Is Melatonin Safe for Kids?

Melatonin has long been touted as a safe, reliable — and natural — way to help kids get to sleep. But is it doing more harm than good? 

Synthetic versions of the naturally occurring hormone — often in the form of drops or gummies for kids — promise an easier bedtime. Nearly 46% of parents reported giving the supplement to a child younger than 13 to help them sleep, according to an American Academy of Sleep Medicine poll.

But a recent study linking chronic melatonin use to heart failure has parents concerned. And another study found a “wide range” in concentrations of melatonin in products. ”Because melatonin is a dietary supplement and not a drug, it’s not FDA-regulated,”  Dr. David Fagan, vice chair for pediatric ambulatory administration at Cohen Children’s Medical Center Northwell Health, says. “The actual melatonin content can vary really widely.”

Fagan spoke to PEOPLE about who might be a candidate for melatonin and what to watch out for, while emphasizing that kids shouldn’t be given melatonin without consulting their pediatricians first.

Is melatonin recommended for children?

“The American Academy of Pediatrics does not recommend melatonin use as a first-line aid to help children get to sleep and to stay asleep,” Fagan tells PEOPLE. Instead, he said, before reaching for supplements, doctors recommend “behavioral sleep strategies.” These include: consistent bedtime, limiting screen time before bedtime, and having a sleep-friendly environment — like a quiet, dark space, perhaps with blackout curtains — before using a supplement like melatonin.

He shared that for children with neurodevelopmental disorders like ADHD or autism, “short-term use of melatonin” does appear to be safe, as children with ADHD, for example, are often on a stimulant medication and melatonin may help regulate their sleep cycles. “But again, the American Academy of Pediatrics and the American Academy of Sleep Medicine do not recommend melatonin as a first-line solution for sleep problems.”

Once approved by a pediatrician, what does safe melatonin use look like?

“We would want to start with the lowest possible dose,” Fagan says, which is usually 1 mg. “And we would never give it to a child under the age of 2.”  He also tells PEOPLE that melatonin should not be used every night, and urged parents to speak to their pediatrician about how to give their child breaks from the supplement. 

What negative side effects should parents should watch out for?

Children can take too much of it, Fagan tells PEOPLE. It can cause “morning grogginess, you could have headaches, mood swings.” The supplement can also cause “really very, very vivid, vibrant dreams.” 

If a child has a seizure disorder and is taking an anti-epileptic drug, the interaction of melatonin and the medication could make that child “more likely to have a seizure,” according to Fagan. It can also increase blood pressure, which is why parents must contact their pediatrician before giving their child melatonin: “Every child is different, but parents should, with their pediatrician, review other medications that the child is on for any potential interactions.”

Is magnesium a safe alternative to melatonin?

“The evidence with magnesium is really very limited and and weak,” Dr. Fagan tells PEOPLE, noting that while it can play a role in relaxation, “there is no strong clinical data showing it improves sleep in healthy children.”

What is the biggest misconception about melatonin?

The biggest misconception about melatonin, he says, is that “it’s a cure-all for sleep problems.”

If a family wants to start their child on melatonin, first, he recommends trying the behavioral sleep strategies listed above. “If they’ve done all of that and exhausted all of that, then we would talk about melatonin.”