Is melatonin safe for children?

To get the prescription-only sleep medication melatonin for her 10-year-old daughter, Fern, a mother in Wellington, has to jump through a few hoops.

First, she finds an online retailer overseas that will ship to New Zealand. These are becoming less and less common as Medsafe works to prevent international retailers like iHerb from selling melatonin to Kiwis.

Then, the package needs to get through customs undetected so she only orders one bottle at a time. Fern’s most recent package – a bottle with 150 cherry-flavour pills, each containing 5mg of melatonin – arrived safely two weeks ago. Her family’s acute sleep needs are sorted for the next few month.

“She is thriving everywhere in life except sleep and you need sleep to thrive,” 33-year-old Fern said of her daughter who was unofficially diagnosed with ADHD by her mother’s colleagues in the medical industry (Fern has held off on getting a formal diagnosis, a long-winded or costly process, but that’s another story).

Fern is one of dozens of Kiwi parents RNZ heard from who use melatonin as a sleep aid for their children. Many parents have a prescription, but unless their child has an ADHD or autism diagnosis, then costs can be high, almost $30 a month for those who need it daily to fall asleep. Others say GPs have been reluctant to prescribe it for what parents say is a debilitating sleep issue for a child that impacts entire families.

It’s a murky situation. Sleep-deprived parents in New Zealand might envy the free-flowing supply of melatonin in countries like the US. However, there is a growing concern that American parents are unnecessarily dosing their kids to sleep on a medication where the broader health impacts are unknown.

“…the restrictions they have put on melatonin is ridiculous,” a 41-year-old mum of four in Christchurch said.

She has a seven-year-old daughter with what she called an “overactive mind”.

“[She] isn’t quite at the point of a referral for a mental health assessment for ADHD…(waitlists are so long anyway),” she wrote to RNZ.

Her doctor has so far declined to prescribe melatonin, telling her that her daughter “may not need as much sleep and 10pm-1am is just her ‘natural’ bedtime”.

She bought some melatonin from a website overseas but it never showed up. Months later she received a refund.

“I am guessing they got [the package] returned to them,” she said.

Ashleigh, a solo parent from Wellington, says she went without medication needed for her benign brain tumour so she could afford her son’s $28 monthly melatonin prescription. Without it, he won’t fall asleep until midnight and even then wakes multiple times before morning.

Doctors suspect he has auditory processing disorder, but he is on a months-long waitlist to get a diagnosis, which opens the door to fully-subsidised melatonin. In the meantime, “the GP told me to get it from overseas because it is way cheaper,” she said.

“I’ve tried but they won’t ship it to New Zealand.”

Despite the anecdotal stories of some parents, studies have so far shown melatonin to be a “dud” in terms of effectiveness, said Dr David Reith, an associate professor of pharmacology at the University of Otago.

“The studies indicate it gets you to sleep 15 minutes quicker. But not that it keeps you asleep, improves the quality of your sleep, or increases the amount of time you sleep,” he wrote in an email to RNZ.

“On the other hand, you can have hangover effects and there are other side effects.”

Dr Reith notes that medicines used for ADHD can prevent sleep, which is why behavioural sleep strategies like limiting screen time or a strict bedtime routine might not work with those children.

“So, getting them to sleep 15 minutes earlier with melatonin is going to look good,” he says.

Some studies have shown melatonin’s effectiveness for sleep issues in kids with autism spectrum disorders, but there is limited or mixed research on melatonin’s short and long term effects, including how it impacts puberty.

What we know now about melatonin indicates “there really isn’t any great harm,” said Dr Alex Bartle, from the Sleep Well Clinic that has locations all over New Zealand.

Melatonin, like other sleep medications, can have a huge placebo effect. While regular use isn’t likely to impact your brain’s own melatonin production – a major concern for parents – prolonged use might make you think you need it to fall asleep.

“Sleep is all about confidence in the end,” Bartle said.

He says the best way for parents to increase their children’s melatonin levels at night is to increase their serotonin levels during the day through spending time outdoors in natural light.

“Chemically, when it gets dark that serotonin converts to melatonin,” Bartle said.

He says that melatonin should become more available in New Zealand but “we don’t need thousands of different types of melatonin because people need to understand why they’re taking it”.

Medsafe’s group manager Chris James says the organisation had been in touch with overseas websites advising them of melatonin’s regulatory requirements in New Zealand.

“They have modified their website to note these are restricted items in NZ and a prescription from a NZ Doctor is required to import them,” he says.

An Auckland mother calls melatonin “life saving” and a “game-changer” for her 10-year-old son, whose melatonin prescriptions are free because of his autism diagnosis.

Among the support groups she runs for parents whose children are on the autism spectrum, “almost every kid is on some form of sleep aid,” she said.

A University of Canterbury study in 2021 found that one in four children on the autism spectrum in New Zealand has been given melatonin for sleep.

“It’s almost like breastfeeding a new born baby in terms of the amount of times they wake up or how they fall asleep,” she added.

Keeping melatonin restricted is needed to shore up supply for families who really require it to function, she says, using Australia’s shortage last year of ADHD medication as an example of what can happen when supply is disrupted.

“It should be regulated otherwise you run the risk of parents who might just use it to get their kids to sleep because they have had enough of their kids being brats,” she said.