Melatonin For Children? A Guide for Parents

A common thread I find in children coming to Sleep Clinic is that many or all of them have been on melatonin at some point, or are taking it currently. Melatonin is an important tool in the treatment of sleep disorders in children, and because it is naturally derived, there is a widespread perception that it is safe. However, I have become concerned by the frequency of its use, especially in an unsupervised way. (In recent years magnesium has also become common– here is a full article on the limited evidence for magnesium supplementation for sleep in children).

It's hard to know exactly how many children are taking melatonin. A study in JAMA in 2022 estimated that use in adults had tripled between 2005 and 2018, and that adults were using higher doses. Melatonin for children products are being marketed aggressively. I worry that the widespread availability of melatonin has led to some parents using it as a shortcut to good sleep practices. An article in the Wall Street Journal (which also provided the sales figures above), quoted a father’s review on Amazon:

OK, yes, as parents my wife and I should do a better job starting the bedtime routine earlier, turning off the TV earlier, limiting sweets, etc., etc. Well, for whatever reason, this is not our strong suit. This 1 mg light dosage of melatonin is very helpful winding our kids down and getting them ready for bed.

Short on time? Here's a quick video which should answer most of your questions:

How often are children using melatonin?

It's hard to know for sure. An article the New York Times, "Parents Are Relying on Melatonin to Help Their Kids Sleep. Should They?", noted that melatonin sales overall had increased by 87% in the year prior to March 2020. The Times conducted a survey of 933 parents with children under age 18. One third had a history of sleep difficulties in the past year. Over half the parents reported giving melatonin to their children at one time.

More recent data has shown that there is an almost 500% increase in melatonin prescriptions in Scandinavia. Additionally, melatonin has become the most common overdose in pediatric emergency rooms and calls to poison control centers in the US. This seems to be a worldwide issue.

What is melatonin? What does melatonin do?

Melatonin is a hormone which is naturally produced by the pineal gland in your brain. It is both a chronobiotic agent, meaning that it regulates your circadian or body clock; and a hypnotic, meaning that at higher doses it may induce sleep. Melatonin is usually used for its hypnotic effect, but it does not have this effect in everyone. Only the chronobiotic effect occurs in all individuals.
The natural rise of melatonin levels in the body 1-3 hours before sleep onset is known as the “dim light melatonin onset” (DLMO). This is the signal involved in body clock scheduling of sleep and corresponds to the end of the “wakefulness” signal produced by the circadian system. Children with insomnia may be given melatonin after their scheduled bedtime passes; what this means is that their bodies are not yet ready for sleep. This is one reason why bedtime fading can be so effective for some children. The doses used clinically (0.5–10 mg or higher) greatly exceeds the amount secreted in the body.

There are a few things to be aware of:

• Blue-white light exposure in the evenings shift the DLMO later. This is why bright light exposure in the evenings can worsen insomnia. I highly recommend eliminating ANY screen time for preschool through elementary school children for an hour prior to bedtime. That means no light emitting Kindles, iPads, smartphones, computers, or (God forbid) television in the bedroom For students in junior high and beyond who need to use computers to complete school work, I highly recommend lowering brightness settings and using software to reduce the blue light frequencies. (For more on this read my post about going on a “light diet” here).
• The effect of dosing melatonin (and light therapy for that matter) are phase dependent. What that means is that the timing of giving melatonin determines both the magnitude and direction of effect. Many people do not realize that the optimal time to dose melatonin for shifting sleep period is actually a few hours before bedtime– that is to say, before the DLMO. The other facet of this is that in teenagers with severely shifted sleep schedule (delayed sleep phase syndrome) may actually have a later shift in their sleep schedule if this is not dosed correctly. Thus I would leave the timing of this to a sleep physician. Jet lag is a similar case[1].
• "All natural" melatonin is from cow or pig brains and should be avoided. Most preparations around now are synthetic, which is preferable.
• The half life of melatonin is about 40 minutes. Thus it is much more likely to help with falling asleep (as opposed to with night wakings).

