Melatonin and Children’s Sleep Problems

Exogenous melatonin may be a useful adjunct in children with chronic sleep disorders unrelieved by traditional medication and supportive treatment. Melatonin, a neurohormone, is involved in regulating the sleep-wake cycle. Normally, melatonin secretion from the pineal gland is activated by the retino-hypothalamic-pineal system with peak serum levels between 2 and 4 am. Impaired production or action disturbs sleep onset and duration. 

Separate studies of oral melatonin administration in children with co-morbid nervous system disorders, e.g., ADHD, anxiety, affective disorders, neurological injury, impaired vision, developmental disabilities, indicated improved sleep onset and/or sleep maintenance in comparison to placebo. One recent study also found significant improvement on RAND-General Health Rating Index and Functional Status II measures for the melatonin group in a randomized, double-blind placebo-controlled trial.

Melatonin is well tolerated with some reports of headache, sedation and temporary depression reported, usually with higher doses.  It may increase seizure activity and is not advised for persons with autoimmune conditions.  Based on published studies, the initial dose for children is 2.5 to 5 mg taken 30 to 60 minutes before bedtime.
The FDA does not regulate exogenous melatonin. It is produced in immediate and controlled release tablets and capsules (300 mcg, 1, 3 and 5 mg).  Synthetic forms are preferred over bovine derivatives to avoid the risk of infectious agent contamination.  The “USP” symbol on a specific manufacturer’s product indicates voluntary adherence to quality control and standardized contents.

(Buck M. Pediatr Pharmacotherapy 2003;9(11):1-4)

Comment: Daytime mood and behavior are significantly affected by the quality and duration of night-time sleep.--J.O.