Melatonin is a popular sleep aid for adults that’s on the rise among kids. But is it safe?

Rachael Gibbons-Newcome had tried everything to defuse her 5-year-old son’s angry outbursts: prizes for good behavior, sticker charts, and calming evening routines.

Out of other options, the family’s pediatrician recommended trying melatonin, a dietary supplement that can aid in sleep. Benjamyn — or “Jammers,” as his family calls him — woke up often and rarely got a good night’s sleep, which the doctor said could be affecting his behavior.

The 41-year-old mother of four was reluctant. But, eventually, she agreed it was worth a try and headed to the store last summer.

“I’m the type of mom who doesn’t like to medicate unless it’s really needed,” said Gibbons-Newcome, who lives in Thornton, in Delaware County.

Melatonin has soared in popularity as an inexpensive over-the-counter fix for elusive sleep, and is now readily available on store shelves in the form of fruit-flavored gummies marketed to children. Sales rose from $285 million in 2016 to $821 million in 2020 as manufacturers made melatonin available in various pills, capsules, and liquids for adults, and tapped a new customer base with gummies — parents desperate to get their kids to sleep.

But some pediatricians are concerned about an alarming trend that has accompanied its use among kids: a 530% increase over eight years in the number of children who unintentionally consumed melatonin or intentionally overdosed on it.

The data, released in June by the U.S. Centers for Disease Control and Prevention, are a warning to parents that even though nutritional supplements don’t require a prescription, they can still be dangerous.

“People don’t think of melatonin as a medicine the way they think of their blood thinner as medicine because it’s sold as a nutritional supplement,” said Kevin Osterhoudt, the medical director of the Children’s Hospital of Philadelphia Poison Control Center, which has tracked a similar trend in melatonin poisonings locally.

Dietary supplements such as melatonin don’t require approval from the U.S. Food and Drug Administration and are not heavily regulated the way medicines are. As a result, “there’s this perception that it’s safer,” said Abigail Strang, a pediatric sleep specialist with Nemours Children’s Health. “People don’t take as many precautions.”

Melatonin is a hormone naturally produced by our bodies in response to darkness to help regulate our internal clocks. Melatonin increases in the evening, making us tired, and decreases in the morning to signal that it’s time to rise.

When melatonin levels are disrupted, our bodies don’t get the message from our brains that we should go to sleep.

Doctors said they aren’t surprised more families are struggling with children’s sleep and turning to melatonin, which research has shown may help children sleep better.

The COVID-19 pandemic has upended routines, added stress, and put many of us — especially children attending school virtually — in front of blue light-emitting screens for a greater portion of the day. These are all factors that interfere with natural melatonin production.

A study published in the journal Sleep Medicine in September 2020 found that a quarter of participants experienced worse sleep during the pandemic’s early months. Melatonin sales shot up 43% that year, according to Nielsen, a global marketing firm.

And pediatric ingestions of the supplement reported to poison control rose 38% — the largest single-year increase in the CDC’s study period between 2012 and 2020.

The vast majority of calls to Philadelphia’s poison control center at CHOP are for children under age 5.

In 2021, CHOP fielded 1,066 calls for melatonin ingestion among children under 5, a 190% increase from 2017.

Osterhoudt attributed the increase to people improperly storing bottles of supplements that look and taste appealing to young children, whose curiosity often leads to their putting things in their mouths.

“We know from decades, if not centuries, of poisoning prevention that it’s not a good idea to make medicines look like candy,” he said. “Anytime we make medicine look like candy, it increases the likelihood of children ingesting it.”

In most cases, children who unintentionally swallow melatonin have mild symptoms, such as sleepiness and nausea, that can be treated at home. Only 1.6% of all cases resulted in more serious symptoms that required hospitalization, and teenagers who intentionally took too much melatonin were more likely to be hospitalized than young children, according to the CDC report.

Still, melatonin ingestions now account for nearly 5% of all pediatric poison control calls, up from 0.6% in 2012.

Osterhoudt and Strang urged parents to store melatonin and other nutritional supplements with the same care they would prescription medications to limit children’s access.

Parents should also carefully consider what supplement they buy. Nutritional supplements such as melatonin are not considered medicine, which means they do not need approval from the FDA. As a result, the amount of melatonin in supplements varies by brand and is sometimes even different from what’s listed on the label, a 2020 study published in the Journal of Clinical Sleep Medicine found.

Melatonin is generally considered safe for children — so long as it is taken in consultation with a doctor and in an appropriate dose.

Parents often ask Nemours’ Strang about melatonin supplements, either because they have taken it themselves or have seen it on display in stores. Some kids who come in are already taking it, sometimes at alarmingly high doses.

After seeing a notable increase in the number of children brought to the Delaware hospital’s sleep clinic for insomnia during the pandemic, Strang worries that some families may be attempting to fix long-term sleep issues with a supplement that’s intended for temporary use.

“A lot of people feel like if they’re having trouble getting their child to sleep, it’s something they have to push through,” she said, noting that sleep is an integral part of overall health that people should talk to their doctor about if they’re experiencing difficulty.

Before recommending melatonin, Strang works with families to make behavioral and environmental changes at home that may be more sustainable. Dimming the lights in the evening, avoiding screens, listening to calming music, and taking a warm bath can all help children wind down at the end of the day and ease into sleep, she said.

For their son, Jammers, Gibbons-Newcome and her husband pored over customer reviews and ingredient labels before selecting a melatonin supplement. They picked one that had the fewest ingredients and that came in the smallest dose she could find.

Since the gummies have an uncanny likeness to fruit snacks, Gibbons-Newcome keeps the jar on a shelf the kids can’t reach. She’d get rid of the bottle to eliminate the risk, if the supplement weren’t helping her son.

Jammers’ behavior began to improve a few weeks after he started nightly doses of melatonin, which was about the same time he began therapy. His mother thinks the combination of therapy and more restful sleep has helped him stay in control of his emotions.

Now 6, Jammers takes melatonin before bed only when he’s had a rough day — and those times are increasingly infrequent.