Sleep and children /

Melatonin

01 In Brief

Melatonin can help some children sleep better, especially those with developmental conditions.

Always combine it with a good sleep routine

Start with the lowest dose possible

Talk to your doctor before starting or changing dose

Be cautious with online products especially gummies

02 What Do I Need To Know?

What is Melatonin

Melatonin is a natural hormone made by a small gland in the brain called the pineal. It helps control our sleep-wake cycle i.e. our circadian rhythm or body clock. Melatonin levels increase in the evening when it gets dark.

Melatonin can be used in children who:

- Have trouble falling asleep

- Have developmental conditions such as ASD, DHD and the rare genetic condition Smith Magenis syndrome.

Melatonin should be used alongside good sleep habits; regular bedtime, no screens > 1hour before bed and a calming bedtime routine   

Is it safe

Short term use appears to be safe, especially in those children with developmental conditions

Long term safety is still being studied, and some concerns have been raised about the potential effects on timing of puberty and growth. This appears to be unlikely.

There is limited research on long term use in children without developmental problems.

Side effects are uncommon and may include 

- Morning sleepiness

- Vivid dreams

- Mild headaches or stomach upset

Dosage guidelines

Always start with the lowest effective dose

Age Typical dose 

2-5 years 0.5 -2mg 

6-12 years 1-3 mg

Adolescents 3-5mg

Many children respond to low doses of 0.5mg-1mg 

Doses > 5 mg rarely add benefit

Children with developmental disorders such as ADHD and ASD may need higher doses sometimes up to 10 mg but only under specialist supervision.

When to give it

For most children: 30-60 minutes before bedtime

For children with body clock delays e.g. falling asleep very late, giving melatonin 2-3 hours before bedtime can work better. 

Duration of treatment

Melatonin does not need to be given every night.

Breaks at weekends or holidays can help check if it's still needed.

In children where ADHD stimulants are prescribed and sleep is delayed it might be needed long term.

There is no rebound or withdrawal effects when Melatonin is ceased, it can be stopped and weaning of dosage is not needed. Evidence supports that it does not affect the natural production of Melatonin by the body.

Prepartions

In Australia Melatonin is prescription only.

This needs to be sourced from compounding pharmacies.

Compounded liquid Melatonin 6mg/ml is often used first to find the lowest effective dose.  Once the best dose is found then children can switch to capsules or tablets.

Short acting preparations are usually tried first

Long acting options include: Circadin 2mg and Slentyo 2mg and 5mg

Online and overseas products

Melatonin is imported as a dietary supplement and is sold over the counter is some countries and online. It is and considerably cheaper than compounded Melatonin.

These products are not regulated in Australia and may have variable dosing or other additives

They can lead to accidental overdose in children who mistake the gummies for lollies. 

03 What Others Say

Sleep Health Foundation 

 

04 I Want To Know More

What is the basis for concerns about timing of puberty and fertility

Melatonin works by attaching to special 'docking stations' called melatonin receptors (MT1 and MT2). In some animals, like sheep or hamsters, melatonin plays a much bigger role: it signals changes in day length (photoperiod) and controls seasonal reproduction and even hibernation. In these animals, high melatonin in winter can delay fertility until the next breeding

Humans also have MT1 and MT2 receptors in the brain’s body clock (SCN), pars tuberalis, hypothalamus, pituitary, and reproductive tissues. However, unlike seasonal animals, human reproduction isn’t strongly controlled by day length. Melatonin’s role in fertility is far less dominant in humans.

GnRH (Gonadotropin-Releasing Hormone) is a key hormone from the hypothalamus. It triggers the pituitary gland to release other hormones (LH and FSH) that start puberty and control fertility. In animal studies, high melatonin levels can suppress GnRH. This led to a theoretical concern that long-term melatonin use in children could affect puberty.

Studies up to 2 years and smaller studies up to 4 years show no delays in puberty or growth, Tanner staging (measure of puberty progress) and growth patterns are normal.

  • Idiopathic sleep-onset insomnia (typically developing children)
    A follow-up study in healthy children (average duration ≈ 3.1 years, mean dose ~2.7 mg) reported no change in pubertal onset. Some mild side effects (e.g., headaches, nausea, apathy with weight gain) were noted, but no serious safety concerns. J Pediatr Pharmacol Ther
  • Neurodevelopmental disorders (ADHD, ASD)
    Open-label studies in children (3 months to 3.8 years) found no serious adverse reactions after long-term IR use. Kosin Medical Journal
    A 26-week open-label IR study (in NDD children) reported effective shortening of sleep-onset latency, with no vital sign changes, no withdrawal, and no rebound insomnia. Adverse events did not increase over time. BioMed Central
The information published here has been reviewed by Flourish Paediatrics and represents the available published literature at the time of review.
The information is not intended to take the place of medical advice.
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Last updated: 05/09/2025 by Dr Liz Hallam