Melatonin 2022/ Is it safe? Is it useful?

Melatonin has been in the news recently.  Here are the shocking statistics that are making the headlines… melatonin ingestions by children accounted for almost 5% of all of the calls to the poison control centers in the US this year! Basically the number of pediatric melatonin ingestions increased a whopping 530% from 8,337 in 2012 to 52,563 in 2021. This is no doubt due in part to the fact that it recently has become more widely available with a variety of pediatric friendly options.  By far the majority of these were young kids getting access to it because it wasn’t stored safely. Your kids are smarter than you think. Just putting something on a high shelf does not mean it is childproof. Don’t underestimate the lure of yummy gummies.   Fortunately 83% of these overdoses were completely asymptomatic; only 1.6% lead to more serious outcomes. Those who showed symptoms had Headache Dizziness Nausea Drowsiness So what is Melatonin anyway? Melatonin is a hormone that occurs naturally in the body. It is produced in an area of the brain known as the pineal gland. Melatonin is released and helps control the body's circadian rhythm. It is not a sedative, but works in combination with light to get the body drowsy when it is time for sleeping. It may help adults and children fall asleep faster and improve the quality of sleep. It is not habit forming. It is interesting to note that melatonin production tends to decline with age (hmm, maybe that’s why I sometimes have trouble sleeping?)   There are no known ill effects, but there is no conclusive research yet on what the impacts may be from long-term use in children. For children older than 3, short term use seems quite safe.   The most common and most widely sanctioned use, is to help combat jet lag. Dr. Kaplan, over at Town and Country Pediatrics, says that it is fine for her patients who want to use it to help get adjusted to a new time zone.   Jet lag can make the first couple days of a trip pretty rough. Your best bet to get over it quickly is a multi pronged approach. It is very important to focus on hydration. Also, try to get as much daylight as possible when you land. If you are arriving someplace after 2 pm, try hard to stay awake and then crash early. If you are getting in earlier than that, a short nap might be necessary.   Then, by all means, add the appropriate dose of Melatonin to the mix. Unfortunately there are no clear dosage or safety guidelines in place. The studies range from 0.1 to 10 milligrams of melatonin. Most doctors think that 2-3 milligrams are a good amount to start with. The common recommendation is: Preschool-age: 1 to 2 milligrams School-age: 2 to 3 milligrams Adolescents: 5 milligrams In all cases however, experts recommend always starting with the lowest dose of melatonin available, then increasing the amount only if necessary. It is best to give it about 30-60 minutes before bedtime. As I mentioned above, melatonin comes in a wide variety of options for how to take it. Aside from tablets, chewables, quick dissolving and liquid, it also comes in sprays, creams, powders, and patches. Not all the forms have the same absorption. Choosing the right one is all about personal preference. For routine sleep .  For a healthy child, melatonin should NOT be part of a regular sleep routine, but there is no harm in giving it for several days to help reboot and get on a good schedule. If sleep issues persist, it is worth having a consultation with your pediatrician. Here are some things that can contribute to healthy sleep habits   Going to bed and waking up at the same time can get the body into a healthy rhythm. You may hear this referred to as 'sleep hygiene'. Make sure your child is getting plenty of physical activity during the day, but avoid too much rough housing right before bed. Try to avoid eating a large meal right before bedtime. Also, if any caffeine or sugar sneak into the diet several hours prior to bedtime, this can make it harder to get a good night's sleep Have a regular bedtime routine. Do some soothing activities, make the room progressively darker and darker. Don’t include any electronic devices as part of the bedtime ritual. The blue lights that are emitted are disruptive and should be avoided for at least an hour before bedtime. A pre bedtime massage is a lovely way to wind down.   White noise machines are fine. A hepa filter can do double duty.   Keep the bedroom cool. According to the National Sleep Foundation the ideal bedroom temperature is actually between 60 and 67 Fahrenheit. You can bump that up a bit for infants and toddlers to 65-70, but cooler rooms are better for sleeping. Consider trying the natural calm gummies. These are magnesium based. They can help you get a good night’s sleep (as well as a good poop). I am a big fan.   Not everyone knows that low iron and/or vitamin D levels can impact sleep. If you or your child are having insomnia, it might be worth getting those levels checked.   Other potential Melatonin benefits My 'go to' pediatric dentist, Dr Rothman shared the following: In the anesthesia literature it has been shown that giving melatonin does not increase depth of sedation during a procedure and therefore may be helpful in getting a good night's sleep prior to dental work, thereby decreasing anxiety. Keep this in mind and chat with your dentist if you have a procedure coming up.   There are ongoing studies exploring other potential benefits for all sorts of issues including migraines, eye health, calming kids on the autism spectrum as well as GERD. It will be fun to see what the future findings are.   Other safety considerations In the United States, melatonin is categorized as a dietary supplement, rather than an actual medication. There is no prescription needed. Supplements are not regulated by the FDA and are subject to less regulatory oversight.  A recent study measured the actual amount of melatonin in 31 different brands and found enormous variations from what was on the label and what was actually in the bottle. Some had significantly more or less than the claimed amount. Because of this, some countries such as Canada have banned the sale of over-the-counter melatonin. It is worth checking to make sure that the brand you buy is USP certified.   There are no safety studies for use in children under 3, pregnant or breastfeeding moms. Melatonin might interact with some medications, so for you grown ups out there, it is important for you to check with your primary physician. Medications that you need to pay attention to include some contraceptives, blood pressure medications, diabetes medications and most sedatives.   The biggest takeaway from this post? If you have melatonin sitting around on the counter, go and properly store it right now.