Friday, October 30, 2015

Melatonin use in children

This article discusses melatonin use in children.

What we do know: Supplemental melatonin can help children with sleep dysfunction (those who lie awake for hours at bedtime) fall asleep. However, melatonin only helps with sleep initiation (falling asleep) not staying asleep. So if you are dealing with wake ups during the night... melatonin is not the solution. Normal awakenings shift and change due to all sorts of developmental milestones and changes as children grow. Overnight awakenings will always be normal although how our children get back to sleep on their own changes our night of sleep dramatically!
What Is Melatonin?
Melatonin is a naturally-occurring hormone that our brains produce to help regulate sleep and wake cycles. People call it the "sleep hormone" because unlike the parts of body that drive wakefulness, melatonin drives sleepiness. Normally, melatonin levels begin to rise in the late evening (around 8 p.m. for kids, around 10 p.m. for teens), remain high for most of the night, and then drop in the early morning a couple hours before we wake up. Light inhibits melatonin and affects how much melatonin your body produces. Hence why being outside in the light during the day with a newborn (especially the ones who want to party all night) or when switching time zones makes a lot of sense! Light from screens (Kindles, iPads, tablets, computers, TVs) inhibits melatonin from being released. Getting outside during the day helps teach your brain day vs. night -- an important strategy for anyone struggling with sleep.
The Melatonin Supplement
The melatonin supplement you find at your local drug store is synthetically produced in factories. Because it's a supplement and not a medicine it's not regulated by the FDA like medicines. Therefore inconsistency in dosing is possible (no one can say that one brand's 1-mg tablet is the same dose as another's). Potency varies by brand and even between different batches from the same manufacturer. Always avoid "natural" melatonin (derived from cow or pig brains) and purchase only the man-made synthetic supplement that is far more readily available.
Melatonin Dosing Recommendations
"There are no clear-cut dosage guidelines because neither melatonin nor any other medication or supplement is approved by the FDA for the purpose of treating insomnia in children," said sleep expert Dr. Maida Chen of Seattle Children's Hospital.
Typically you always want to use the lowest dose: 0.5mg or 1mg -- then consider increasing by 0.5mg every few days if your child isn't falling asleep within an hour of bedtime. While increasing dose, make sure you're also working on consistent bedtimes, policing screens in the bedroom, and working to get good exercise OUTSIDE during the day. Many children will respond to a dose 0.5mg or 1mg an hour or two prior to bedtime. Some children and teens with significant challenges falling asleep are often given doses as high as 3mg to 6mg with severe insomnia at bedtime but in my experience many children get the hypnotic effect at smaller doses. Talk with your child's physician about how to determine a dose if or when melatonin is being used and if it's not working, GET OFF OF IT. Not all children respond to the hypnotic effect of supplemental melatonin.
Timing: You want to give melatonin prior to bedtime to help with increasing sleepiness. Most physicians recommend giving about 1-2 hours prior to ideal bedtime when helping little children fall asleep. However, it does depend why and how you plan to use melatonin. Here's a GREAT on how melatonin works and when to administer from Dr. Craig Canapari -- a pediatric sleep expert at Yale.
Children With ADHD and/or Autism Spectrum Disorders (ASD)
Children with ADHD and/or autism spectrum disorder are known to have challenges falling asleep. Studies with melatonin have been done in these populations of children. Dr. Chen explains:
"More trials of melatonin for sleep difficulties have been done in children with ADHD or ASD than studies for typically developing children. Evidence from these trials suggests that melatonin is safe and does shorten the length of time it takes to fall asleep. However, the effects are not generally overwhelming and not every child who takes melatonin shows sleep improvement. The studies mostly evaluate short-term use only." Most worries about long-term use and safety are speculative (based on studies in animals or adults) but without clarity from research it's always best to get kids off melatonin when you can.
Sleep matters. Good sleep is essential. But it's rare for a child to need meds.
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