Here's a short video I put together to explain how when you give the melatonin dose really matters. (Maybe just for the supernerds out there like myself).

How effective is melatonin for sleep problems in children?

The overall effects of melatonin for children include falling asleep more quickly and an increase in sleep time. Like all medicines used to help children fall asleep, there is fairly limited information available. This means that most studies have small groups followed for short periods of time. Furthermore, melatonin not regulated as a pharmaceutical in the U.S. Thus, there is no large pharmaceutical company bankrolling larger and long-term studies (more on this below) . Rather it is regulated as a food supplement by the FDA. (I have more on the 1994 legislation which resulted in this here). For a terrific review, including dosing recommendations, I highly recommend the melatonin material from the International Pediatric Sleep Association, which includes parent guides in multiple langauage as well as literature revies of the use of melatonin in typically developing children, and children with autism.

Here is the big picture, however. Melatonin seems to result in about 30 minutes more of sleep at night, predominantly due to shortening time to fall asleep. This seems to be fairly consistent across trials in children. Like all sleep medications– it's not magic.

When breaking down the research in this group, I'm going to try to use meta-analyses– articles which combine multiple studies which often contain assessment of the quality of different studies– when available.

Chronic sleep onset insomnia and melatonin in typically developing children

Problems with falling asleep are common in children, just like in adults. Chronic insomnia is defined as difficulty falling or staying a sleep for at least three times per week for three months or more, resulting in dissatisfaction with sleep or daytime issues.

A meta-analysis by Edemann-Calleson in 2023 combined data from 419 children and demonstrated about a 30 minute increase in sleep overnight, with 18 minutes coming from falling asleep more quickly (a reduction in sleep latency). Importantly, there was no improvement in daytime functioning AND there was an increase in adverse events in the treatment group when compared with placebo.

The 2025 IPSA position paper on melatonin for typically developing children offered some important recommendations for this age group:

1. There should be a thorough medical and sleep evaluation before starting melatonin, including a detailed sleep history.
2. A thorough clinical sleep evaluation should include current schedule, duration, sleep onset latency, and use of electronic devices.
3. Melatonin should only be used when supervised by a medical. provider.
4. Behavioral approaches should be used first.
5. Melatonin should not be administered to children less than age 2 except in very rare circumstances.
6. Melatonin is only indicated for insomnia or circadian disorders.
7. Melatonin should not be used to “make sleep better” in children without sleep-related complaints.
8. Melatonin should not be recommended to force adolescents (i.e., who do not have a circadian rhythm sleep-wake disorder) to fall asleep earlier to accommodate early school start times

Autism and melatonin

Sleep problems are common in children with autism spectrum disorder (ASD). Multiple types of problems occur, including prolonged time to fall asleep, less sleep during the night, and problems with nocturnal and early morning awakenings. Some children with autism have decreased levels of melatonin as well as decreased variation in melatonin secretion throughout the day. Because of this, melatonin has commonly been used in autistic children, which seems to result in less difficulty falling asleep and more sleep at night. Some studies used immediate release preparations, whereas others use long acting forms of melatonin. The majority of studies involved melatonin dosing 30–60 minutes prior to bedtime.

A 2025 meta-analysis by Yang et al showed that the most significant effect was on sleep efficiency (which is essentially time asleep divided by time in bed) and total sleep time, as opposed to sleep latency. The benefit of melatonin was greater for older children (kids >10 benefited more than kids from 6-10 who benefited more than kids < 6 years of age). The effectiveness of melatonin sometimes lessenned with time. Higher doses seemed to be more effective than lower doses.

A 2017 trial looked at a time released melatonin preparation called PedPRM at doses of 2-5 mg. The children in this trial slept 57.5 minutes more (compared with the children who did not receive the medication, who slept 9 minutes more). Most of the benefit seemed to be due to improvement in falling asleep– on average, treated children fell asleep 39 minutes faster. This medication is available in Europe under the brand name Slenyto but is unlikely to be approved by the FDA in the USA, unfortunately.

