As melatonin consumption in children explodes, experts urge caution

Melatonin consumption is skyrocketing, especially among children, leading to increased calls to poison control centers and emergency room visits.

Last year, poison centers received 44,538 calls regarding melatonin ingestion in people 19 and younger — up from 8,258 in 2012, according to the U.S. Poison Centers, which represents 55 centers in the United States. Emergency room visits related to melatonin increased from 382 in 2009. 2012 to 1,782 in 2017-2020.

“That’s the bread and butter of poison centers: a lot of accidental ingestion in children, especially with melatonin,” says Kait Brown, the organization’s clinical executive director, PharmD, DABAT. “We see it every day, multiple times a day.”

The majority of cases — nearly 85 percent of calls last year — involve children 5 or younger, Brown said, usually when they find their parents’ stash and mistake it for candy. Melatonin should be stored out of reach of children because it usually comes in tasty flavors, often in gummies that appeal to children, and does not always include a child-resistant cap like medications do, Brown explains.

A typical call to the poison control center comes shortly after a child ingests melatonin, says Brown, who previously worked the phones at the Utah Poison Control Center. The poison check will ask about the child’s dosage, symptoms and medical conditions, she says.

Drowsiness, the most common side effect, usually appears within an hour. Monitor the child’s breathing and tickle or poke them to make sure they are not overly sedated, Brown says. Especially with gummies, the child may experience nausea and diarrhea, like when a child eats too much candy, she says. (Never force the child to vomit.)

Parents should call 911 if the child is having trouble breathing or waking up. Rare reactions, such as tremors or hallucinations, may also require a hospital visit, she says.

In the vast majority of cases, the children were fine and the cases could be managed at home, Brown says.

Yet this is not always the case, according to the CDC report. Of the 260,435 melatonin ingestions in children reported to poison control services between 2012 and 2021, more than 4,000 required hospitalization and 287 children were sent to intensive care. Five children required ventilation and two died, the CDC reports. (Other factors may have caused these deaths, Brown notes, because complete medical records were not available.)

The most distressing cases are those where young people try to harm themselves, says Michael Toce, MD, associate pediatrician in the emergency medical division at Boston Children’s Health.

These cases require psychiatric hospitalization and the patient can spend days in the emergency room waiting for a bed, Toce says.

Melatonin supplements are marketed as an affordable sleep aid and available over-the-counter in the United States (although many European countries require a prescription). Some studies suggest they help with sleep, but the evidence is unclear.

Additionally, the FDA regulates dietary supplements that include melatonin in a much less stringent manner than prescription and over-the-counter medications. Regardless of the bottle label, amounts of melatonin can vary – from 83% to 478% of the advertised dose – according to a 2017 study in the Journal of Clinical Sleep Medicine, and some brands contain other substances, such as serotonin, a neurotransmitter that requires a prescription. (Parents should look for brands verified by the United States Pharmacopeia, according to Harvard Health.)

There are also concerns about the possibility of long-term hormonal effects on sexual maturation in developing adolescents, although studies are so far lacking. The CDC warns that “additional research is needed to describe the toxicity and outcomes associated with melatonin ingestion in children.”

Yet sales of melatonin supplements nearly tripled between 2016 and 2020 to $821 million, fueled in part by pandemic-related anxiety, experts say. A Sleep Foundation survey last year found that more than one in four adults use it regularly, while The Journal of the American Medical Association reported this month that nearly one in five children ages 5 to 13 have taken the supplement in the past month.

It’s a question that Michelle Caraballo, MD, addresses daily.

“(It) really depends on the child and the specific situation,” says Caraballo, a pediatric pulmonologist and sleep medicine specialist at Children’s Health Dallas.

According to the National Institutes of Health, there is some evidence that melatonin supplements may be helpful in certain populations, including children with attention deficit hyperactivity disorder or autism spectrum disorder.

In nine years as a sleep specialist, Caraballo has only stopped using it in two patients, she says: a teenager who suffered from headaches and a child who was very sensitive to melatonin and who slept until noon the next day.

“I admit I sometimes give it to my own children,” she says.

Typically, she recommends no more than one milligram per year for her younger patients, and she never recommends more than 10 milligrams – although she has treated patients taking up to 40 milligrams without noticeable side effects. , she says. .

Still, she believes that before parents consider melatonin, they should make sure their child adheres to proper “sleep hygiene.” That means:

Strict bedtimes: A bedtime routine 7 days a week, without exception. Allowing kids to stay up 2-3 hours later on the weekend is akin to the time difference of a coast-to-coast flight.

  • Soothing routine: Children should relax before bed by doing something calming, like reading a book or taking a bath.
  • Good place to sleep: Keep the room cool, dark and quiet. (Blackout curtains can be helpful in summer time.)
  • Digital-free zone: Do not allow phones or televisions in the bedroom, as the blue light emitted by the devices can disrupt natural melatonin production.
  • Diet and exercise: Avoid caffeine after lunch, as well as vigorous exercise 2 hours before bedtime. (And parents should avoid drinking alcohol before bed.)
  • No nap: Avoid naps once the child is over 5 years old.
  • Ban animals from the bed: Studies show that sleeping with animals can harm sleep quality.

“Before I recommend medication to anyone, I want to make sure good sleep hygiene is in place,” says Caraballo. “We can usually solve any problems through behavioral changes. Children respond well to routine. The body usually does it, but certainly children do.

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