, the levels of melatonin increase and this signals to your body that it is bedtime. Having lots of light turned on can reduce your bodies melatonin production, making it hard to fall asleep.

Melatonin can be used for sleep difficulties in children. The only commercially available form in Australia, is a medication called Circadin. If it is crushed, it will lose its long acting properties which poses challenges for small children who can’t swallow tablets. A liquid form is available but has to be compounded at special pharmacies.

The main body of evidence for Circadin is in children with developmental problems such as Autism and developmental delay. In these children, melatonin seems to help children fall asleep early, but there was less evidence suggesting it helped them sleep through the night, or sleep for longer overall.

Although melatonin has been widely used in children for more than a decade, it is important to know that there is limited data regarding the safety of melatonin in children. In children with epilepsy, melatonin can provoke seizures so an alternative should be considered. There is currently research underway looking at to the optimal timing, dosing and safety of its use in children. Until that information becomes available, it is important for parents to continue working on improving their child’s sleep hygiene, and then discuss with their doctor whether it is appropriate to use melatonin.

You should discuss with your doctor whether it is appropriate to use melatonin “after all other strategies have been tried”.

References:

Kennaway D (2015) Potential safety issues in the use of the hormone melatonin in paediatrics. Journal of Paediatrics and child health 51: 584-9

Zisapel N (2015) Safety of melatonin. Journal of Paediatrics and child health 51:840-1

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