The 2024 IPSA recommendations on melatonin use in ASD included:

1. A trial of behavioral strategies first
2. Ruling out other sleep disorders such as restless leg syndrome, obstructive sleep apnea, and restless sleep disorder first
3. Starting a low dose and titrating up with a maximum dose of 10 mg, under the supervision of a specialist.
4. Dosing 30-60 minutes prior to bedtime
5. Periodically checking in to see if the medication is still necessary.

Buckley et al have a 2020 American Academy of Neurology guideline which also recommends addressing other issues first, then trying melatonnin, then trying long acting melatonin (10 mg) or short acting melatonin– starting at 2 mg and working up to a maximum of 10 mg. (True story– I worked with Ashura Buckley when I was a fellow and so was she).

As in other children, melatonin should be added to a behavioral management plan. For pediatricians, there is a great practice pathway which suggests the addition of medication only after a behavioral intervention has failed. Two great resources for families are the Autism Speaks Sleep Toolkit, and the book Solving Sleep Problems in Children with Autism Spectrum Disorders: A Guide for Frazzled Families(affiliate link).

ADHD and melatonin

Attention deficit hyperactivity (ADHD) is commonly associated with sleep problems, just as sleep problems can cause attentional issues. Interestingly, the authors one of the early papers describing ADHD (referred to as "hyperkinetic disorder") wrote this:

Generally, the parents of hyperkinetic children [who would currently be referred to as children with ADHD] are so desperate over the night problems that the daytime ones pale in significance. (Laufer MW, Denhoff E. Hyperkinetic behavior syndrome in children. J Pediatr. 1957;50(4):463–474. doi: 10.1016/S0022-3476(57)80257-1)

As many as 70% of children with ADHD may have sleep problems. Sleep problems include difficulty falling asleep, abnormalities in sleep architecture (e.g. the proportions of different stages of sleep), and daytime sleepiness.

A 2024 review article by Cortese on the management of sleep issues in ADHD noted that there were two positive randomized controlled trials showing benefit. A systematic review by Larsson in 2024 showed a 30 minute decrease in sleep latency, improved sleep efficiency, but no evidence of improvement in quality of life or ADHD daytime symptoms

One small trial did demonstrate that melatonin helped with insomnia on children with ADHD on stimulants, but this was limited to chart review.

Delayed Sleep Phase Syndrome and Melatonin

Delayed sleep phase syndrome (DSPS) is a common disorder in teens, where their natural sleep period is shifted significantly later than the schedule which their commitments (usually school) mandates. Thus, teens with this disorder an unable to fall asleep by 1–2 AM in the morning or even later. I have seen kids who are routinely falling asleep between 4–5 AM. Melatonin has a clear role in this disorder, as small doses 3–4 hours earlier than sleep onset (along with light exposure limitation, sleep hygiene measures, and gradual changes in schedule [chronotherapy]) can be effective in managing this disorder. The reason for the delay is a marked delay in the DLMO, so melatonin dosing can move sleep periods earlier. For children with DSPS, giving a dose 4–6 hours prior to the current time of sleep onset, then moving it earlier every 4–5 days, is recommended, with low dose preparations. Of all the conditions mentioned here, this has the clearest benefit from melatonin. Here is a terrific review article.

Children With Neurodevelopmental Delay and Melatonin

Children with various causes of neurodevelopmental delay may have significant insomnia and melatonin may help. However, in some children melatonin use caused persistently high daytime blood levels of melatonin (and daytime sleepiness). A different review article by Edemann-Callesen in 2023 looked at melatonin in a mixture of conditions (including atopic dermatitis, epilepsy, mental retardation, Angelman, Dravet, Rett, cystic fibrosis, post-concussion. Total sleep time was increased by 19 min (mostly via reducing latency), but no evidence of subjective sleep improvement or daytime improvement.

Blindness and Melatonin

Some children with blindness may have issues with sleep wake time as they do not have light regulating their circadian clock and may thus develop sleep disorders. Very small trials in adults have shown benefit (here’s one) but the data is very limited.

