The never-ending pursuit of quality sleep for their children keeps many-a-parent up at night (perhaps both literally and figuratively). There can be challenges in infancy, toddlerhood, childhood and/or adolescence. When parents and their children have done all the “sleep hygiene” techniques recommended by pediatricians (see the age-related tips in each of the hyperlinks above), they feel at a loss for what else to do. Invariably, the defeated feeling leads to an internet search, a posting on a Facebook group, or texting every other parent in your Contacts for advice. The result is often the promotion or recommendation of one of a variety of products that claim to help with sleep. In this article, Dr. Grabill reviews what we currently know (as of summer 2024) about sleep aids and supplements for kids.
Before diving into specific products, we must first explore some important caveats.
(1) Infants should not be given any supplements or herbals unless otherwise specifically recommended by their pediatrician.
(2) Weighted blankets/swaddles, sleepers like the recalled Rock ‘n Play, or other devices that claim to promote better infant sleep are not recommended because they may negatively affect a child’s innate arousal mechanisms and result in suffocation, asphyxiation, or SUID (sudden unexplained infant death, formerly SIDS).
(3) Data on sleep aids/supplements in children and adolescents are sparse. PAR pediatricians seek to practice evidence-based medicine. Evidence-based medicine at its core is making recommendations based on well-designed clinical trials that show both effectiveness and safety of the treatment or intervention in question. There are not many of these well-designed clinical trials from which we can make recommendations related to sleep aids.
(4) The sleep aids/supplements discussed in this topic are not regulated by the FDA. They, therefore, do not have to show proof of safety, effectiveness, or purity (i.e. contain the active ingredients, and in the quantity, claimed). For example, a 2023 study1 found 22 of the 25 over-the-counter melatonin gummies studied were inaccurately labeled (actual quantity of melatonin in these products ranged from 74% to 347% of that claimed on label).
With all those caveats in mind, let’s look at some of the more common sleep supplements pediatricians are asked about.
Melatonin
Melatonin is a hormone made by the pineal gland, which sits in the skull behind the eyes. Kind of like those solar-switch patio lights you may have at home that come on automatically when the sun sets, the pineal gland is activated to release melatonin when the eyes detect less light in the evening. Not surprisingly, the natural melatonin surge to make someone sleepy in the longer summer days does not happen until later. The opposite is true on the shorter, winter days.
Synthetic melatonin is meant to mimic the body’s natural melatonin and induce sleep. It comes in a variety of forms (e.g. liquid, chewables, tablets, gummies, capsules). As mentioned above, the amount of actual melatonin in a product may not match that claimed by the label. Melatonin supplements can be helpful for short-term use to reset the body clock in instances of jet lag, transitioning from summer break to school year, or when sleep has been disrupted by a recent illness. Studies have shown melatonin supplements help induce sleep for some children with neurodevelopmental conditions such as autism and ADHD2. If your child is experiencing one of the above circumstances, has been diagnosed with a sleep disorder, or has a neurodevelopmental diagnosis that makes it harder for them to sleep, talk with your pediatrician to see if a melatonin supplement may be helpful and/or safe to get their sleep cycle on track.
A few important notes about melatonin:
(1) Dosing – assuming a quality product is used, most children will respond to 0.5 or 1 mg, taken anywhere from 30 to 90 minutes before bed. Those with with neurodevelopmental disorders may require slightly higher doses (as much as 3-6 mg), but you should still start in the 0.5-1 mg range and assess for benefit over several days.
(2) Melatonin is a hormone, and could affect or be effected by other hormones in the body. Long-term use has not been studied in children and there are concerns ongoing use could affect growth, development, puberty hormones or the ability to naturally produce melatonin. Only short-term use is recommended (i.e. 1-2 weeks). Some children do well switching to a placebo after confidence to fall asleep is gained with short-term melatonin use.
(3) Melatonin supplements should not be taken by children who take other medicines that can make them drowsy (e.g. antihistamines, ADHD medicines like guanfacine or clonidine, etc). If you are considering melatonin for your child and they take any over the counter or prescription medications, contact your pediatrician before starting to ensure it’s safe and appropriate for your child.
(4) Melatonin is not a substitute for establishing and maintaining a good sleep routine. For more on how to do so, review the age-based sleep topics for toddlers, children and adolescents.
Magnesium
Magnesium is a mineral found in many food sources and serves many important roles in the body. Vegetables (especially green leafies), fruits, nuts, seeds and whole grains are rich in magnesium. Magnesium helps the body make proteins and bone, regulate blood pressure and blood sugar, and is necessary for optimal function of nerves and muscles among other functions. It is a common ingredient in antacids (magnesium hydroxide) and laxatives (magnesium citrate). Magnesium glycinate is promoted by many supplements as a sleep aid. A 2023 Systematic Review of available papers studying magnesium and sleep disorders found an “uncertain association” in well-designed clinical trials3. Unfortunately, at the time of this writing, no studies have been found that assess the effectiveness or safety of magnesium for inducing sleep in children. We therefore cannot recommend its use at this time.
