Mountains of medical evidence have established the importance of adequate sleep, especially for children and their rapidly developing brains. Unfortunately, more children are now experiencing insomnia, leading many parents to turn to melatonin, an over-the-counter supplement that is believed to help regulate sleep cycles. A recent survey by the American Academy of Sleep Medicine found that about 46% of parents have given melatonin to kids under 13 in the last year.
But it’s important to remember that melatonin is not under FDA oversight, and it’s possible to overdose on the supplement. Yet many parents view it as natural and equate it to a vitamin supplement. Dr. Gene Beresin, executive director of the Clay Center for Young Healthy Minds at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School, joined GBH’s All Things Considered host Arun Rath to elaborate on melatonin usage and the importance of sleep for kids. The following is a lightly edited transcript.
Arun Rath: Give us a little bit more detail, setting the baseline here, about why sleep is so important to kids’ well-being.
Gene Beresin: Sleep is important for attention, concentration, cognitive performance—which means the performance of thinking clearly—and memory. It’s important for resiliency. For toddlers, it’s important for the growth and development of a whole variety of functions.
It’s also important for medical health. It’s important for the immune system, and there are some studies that show that good sleep prevents diabetes, obesity, hypertension and heart disease. When you’re sleep-deprived, it’s a risk factor. I mean, there are driving accidents. Sometimes, young people will turn to stimulants because they’re not alert and they want to be more alert. Substances can be misused.
It prevents impulsive behavior. It’s important for executive functioning—that means organizing, monitoring your time, setting priorities and staying organized. It also associated sleep deprivation with tantrums and oppositional behavior.
It’s super important. I think we all know that with a good night’s sleep, you feel refreshed. You feel like you’re at the top of your game. And that’s not just for kids; it’s true for adults as well.
Rath: As we mentioned, more people are turning to melatonin for better sleep. What do parents need to know about it before, say, going to the store, buying melatonin and giving it to their child? What should they know?
Beresin: Well, I think they need to know that, first of all, melatonin is a natural organic substance that the brain produces. The pineal gland produces it, and it’s stimulated by darkness. It’s used to help the onset of sleep. It’s natural, but it’s also the second most common over-the-counter substance used by parents, next to vitamins.
You mentioned the American Academy of Sleep Medicine study that 46% of parents are giving it to kids under 13. Another study has shown that in the last decades, that number has increased. In the last few years, it’s increased by 530%, so it’s gone way up. That’s because 40 to 80% of kids have sleep problems.
Now, some of them are due to psychiatric disorders, so it’s useful, for example, if you have a sleep disorder such as delayed sleep onset or if you have attention deficit hyperactivity disorder, autism spectrum disorder, depression, anxiety, post-traumatic stress disorder, or obsessive-compulsive disorder. So there are a lot of psychiatric problems that actually merit helping kids get to sleep.
That being said, I always want to see behavioral measures done first and melatonin done second. But, you know, some of us have believed in better living through modern chemistry. If you can just give a pill, they take that. But the most important thing—and we can get to this—is sleep hygiene.
The other thing is that, when it’s used appropriately, as one study showed, for teenagers and school-aged kids that had depression and anxiety, melatonin was useful in preventing intentional self-harm—not accidental self-harm, but intentional self-harm. So, there may be some very good reasons for using melatonin after you’ve tried to improve sleep through good hygiene.
The thing you mentioned earlier, though, is that over-the-counter medications, including melatonin, are not regulated by the FDA. Some studies have shown that, depending on the melatonin you get, you can get either half of the amount to four times the amount.
Then, in another study that looked at 30 brands of melatonin, 70% contained a different amount than the label. In fact, 80% less to 400 times more. So, you don’t really know what you’re getting unless it’s stamped with the USP verified—that’s the United States Pharmacopeia verified—which meets the standards of good manufacturing practice. That’s the standard that the FDA uses for looking at the safety and quality of all medications.
There are only four brands of melatonin that I found that actually have that stamp on them, so one tip for parents is that if you need to use melatonin, get the brand with the USP-verified stamp.
Rath: Good to know to look out specifically for that mark, for that label.
Beresin: Yes, because you don’t know what you’re getting. That’s the problem with over-the-counter medications. Many of them are extraordinarily helpful. I mean, many people use non-steroidal anti-inflammatory medications like Advil, Aleve, or even Tylenol, but those are regulated. There are many, many others that aren’t regulated.
When you go to the pharmacy and you get an over-the-counter medication, it’s not regulated. When we buy prescription medications, we expect that they are FDA-regulated, so there are certain guidelines that the pharmaceutical companies have to meet in order to actually produce them.
Rath: You mentioned at the outset about sleep hygiene and turning to behavioral techniques before turning to substances or supplements. What are the kinds of things that we can do without using things like melatonin?
Beresin: I want to emphasize this. Before you reach for the drug, try the behavioral means first because in many, many cases—in fact, the majority of cases—kids can get to sleep if they have a consistent and regular bedtime, if there’s some soothing and calming routine before bed, like taking a bath, reading or quietly chatting. If they have about 20 or 30 minutes before their bedtime to get ready for it, if there room is cool and dark.
Avoiding naps during the day is super important. Some relaxation techniques that can be used before bedtime, like meditation, breathing exercises, or listening to music. Look—young kids loved lullabies. Why do you think lullabies are so helpful? Because they are soothing and calming, and they connect the child and the parents.
There are things to avoid, like daytime naps and anything with caffeine in it, such as soda, coffee, tea or chocolate in the afternoon, at least six hours before bedtime. Exercise is great for sleep, but not if it’s done in the evening.
What I think is most important right now is blue screens. Blue screens from cell phones, TVs, tablets and monitors suppress melatonin. Many school-aged kids and teenagers have blue screens in their rooms. If they’re using them before bedtime, it’s going to offset the sleep cycle, so, again, I would go through this whole regimen of behavioral techniques first before you reach for the sleep aid unless it’s absolutely necessary.