Eczema and Melatonin

Eczema is associated with dry, itchy skin and kids with it can have problems with insomnia and non-restorative sleep. Some research has suggested that children with eczema may have low melatonin levels, and a recent trial suggest that melatonin may be helpful.

It sounds great. Why should I worry about melatonin?

There are several areas for concern, specifically known and theoretical side effects, and problems with preparations.

• There is a risk of overdose. A June 2022 study showed that the rate of melatonin overdoses in children had risen by 530% in the last ten years. Here's an article on how you can avoid overdose and safely use melatonin.
• Side effects (known): In the short-term, melatonin seems to be quite safe. Unlike many other sleep inducing agents, “no serious safety concerns have been raised” (from a review by Bruni ). The most common side effects include morning drowsiness, bedwetting, headache, dizziness, nausea, and diarrhea. These effects are generally mild, and in my practice only the morning drowsiness seems to be significant. It can also interact with other medications (oral contraceptives, fluvoxamine, carbemazepine, omeprazole, and esomeprazole, to name a few).
• Problems with preparations-- poor labeling:Melatonin preparations have been shown have to variable concentrations from preparation to preparation. Moreover, the amount that a child’s body absorbs may vary.  Remember how I told you that melatonin was treated as a food supplement by the FDA?
• Long term safety is limited. As pointed out in a 2026 analysis, only two studies have looked at long term safety data.
• Problems with preparations-- inaccurate dosing: A recent study showed that the amount of melatonin can vary anywhere from -83% to +478% from the labeled dose. This means that if you are giving your child a dose of 3 mg, the actual dose may actually be anywhere from 0.5 mg to 14 mg. Moreover, the lot to lot variability was as high as 465%– meaning that you may buy a different bottle of medicine, from the same manufacturer, and still one bottle may have more than four times as much as melatonin as another, Finally, the researchers found serotonin (a medicine used in other conditions, and also a neurotransmitter) in 71% of samples. Furthermore, another study looked specifically at gummy preparations:the actual preparations contained an amount of melatonin differenting from 74 to 347% of the labeled dose. To me, this is the most concerning issue with melatonin– you don't know what you are getting. 

Side effects (theoretical): Melatonin given to children may lead to persistently elevated blood melatonin levels throughout the day. This can be associated with persistent sleepiness, but the other effects are unclear. It is important to know that melatonin has NOT been tested as closely as a pharmaceutical as the FDA regulates it as a food supplement. The studies following children who have been using melatonin long-term have relied mostly on parental reports as opposed to biochemical testing. A physician in Australia named David Kennaway has published two editorials pointing out the inadequacy of information on long-term use in children. (You can read this here). He states his point of view in a pithy fashion]"

…parents should always be informed that (1) melatonin is not registered for use in children, (2) no rigorous long-term safety studies have been conducted in children and by the way (3) melatonin is also a registered veterinary drug used to alter the reproduction of sheep and goats ."

This means there is substantially less regulatory oversight in terms of safety and efficacy. I also find that the labelling of preparations is frequently misleading. Take the example of this liquid preparation, which many of my patients have tried. It is labeled as “1 mg” but each dropperful contains 0.25 mg.

You need to go to the web to get this information as it is not on the bottle. (It may be in the package insert, but I suspect few people read these).

A 2020 study of the PedPRM long acting melatonin formulation followed 80 children for 2 years, and did not show any evidence of effects on weight, height, body mass index, or Tanner staging (a measure of sexual development). This is the best long term study of melatonin safety and is quite reassuring– but I wish there were more long term studies.

My child is already on melatonin. Do I need to freak out?

