Doctors are warning parents about the risks of giving their children melatonin supplements – an increasingly popular solution to achieve a desired bedtime – as the supplement is not regulated and the effects on a child's development are largely unknown.
"The long-term safety data is simply not there," says Dr. Mark Feldman, director of community pediatrics at the University of Toronto.
While sleep disorders in children are a common problem, summer brings its own challenges with longer daylight hours, changes in routine and often a relaxation of rules – all of which can make it harder to get the kids into bed and sleeping soundly.
Approximately one in four parents complain to their family doctor that their child has trouble sleeping, according to Dr. Shelly Weiss, a neurologist at the Hospital for Sick Children in Toronto.
Pediatricians say they have seen a sharp increase in recent years of parents giving melatonin supplements to their kids to make bedtime easier.
Melatonin is naturally produced by the body in the pineal gland, which releases the hormone in response to several factors, including the amount of light and both physical and mental activity.
"It sort of tricks our own biological clock into thinking that it's nighttime a little earlier," Feldman says.
There are currently 169 melatonin products licensed by Health Canada. Fifty-seven of those were licensed in 2012 in various forms, including pills, edible strips, fruit-flavoured liquid drops and even "bites" flavoured with unsweetened chocolate. You do not need a doctors' prescription.
Since the hormone is considered a dietary supplement similar to vitamins or minerals, synthetic melatonin is not controlled or regulated like other pharmaceutical drugs.
Health Canada classifies melatonin as a natural health product and stresses that it should only be used to treat sleep disorders in adults.
"We wouldn't recommend it for the average healthy kid," says Feldman, one of the authors of the report.
According to health product manufacturer Webber Naturals, melatonin makes up 5 per cent of all supplement sales in Canada.
It is unclear whether there is a long-term downside to children taking melatonin, because widespread use of the supplement by children is a relatively recent issue. In a report released last summer, the Canadian Paediatric Society emphasized that no long-term studies have been done on its safety or effectiveness.
But other experts disagree, arguing melatonin use is safe. Dr. James Jan, a neurologist who has been studying the impact of melatonin on children for the past 32 years, says he has not seen any long-term side-effects.
"There is no risk in large doses, because once the body is flooded with melatonin, what's not needed is washed out," Jan says.
But because melatonin is a hormone, Weiss says, it could delay a child's development during puberty.
"You're giving a natural hormone in an unnatural amount," Weiss says.
There's also the risk that a child will come to rely on the melatonin supplements to fall asleep.
"It's a psychological risk – you're using a pill instead of using good sleep hygiene," Weiss says, noting that you're teaching the child that healthy sleep depends on a pill.
Melatonin should not be ruled out entirely. It can effectively be used to combat jet lag, or in more serious cases of children with neurological or behavioural disorders.
At the end of the day, pediatricians say parents need to think twice before reaching for the pills and work with their doctor to get to the bottom of their child's sleeping problems.
"The most important thing is to talk to their physician about the cause of their insomnia," Weiss says.
SUMMER SLEEPING TIPS
Dr. Mark Feldman, director of community paediatrics at the University of Toronto, gives these three tips for establishing good sleep habits in children:
- Establish a regular time to wake up and go to bed, and stick to it – even on weekends. "If you go to bed at different times, it's harder to fall asleep."
- Remove all electronics from a child's room. No TV, no computer, no cellphone. "They're just so distracting," Dr. Feldman says.
- Make sure your child gets regular exercise.