Abstract
Occasional sleeplessness in children is common, with as many as 25% of all healthy children experiencing a problem sleeping at some point over the course of their childhood. Occasional sleeplessness is poorly understood, has a significant impact on quality of life in children and their families, and is often challenging to manage. There is substantial evidence supporting the safe and effective use of the widely available dietary supplement melatonin for children with chronic conditions. This article summarizes the views expressed in a recent Consensus Panel meeting convened to evaluate the use of melatonin in children, as well as the published scientific literature related to the effectiveness and safety of melatonin, with a focus on occasional sleeplessness in healthy children. We provide an evidence-based framework for the implementation of a standard process to effectively manage occasional sleeplessness in children and adolescents. Unsubstantiated concerns in the past may have limited melatonin's use in children with conditions for which the supplement may support a better sleep pattern and, by doing so, may help to improve quality of life. Melatonin dietary supplements using high quality standards may be provided to children together with cognitive-behavioral therapy after proper sleep evaluation and after improved sleep hygiene, family education, and sleep diary activities have failed to resolve sleep difficulties. [Pediatr Ann. 2021;50(9):e391-e395.].
Highlights
EFFICACY OF MELATONIN FOR SLEEPLESSNESS IN THE PEDIATRIC POPULATIONSeveral reports evaluated melatonin for sleep irregularities in children. In a crossover randomized controlled clinical trial (RCT), students (age 14 to 19 years) who were experiencing sleep onset (SO) difficulties during 5 weeks of school received daily melatonin (1 mg), administered between 4:30 pm and 6 pm
Occasional sleeplessness in children is common, with as many as 25% of all healthy children experiencing a problem sleeping at some point over the course of their childhood
This review focuses on efficacy and safety of melatonin for occasional sleeplessness in healthy children, referring to irregularities in sleep quality without underlying pathology
Summary
Several reports evaluated melatonin for sleep irregularities in children. In a crossover randomized controlled clinical trial (RCT), students (age 14 to 19 years) who were experiencing sleep onset (SO) difficulties during 5 weeks of school received daily melatonin (1 mg), administered between 4:30 pm and 6 pm. Melatonin administration in healthy children (age 6 to 12 years) with chronic sleep onset insomnia (CSOI) resulted in improvement, as measured using actigraphy.[12,13] In one RCT with 40 children receiving melatonin (5 mg) or placebo for 4 weeks after a 1-week baseline, children in the melatonin group fell asleep earlier (sleep diary, 63 [95% confidence interval or CI, 32-94] minutes; actigraphy, 75 [95% CI, 36-114] minutes; and with increased total sleep time (41 [95% CI, 19-62] minutes) as compared to the placebo group.[12]. In a recent RCT with predominantly healthy children (age 7 to 12 years) with CSOI using sleep diaries and actigraphy,[15] melatonin was compared to daily blue-green light therapy or placebo pills for 3 to 4 weeks. Effect size was similar between groups suggesting efficacy of melatonin at 0.15 mg/kg when given at least 1 to 2 hours before DLMO and before desired bedtime for children with CSOI.[16]
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