I don’t think so, as there is little concrete evidence of significant harm. However, if you started melatonin on your own I beg you to discuss it with your child’s physician to see if it is really necessary. If your child has been using it long-term and sleeping well, you can consider slowly reducing the dose and seeing if it is still really necessary. Try to use it as needed as opposed to nightly. Also, I would take a hard look at sleep hygiene and ensure that you are ensuring good bedtime processes such as a high quality bedtime routine and avoidance of screen time for at least an hour prior to bedtime. I would try to reduce the dose, and potentially only use it as needed as opposed to nightly. Finally, as per the 2025 IPSA recommendations, I would limit use of melatonin to 3-6 months and try your child off of it periodically.

Please do take measures to keep melatonin in a safe place and dose it appropriately. For more on melatonin safety, including reducing overdose risk and avoiding interactions with other medications, read this article.

My doctor and I have talked about it. What should we consider regarding how and when to give melatonin?

Melatonin can be a tricky medication to dose. Effects change depending on when you give it compared to your child’s usual sleep schedule. Thus, a small dose a few hours before bedtime can have more of an effect than a large dose given at bedtime. Generally 30-60 minutes before your child's bedtime is the sweet spot. Sometimes, earlier may work better.

As per the 2025 IPSA guidelines:

• Melatonin should only be used for for chronic insomnia disorder and circadian rhythm sleep-wake disorders
• NOT for sleepwalking, restless sleep, etc.
• NOT to force earlier sleep in adolescents with normal circadian timing
• Minimum evaluation before starting: detailed sleep history + 14-day sleep diary
• Behavioral interventions must precede and accompany melatonin
• Treat as medication requiring provider recommendation and supervision
• Immediate-release for sleep onset delay only; prolonged-release may help night wakings (in children with autism)

What is the dose of melatonin for children?

As per the 2025 IPSA guidelines, the dose ceilings are age based. You should start at 0.5 mg and increase weekly by 0.5 mg to improvement, or when you hit the maximum dose:

Here is a direct link to the parental information sheet from IPSA in English.

Age based dosing recommendations.

• Under 2: not recommended
• 2–3 yr: max 1 mg
• 4–5 yr: max 2 mg
• 6–10 yr: max 3 mg
• Older school-age/adolescents: max 5 mg
• Note that you may go higher in children with autism as noted above.

I've surveyed the latest guidelines and put together a melatonin dosing calculator that will help you select the safest dose for your child.

Here's the critical part. Melatonin is not a substitute for good sleep hygiene practices and should only be used in concert with a high quality bedtime, limitation on light exposure, and an appropriate sleep schedule.

When possible, purchasing a USP Verified preparation may indicate that the product is manufactured to the requirements of the U.S. Pharmacopeial Convention, which could mean that the quality controllers are tighter.

Please read my article on the safety risks of melatonin.

What is the take home? Should my child take melatonin?

I have not met a parent who is eager to medicate their child. Such decisions are made with a lot of soul-searching, and frequently after unsuccessful attempts to address sleep problems via behavioral changes. Treatment options are limited. There are no FDA-approved insomnia medications for children except for chloral hydrate which is no longer available. Personally, I use melatonin for children commonly in my practice. It is very helpful for some children and families. I appreciate Dr. Kennaway’s concerns but I have seen first hand the consequences of poor sleep on children and families. I always investigate to make sure that I am not missing other causes of insomnia (such as restless leg syndrome). My end goal is always to help a child sleep with a minimum of medications. I know that this is the goal of parents as well. Some children, especially those with autism of developmental issues, will not be able to sleep without medication. So, melatonin may be a good option for your child if:

• Behavioral changes alone have been ineffective
• Other medical causes of insomnia have been ruled out
• Your child has chronic insomnia or a circadian disorder, not just "bad sleep" or difficulty with an early school start time
• Your physician thinks that melatonin is a safe option for your child and is willing to follow his or her insomnia over time
• You have a plan for when to stop. It should not be open ended for most children.

One other thing- if your child's sleep difficulties came out of the blue, perhaps you are dealing with a sleep regression. Here's what you can do.

A special thanks to Bob Young R.Ph (aka the legendary "Bob from Pharmacy") for his assistance with the initial version ofthis article.

Originally published April 2026. Last reviewed/updated by Dr. Craig Canapari, MD in April 2026