Last week, I published a long post entitled, Should My Child Take Melatonin? A Guide for Parents. In that article, I really tried to focus on the medical side of the question. How safe is it? How should it be used? When should it be used? Obviously, the answer will vary for each child.
My friend, Terra Ziporyn Snider, the executive director and co-founder of Start School Later, put the following question to me in the comments:
Many parents, some of them health professionals and biomedical scientists, have told me that they’ve given their teenagers melatonin to help them cope with brutal school hours that are out of sync with normal adolescent circadian rhythms. I am concerned that this practice “medicalizes” what is actually a social problem – in other words, instead of addressing an unhealthy institutional practice (starting middle and high schools at 7 am), we are labeling perfectly normal children as patients in need of treatment. I’d be curious to get your thoughts on this.
I find this question thornier than the medical one. Last year I saw a teenager [1] with some mild learning disabilities who was getting into bed every night at 10 PM without her phone, and could not fall asleep until midnight. As a result, she struggled to get up at 6 AM and would regularly miss her 7:30 AM school start time. In situations like this, I usually do prescribe a medication, sometimes melatonin, in association with sleep hygiene measures. I don’t have a problem doing this; it’s my job.
The kids that come to see me in Sleep Clinic tend to have very severe or challenging sleep disorders, and frequently other medical or mental health issues as well. Occasionally I do see an otherwise healthy kid (like the girl above) who is doing everything right and just cannot tolerate the schedule.
The problem is, stories like this are really common in general pediatric practice. I recently spoke to a pediatrician who was asking me advice on prescription sleep medication. I asked her how often she needed prescribe sleep medication to her patients: “All the time,” she said. “This is an epidemic.” This is hardly surprising considering that only 10% of teenagers get enough sleep at night. Sometimes kids end up on stimulants as well so they can focus during the day, simply so they can survive.
As a society, we have to ask ourselves where our priorities lay. None of us (parents, doctors, kids) are excited about using sleep inducing medication simply so teenagers can go to sleep early enough to survive. A lot of communities are resistant to later school start times. The American Academy of Pediatrics has recommended 8:30 AM school start times for all teens. It’s time for a change. Otherwise we are going to see more and more kids on sleep medicines. Just yesterday, I was speaking to a teacher in training who was recalling that, in high school, he had math every day at 7:20 AM. “It was awful,” he recalled. “It was not my best subject to begin with.” I wonder how many of the people objecting have to get up at 6 AM and be at their job by 7:15 AM, performing at their best?
[1] : As always, all patient stories have had the details changed for patient privacy and usually represent a composite.
Dr. Canapari,
Many thanks to you and to Terra Snider for thinking more about this issue.
Do you think an alternative or adjunct to prescribing sleep medication for teens whose body clocks don’t sync with early school start times might be to write a “prescription” for that student to avoid early morning classes, or to be allowed to make up work occasionally?
As a physician assistant and the mom of two teens, I don’t think that missing school on a regular basis is a great idea — but neither is taking medicine when you’re not really ill.
I wonder what would happen if pediatricians, family doctors, sleep doctors, psychiatrists and psychologists in a community with very early start times started writing “healthy schedule prescriptions” for their teen patients. Would it help a community understand the harm we’re doing with these crazy schedules?
Thanks again for your thought and work in this area. –Kari
Kari Oakes, PA-C
Co-Director, Research and Development
Start School Later
Dear Kari– Thanks as always for your insight. This is a thorny issue and I don’t think that this is necessarily the right approach across the board. When I see patients in clinic I always work with the school districts to produce meaningful accommodations. Rarely, this means consistently later start times for teens. Perhaps, this is a function of the kids that I see, but many of them also have difficulty doing the other things which I ask of them (consistent wake times on weekends and strong limits on light exposure (usually phones)) in the evening. I don’t write letters until I am sure that the teens are complying. The other thing is that most teens actually want to be like everyone else, and that includes getting to school on time.
Hello! I live in Argentina. My teenage girl starts school at 7:30am. and I also think it is too early. She tries to be in bed by 10 pm but this is generally imposible as she stays up studying or finishing homework. At the end of the week she is exhausted…
I hear you. It is painful.