Chamomile
Chamomile has been used as a medicinal herb dating as far back as ancient Egyptian, Greek and Roman civilizations. At this time chamomile is most commonly consumed in teas, but a growing amount of herbal supplements have included it for potential calming effects and GI benefits4. There are no studies on chamomile use for sleep in children. One research paper that analyzed multiple studies on chamomile benefits for sleep in adults found the cumulative evidence to show benefit in reducing both time to fall asleep (aka sleep onset latency) and number of nighttime awakenings5. While these are encouraging findings, the data cannot necessarily be translated to children. Until studies have been conducted in the pediatric population we are unable to recommend chamomile supplementation as a sleep aid for children.
CBD/THC
Cannabidiol (CBD) and tetrahydrocannabinol (THC) are among the many chemicals extracted from the cannabis plant that create various effects on the human body. Though cannabis is most commonly used recreationally, there has been a growing number of medical uses in the past decade or so. Specifically in children, dronabinol (Marinol®) is used to decrease nausea and increase appetite in those undergoing chemotherapy and other cancer treatments. Highly purified CBD (Epidiolex®) has been used in combination with traditional medicines for severe, treatment-resistant seizure disorders such as Lennox-Gastaut and Dravet syndromes6.
Like chamomile, cannabis-derived substances have been used by the public for their calming effects to aid in sleep. There have been hundreds of studies (some well-designed, some not-so-much) on the use of cannabis for sleep disorders in adults, according to a 2022 systematic review article in the medical journal Sleep7. However, none of these studies evaluated the effects on children, and with good reason. The child’s brain is still growing and developing until about age 25 and exposure to cannabis products before then can cause problems with thinking, problem solving, focus, attention, memory, and learning8. For all these reasons and more we do not recommend cannabis products for sleep aids in children or adolescents of any age.
Pediatricians remain as frustrated as parents at the lack of studies and data on what may be helpful to help children get better quality and quantity of sleep. If you’ve tried all the sleep hygiene tips and tricks, and feel like you’re getting nowhere, have a conversation with your pediatrician about the best next steps. This may include consideration of physical and/or mental health diagnoses that make it hard for your child to sleep, or referral to a sleep medicine specialist. We’re here to help. Don’t hesitate to reach out.
1) Cohen PA, Avula B, Wang Y, Katragunta K, Khan I. Quantity of Melatonin and CBD in Melatonin Gummies Sold in the US. JAMA. 2023;329(16):1401–1402. doi:10.1001/jama.2023.2296
2) Esposito S, Laino D, D’Alonzo R, et al. Pediatric sleep disturbances and treatment with melatonin. J Transl Med 17, 77 (2019). doi.org/10.1186/s12967-019-1835-1
3) Arab A, Rafie N, Amani R, Shirani F. The Role of Magnesium in Sleep Health: a Systematic Review of Available Literature. Biol Trace Elem Res. 2023 Jan;201(1):121-128. doi: 10.1007/s12011-022-03162-1. Epub 2022 Feb 19. PMID: 35184264.
4) https://www.nccih.nih.gov/health/chamomile
5) Kazemi A, Shojaei-Zarghani S, Eskandarzadeh P, Hashempur MH. Effects of chamomile (Matricaria chamomilla L.) on sleep: A systematic review and meta-analysis of clinical trials. Complementary Therapies in Medicine. 84 (2024). doi.org/10.1016/j.ctim.2024.103071
6) Laux LC, Bebin EM, Checketts D, Chez M, Flamini R, Marsh ED, Miller I, Nichol K, Park Y, Segal E, Seltzer L, Szaflarski JP, Thiele EA, Weinstock A. CBD EAP study group. Long-term safety and efficacy of cannabidiol in children and adults with treatment resistant Lennox-Gastaut syndrome or Dravet syndrome: Expanded access program results. Epilepsy Res. 2019 Aug;154:13-20. doi: 10.1016/j.eplepsyres.2019.03.015. Epub 2019 Mar 25. PMID: 31022635.
7) Velzeboer R, Malas A, Boerkoel P, Cullen K, Hawkins M, Roesler J, Wei-Ku Lai W; Cannabis dosing and administration for sleep: a systematic review, Sleep, Volume 45, Issue 11, November 2022, zsac218, doi.org/10.1093/sleep/zsac218