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.
