Should I Give My Child Melatonin to Help Them Sleep?

Emily Oster

7 min Read Emily Oster

Emily Oster

Should I Give My Child Melatonin to Help Them Sleep?

Q&A on short- and long-term use

Emily Oster

7 min Read

I’m wondering if you have any research on how to help kids with difficulty going to bed? My son, who is 3.5 years old, has been repeatedly leaving his room after our bedtime routine. We have tried sticker charts, etc., but after a month of often 1.5-hour struggles, we tried melatonin, and he is out very quickly. We are thrilled with the results but wondering if it’s the best way — and also if there’s any research on giving melatonin to kids?

—Anonymous

Nothing I like better than a data review question.

First things first: What is melatonin? Melatonin is a natural hormone responsible for helping us fall asleep and for regulating our circadian rhythms. It’s secreted by the pineal gland, part of the endocrine system. With less melatonin, sleep cycles are disrupted (this happens more as people age, for example, or with certain diseases).

The melatonin that you can buy over the counter, which is what we’re talking about here, is just a version of that hormone. Put very simply, it works by supplementing the hormones your body produces naturally. Melatonin is widely available over the counter or online — it comes in quick-release or delayed-release form, in gummies and pills. An important note, which I will return to later, is that this is a largely unregulated space, and the actual hormone concentration in over-the-counter options often varies from what is stated. This point will matter more for thinking about longer-term usage.

Melatonin, in both kids and adults, is used for two primary sleep reasons. The first is jet lag or some other significant disruption in circadian rhythm. The second is general insomnia, especially “sleep onset” insomnia as described here, in which the issue is difficulty falling asleep in the first place. I’m going to talk about each of these in turn, since the way we’d think about them is a bit different. In both cases, the key questions are simple: Does it work, and is it safe?

Melatonin and jet lag

There is significant randomized controlled trial evidence supporting the use of melatonin to address jet lag in adults. There is an excellent Cochrane Review of trials (linked above), which ends with “Melatonin is remarkably effective in preventing or reducing jet lag, and occasional short-term use appears to be safe.”

In these data, adult doses in the range of 0.5mg to 5mg show similar impacts, likely arguing for using lower doses. A key is to take the medication close to the “target bedtime” (i.e. at night).

There is limited direct evidence in children, although given the evidence from adults and the general principle, it seems extremely likely that children would also respond positively. Safety data on long-term use (again, below) suggests limited reason for concern. Children are likely to respond to a lower dose than adults, perhaps as little as 0.25mg.

Bottom line: As a short-term support for jet lag, melatonin may well be a good idea.

Melatonin and sleep problems

The question asked above, though, isn’t about short-term use for jet lag but about longer-term use as a sleep aid. The answer to this is more complicated.

First, I should note that in The Family Firm I spend a lot of time talking about how important sleep is. We have good evidence, from randomized trial data and school start-time variation, that sleep is important for kids to function well, and that even an hour more or less can matter. So thinking about how to make bedtime go better isn’t just about limiting conflict or making the lives of parents easier; it’s also about getting your kid the better sleep they need.

Knowing this, I think, may push some parents to look to melatonin — which seems like a safe, natural option — as a way to improve bedtime. Indeed, when I spoke with a couple of pediatricians, they said this is an extremely common question.

They made a point — the same point made in broader medical discussions of melatonin for children — that it shouldn’t be a first line of defense, nor is it a magic bullet. Giving your kid a dose of melatonin at 8pm probably isn’t going to suddenly move them from falling asleep at 11 to 8:30.

So before you turn to melatonin, it’s worth thinking through the other elements of bedtime. Is there a consistent and predictable bedtime routine for your kid? Are they going to bed at the “right” time for their age and sleep needs? If your child wakes up without trouble and seems well-rested during the day, they may just need a later bedtime. If your child is still napping during the day and then struggling to sleep at night, dropping the nap should be the first line. Finally: screens in the couple of hours before bed mess up sleep for kids. I talk about this in Family Firm, and there is good randomized evidence on it.

This is all to say that before you consider melatonin, there are other steps first. (This is a general point, not an admonition to the letter writer above, since it sounds to me like they did think through these other steps.) In addition, melatonin is typically used to promote falling asleep, not continued sleep: The focus of efficacy is sleep-onset insomnia, so it is not likely to be the answer if your child is waking up in the middle of the night.

Most of the evidence on melatonin and children focuses on children with neurodisabilities, including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). There is a sense that some of the findings might well translate to neurotypical kids, but those populations aren’t well studied.

On the question of efficacy, this review and meta-analysis covers 11 trials with about 600 children. The trials, when put together, show evidence of the efficacy of melatonin in promoting sleep. The effects are especially large in children with ASD (versus those with other neurodevelopmental disorders). The average sleep increase is about 15 minutes, which may seem small but means a longer increase in some kids.

We always worry about medications, and in this case concerns have been raised about interactions between treatment with melatonin and the function of the natural endocrine system. However: safety data on long-term use (also focused on children with neurodisabilities) has argued that there is evidence of safety in the short and long term (or rather, that it is “well tolerated”). There is little positive evidence to support concerns about interactions with puberty timing. Having said this, we do not have any kind of significant evidence on long-term use in neurotypical kids. This makes it difficult to substantiate claims of either safety or harm.

Typical dosing for melatonin is in the range of 1 to 3 mg, given shortly before bedtime.

Two very important notes. First, any long-term (or even probably short-term) use of melatonin is a discussion to have with your pediatrician. Second, testing in many over-the-counter melatonin options suggests that the concentration in many cases differs widely from what is advertised. Pharmaceutical-grade melatonin is also available over the counter but with more consistent dosing. For longer-term use, this option would be appropriate.

The bottom line on melatonin

Pulling all this together:

  • Short-term use of melatonin for jet lag and short-term sleep disruptions: good evidence of efficacy and limited concerns
  • Long-term use for sleep-onset insomnia: definitely not without pediatrician discussion, and not a first line for neurotypical children; may be appropriate in some circumstances

There is an intermediate answer in here for the question asker. It sounds like the melatonin has really worked where other options didn’t. In this sense, “data” on efficacy from broad studies isn’t really necessary, since you know it works. It’s likely that you’re reluctant to use it forever, though. I might approach this as probably short-term use, with a planned experiment of weaning off down the line.

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The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide
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It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents

It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents
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My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor

Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor
...

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Good news: fancier vitamins are not better.  Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough. 

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better. Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough.

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips
...

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#parentdata #emilyoster #newborncare #parentingadvice #parentingtips

When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips
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The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

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🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth

The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth
...

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Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata
...

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Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships
...

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Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles
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#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity
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What's in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you.

What`s in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you. ...

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport
...

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way. 

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way.

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes
...

Congratulations on making it through another year of panic headlines! We’ve had some doozies this year, like aspartame causing cancer and the perils of white noise, but these headlines are very often based on poor data. Correlation does not equal causation. There will certainly be more panic headlines in 2024, but ParentData is here to debunk them for you.

#emilyoster #parentdata #happynewyear2024 #panicheadline #datadriven

Congratulations on making it through another year of panic headlines! We’ve had some doozies this year, like aspartame causing cancer and the perils of white noise, but these headlines are very often based on poor data. Correlation does not equal causation. There will certainly be more panic headlines in 2024, but ParentData is here to debunk them for you.

#emilyoster #parentdata #happynewyear2024 #panicheadline #datadriven
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