The Melatonin-ification of Childhood Bedtimes
(UNDARK, Michael Schulson) — Two years ago, at a Stop & Shop in Rhode Island, the Danish neuroscientist and physician Henriette Edemann-Callesen visited an aisle stocked with sleep aids containing melatonin. She looked around in amazement. Then she took out her phone and snapped a photo to send to colleagues back home.
“It was really pretty astonishing,” she recalled recently.
In Denmark, as in many countries, the hormone melatonin is a prescription drug for treating sleep problems, mostly in adults. Doctors are supposed to prescribe it to children only if they have certain developmental disorders that make it difficult to sleep — and only after the family has tried other methods to address the problem.
But at the Rhode Island Stop & Shop, melatonin was available over the counter, as a dietary supplement, meaning it receives slightly less regulatory scrutiny, in some respects, than a package of Skittles. Many of the products were marketed for children, in colorful bottles filled with liquid drops and chewable tablets and bright gummies that look and taste like candy.
A quiet but profound shift is underway in American parenting, as more and more caregivers turn to pharmacological solutions to help children sleep. What makes that shift unusual is that it’s largely taking place outside the traditional boundaries of health care. Instead, it’s driven by the country’s sprawling dietary supplements industry, which critics have long said has little regulatory oversight — and which may get a boost from Secretary of Health and Human Services Robert F. Kennedy Jr., who is widely seen as an ally to supplement makers.
Thirty years ago, few people were giving melatonin to children, outside of a handful of controlled experiments. Even as melatonin supplements grew in popularity among adults in the late 1990s in the United States and Canada, some of those products carried strict warnings not to give them to younger people. But with time, the age floor dropped, and by the mid-2000s, news reports and academic surveys suggest some early adopters were doing just that. (Try it for ages 11-and-up only, one CNN report warned at the time.) By 2013, according to a Wall Street Journal article, a handful of companies were marketing melatonin products specifically for kids.
And today? “It’s almost like a vitamin now,” said Judith Owens, a pediatric sleep specialist at Harvard Medical School. Usage is growing, including among children who are barely out of diapers. Academic surveys suggest that as many as one in five preteens in the U.S. now take melatonin at least occasionally, and that some younger children consume it multiple times per week.
On social media, parenting influencers film themselves dancing with bottles of melatonin gummies or cut to shots of their snoozing kids. In the toxicology literature, a series of reports suggest a rise in melatonin misuse — and indicate that some caregivers are even giving doses to infants. And according to multiple studies, some brands may contain substantially higher doses of the hormone than product labels indicate.
The trend has unsettled many childhood sleep researchers. “It is a hormone that you are giving to young children. And there’s just very little research on the long-term effects of this,” said Lauren Hartstein, a childhood sleep researcher at the University of Arizona.
In a 2021 journal article, David Kennaway, a professor of physiology at the University of Adelaide in Australia, noted that melatonin can bind to receptors in the pancreas, the heart, fat tissue, and reproductive organs. (Kennaway once held a patent on a veterinary drug that uses melatonin to boost the fertility of ewes.) Distributing the hormone over the counter to American children, he has argued, is akin to a vast, uncontrolled medical experiment.
“It is a hormone that you are giving to young children. And there’s just very little research on the long-term effects of this.”
To others, that kind of language might seem alarmist — especially considering that melatonin appears to have mild side effects, and that sleep problems themselves can have consequences for both child and parental health. Many caregivers report melatonin is helpful for their children, and it’s been given for years to children with autism and ADHD, who often struggle to sleep. Beth Malow, a neurologist and sleep medicine expert at Vanderbilt University Medical Center who has consulted for a pharmaceutical company that manufactures melatonin products, raised concerns about a tendency to highlight “the evils of melatonin” without noting that “it’s actually very safe, and it can be very helpful.” Focusing just on the negatives, she added, “is to throw the baby out with the bathwater.”
All of this leaves parents navigating a lightly regulated marketplace while receiving conflicting medical advice. “We know that not getting enough sleep in early childhood has a lot of bad effects on health and attention and cognition and emotions, et cetera,” said Hartstein. Meanwhile, she added, “melatonin is safe and well-tolerated in the short term. So there’s a big question of, well, what’s worse, my kid not sleeping, or my kid taking melatonin once a week?”
As for the answer to that question, she said: “We don’t know.”
The urge — the desperate, frantic, all-consuming urge — to get a child to fall sleep is familiar to many parents. So is the impulse to satisfy that urge through drugs. Into the early 20th century, parents sometimes administered an opiate called laudanum to help young children sleep, even though it could be fatal. Decades later, when over-the-counter antihistamines like Benadryl became popular, some parents began using them, off-label, as a sleep aid.
“Most people are pretty happy to resort to over-the-counter medication if their kids are not sleeping,” one mother of two small kids told a team of Australian researchers for a 2004 study. “It really saves the children’s lives,” she added, because “it stops mums from throwing them against the wall.”
Compared to other sleep aids, melatonin supplements have obvious advantages. Chief among them is that they mimic a natural hormone: The body secretes melatonin from a pea-sized gland nestled in the brain, typically starting in the early evening. Levels peak after midnight, and drop off a few hours before sunrise.
Artificially boosting melatonin helps many people fall sleep earlier or more easily.
“There’s a big question of, well, what’s worse, my kid not sleeping, or my kid taking melatonin once a week?”
When a child takes a 1 milligram dose of melatonin, the hormone quickly enters their bloodstream, signaling to the brain that it’s time for sleep. Melatonin reaches levels in the blood that can be more than 10 times higher than natural peak concentrations. Soon, many children begin to feel drowsy.
Children can generally tolerate melatonin. Known side effects appear to be mild, and, compared to antihistamines, people taking low doses of melatonin are less likely to wake up feeling groggy the next morning.
As early as 1991, some researchers began administering small doses of the hormone to children with autism, who sometimes have extreme difficulty falling and staying asleep. A series of trials conducted in the Netherlands in the 2000s found that melatonin could also have modest benefits for non-autistic children experiencing insomnia, and it seemed to be safe in the short-term — although the long-term consequences of regularly taking the hormone were unclear.
The timing of the research coincided with a move in the U.S. to loosen regulations on dietary supplements, led by Sen. Orrin Hatch of Utah, a supplement-industry hub.
News reports suggest that, by the late 2000s, some parents were trying melatonin for older children.
It’s hard to know for sure who first decided to market melatonin specifically to children, but a key player seems to be Zak Zarbock, a Utah pediatrician and father of four boys who, in 2008, began selling a drug-free, honey-based cough syrup. In 2011, his company, Zarbee’s, introduced a version of its children’s cough remedy that contained melatonin. Soon after, Zarbee’s launched a line of melatonin supplements tailored to children. In a 2014 press release, Zarbock stressed that “a child shouldn’t need to take something to fall asleep every night.” But melatonin, he said, could act like “a reset button for your bedtime routine” when things got out-of-whack. (Zarbock did not respond to interview requests.)
More products followed, and usage rates have climbed. One possible reason for that is that American children are having more difficulty falling asleep. Some experts think screen use is causing sleep problems, and rising rates of anxiety and depression among children may also be affecting slumber. Clinicians report treating families that use melatonin to counteract the stimulating effects of caffeine.
Another possibility — and they’re not mutually exclusive — is that supplement makers sensed a market opportunity and seized it. Gummies have made melatonin more palatable to children; supplement makers now market widely to parents online. At least one company seems to have made overtures to parents via a pediatrics organization: Vicks ZzzQuil, a popular line of children’s melatonin products, sponsored a 2020 webinar on sleep hosted by the American Academy of Pediatrics.