No magic "medicine" for sleep problems in children-Ask Dr. Paul Library

DEAR DR.PAUL: My eight-year-old son has a great deal of difficulty falling asleep. I asked my doctor about natural products, specifically melatonin. Have studies been done on melatonin in children with sleeping difficulties? Does it work? Is it safe in children?

PEDIATRICIAN DR.PAUL Answers: Sleeping difficulties are quite common in children and many parents are frustrated by this problem. Lots of them have asked me about giving their children medications or sedatives to help them sleep.

Unfortunately, we do not use such medications in children for insomnia or other sleeping difficulties. So, no, there is really no magic cure or pill. I am glad you asked the question though, as it gives me the opportunity to talk a bit about the general approach for handling sleep problems, and secondly, to talk a little bit about melatonin.

Melatonin, is a natural substance made by the pineal gland in the human brain, and is generally thought to be related to the circadian rhythm, or sleep-wake system or cycle. The circadian rhythm is what controls our sleep needs and time perception/awareness - in other words, it is the body's internal clock.

Some recent studies have suggested this is the role of brain melatonin even in infants. In light of this relationship, it is natural to ask the question: Can melatonin help children sleep?

The only studies looking at melatonin administration and sleep problems were done on a limited number of children, all of whom had some kind of neurologic, developmental, or brain problem with severe sleep disorders. Most of these studies did suggest that melatonin use might be useful in this specific situation. This makes some sense because we know that the brain itself produces melatonin.

And presumably, some brain anomaly or damage may result in a "melatonin deficiency" so to speak. However, there have been no studies performed looking at melatonin administration and sleep difficulties in normal children. As a matter of fact, because melatonin is not considered a controlled medication, there have been no studies looking at the safety of melatonin use in children. We know, however, that overuse of melatonin may result in seizures.

Given that there are no studies on the effectiveness of melatonin, and importantly, on its safety in children, I would not recommend melatonin use for children.

Now you might say, why not? Melatonin is a natural product, made by the body itself. What harm can it do? In fact, this is a question many people ask me when it comes to so-called "natural" products. The term "natural remedy" or "natural product" does not automatically nor necessarily mean safe or effective. So what do we do for the child with sleep difficulties? Behaviour and routine modifications along with patience, and a lot of support and love will help.

An individualized "sleep time action plan" and diary, in this regard, devised in co-operation with your doctor can be quite useful.

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