Can Melatonin Cause Behavior Problems?

Many children and teenagers can't fall asleep and sleep through the night. Those who support the use of melatonin argue it offers benefits without any increase in significant behavior problems in children.

Many children and teenagers can't fall asleep and sleep through the night ( insomnia). Insomnia causes many problems for children and their parents. Melatonin is a treatment used to help with sleep difficulties and is increasingly popular. Does melatonin cause behavior problems or reduce them? Are there reasons you shouldn't give your child melatonin?

Melatonin is a hormone produced by the pineal body, a gland seated in your skull, below your brain. The pineal gland releases melatonin into your body as night approaches. Increased levels of melatonin can put you in a state of quiet wakefulness, making it easy to fall asleep. Melanin is not a hypnotic drug-like pentobarbital or diazepam.

As many as 25% of children have insomnia. In children with disorders like autism, attention deficit hyperactivity disorder (ADHD), and cerebral palsy, the proportion may be as high as 75%. These children have many problems caused by poor sleep, including:

• Daytime sleepiness
• Poor concentration
• Poor school performance
• Hyperactivity
• Irritability and restlessness
• Poor memory
• Anxiety
• Depression
• Learning difficulties

Melatonin offers many benefits to these children. They fall asleep more quickly, and the total duration of sleep is longer. Melatonin is effective even in children taking methylphenidate for the treatment of ADHD. 

There are mixed positions on the use of melatonin to improve sleep in children. According to the American Academy of Pediatrics, melatonin should never be used in place of good sleep routines. They also advise caution when using melatonin long-term because there isn't enough research on safety.

Poor sleep is often associated with behavioral problems. A young child's anxiety or refusal to sleep without a parent may prevent them from falling asleep. Older children often stay awake because of social media and other electronic device use, caffeine, alcohol, and irregular bedtime habits. If these are the reasons for poor sleep, you shouldn't give your child melatonin, but should address the behavioral problems instead.

You shouldn't give your child melatonin if they have an autoimmune disorder, epilepsy, depression, diabetes, or high blood pressure. Also, let your pediatrician know about the medicines your child is taking. Some medicines and supplements may cause dangerous interactions with melatonin.

Those who support the use of melatonin argue it offers benefits without any increase in significant behavior problems in children. It is used in both healthy children and children with developmental disorders. No adverse behavioral effects have been seen. However, there are at least two frequently reported side effects of melatonin in children: morning drowsiness and bed wetting. 

Unlike most insomnia medicines, melatonin is not a strong sleep inducer. It works by increasing ordinary day-night shifts in alertness and sleepiness. There are no reports of memory impairment with melatonin. Your child has almost no risk of dependence or addiction. Increases in hyperactivity, defiance, or aggression are also not seen.

Your child may complain of daytime fatigue after starting melatonin therapy. Other possible effects are agitation and mood swings. Stopping melatonin intake does not cause rebound insomnia or withdrawal issues. Those who support the use of melatonin believe it is a safe therapy in terms of behavioral effects. The most frequent effects of use are sleepiness and fatigue.

Your child's behavior may seem different. Once your child starts taking melatonin they should begin sleeping better. The irritability and restlessness caused by lack of sleep will gradually fade away. You may also notice that anxiety and depression are reduced over time. 

Melatonin appears to be safe used at regular doses. The common side effects are daytime sleepiness and fatigue, restlessness, headache and pain in the limbs, dry mouth and skin, and night sweats. Rarely, some children may have serious side effects like fainting, bleeding, severe allergy, dizziness, or depression.

Half of the known children with poor sleep have behavioral insomnia of childhood (BIC). Young children delay or refuse their bedtime because of poor routine establishment and limit-setting by the family. In older children, behaviors that cause insomnia include device use, caffeine, alcohol abuse, sedentary habits, and irregular bedtimes. 

Before using any pharmacological methods, you should establish good sleep hygiene and routines. Though older children sometimes resist these routines, they have lasting benefits and are worth the effort.

Good sleep hygiene

Children shouldn't nap during the day. Serve them dinner two hours before bedtime, and turn off all screens (computers, games, phones, and televisions) at this time. Your kids should sleep in their own beds and have regular bedtimes and waking times. Get them used to sleeping in a dark room. Never serve them any caffeine-containing drinks in the evening (coffee, sports drinks, energy drinks, sodas, and others).

Sleep routines

These will vary with your child's age and family preferences. Consistency is important. These routines may not work immediately, but you should stick to them. Good sleep habits are the best and safest medicine.

Melatonin reaches peak blood level an hour after taking. You should give the dose about two hours before your child's bedtime. Melatonin is metabolized by the liver, and the blood level falls to half in 40 minutes. Some tablets release melatonin slowly to provide steady action through the night. 

The Canadian Paediatric Society advises these doses:

• Below one year: 1 milligram.
• Older children: 2.5 to 3 milligrams.
• Adolescents: 5 milligrams.

Melatonin should never be the first plan for dealing with sleep issues. Developing good sleep hygiene and routines is the essential first step. You should add melatonin if sleep routines alone are not working. 

Melatonin is safe and causes no important behavioral changes. A few children who take it complain of daytime tiredness and sleepiness. Melatonin does not cause increased aggression, inattention, or hyperactivity.

Since it is not a strong hypnotic, there is no risk of dependence or addiction. By improving sleep, melatonin can reduce the adverse behavioral effects of insomnia. Improving your child's sleep can benefit them as well as the entire family.