Dr. Michael Wald’s responses in the form of an interview commenting on the Canadian Sleep Society recommendation against melatonin for children.
Interviewer: The Canadian Sleep Society recently reported that giving most kids melatonin does not help them sleep and may actually be bad for them. Dr. Wald, , what are your thoughts on giving melatonin to kids?
Dr. Wald: Melatonin can certainly be the wrong thing to do for kids, and adults. People need what they need. If they take something that they do not need it can prove harmful. However, melatonin is often needed by kids because they are overly stressed, do not sleep, often are not fit and have poor diets. All of these and other lifestyle factors increase cortisol in the body that can cause anxiety issues, sleeplessness and moodiness. Melatonin is proved to offset cortisol’s effects. Melatonin is safe enough for most kids that I believe it is a reasonable place to start, especially compared to prescription sleep aids that have not been studied in children, carry serious side effects (including addiction) and do not attempt to fix the cause of the sleep issue. If a child has low melatonin they will wake up at various times during the night. If melatonin is taken before bed by approximately one hour, and even upon awakening at night (in the form of a liquid that’s fast and easy to supplement), it can effectively help reset circadian rhythms allowing for better quality stage III REM sleep.
Interviewer: What do you think about giving melatonin to children with ADHD? Do you think it helps them? If so, why? I have seen melatonin help some kids with ADHD.
Dr. Wald: Melatonin can reduce excitatory brain chemicals that cause hyperactivity. The attention component of ADHD is often secondary to the excitatory component. Said another way, it is hard to pay attention when the brain is telling the body that a stress reaction is going on. Melatonin also reduces various inflammatory chemicals in the body that hyposensitizes the sympathetic nervous system in kids causing or worsening ADHD symptoms. However, ADHD is a complex health issue that will certainly not be solved with melatonin; only a comprehensive lifestyle approach will afford the most overall benefit for ADHD. This comprehensive approach should involve: exercise, attention to diet and nutritional supplements, consideration of medication, psychotherapy, attention to coping mechanism methods, habit reversal, etc.
Interviewer: Should parents of kids with ADHD give melatonin to their children before bed every night, or only under certain circumstances?
Dr. Wald: For melatonin to work the right dose and timing must be emphasized. Most people will give 3 mg of oral melatonin for a few days or a few weeks and if it does not work they give up. Often it can take longer. The dose of melatonin should be somewhat based upon the weight of the child and other lifestyle factors that might worsen the ADHD. For example, if the child is overworked or has lots of stress, higher doses of melatonin, and more frequent administration, may be indicated. Also, not all melatonin is the same quality and guidance by a trained health professional in its use should be sought.
Interviewer: What is the correct dose in kids with ADHD? Start with 3mg 1 hour before bed in a liquid or capsule form for 1 week. If the child does not improve increase to 4mg taken the same way. If this does not work, and the child also wakes up one or more times during the night, use a liquid form (easier to take when tired) at each interval that the child awakenings, but only if the child is awake for more than 30 minutes during each interval of sleep. The number of total dosages per night should not exceed 12mg.
Interviewer: Does melatonin counteract any prescription medications given to kids with ADHD? If so, which ones? Melatonin can have an additive effect upon when taken with certain sedative medications. Some sedative medications include clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal), zolpidem (Ambien), and others.
Interviewer: Alternative sleep remedies to melatonin to help kids with ADHD sleep
Dr. Wald: Consider the following for your child:
- Identify and help manage the child’s stress.
- Consider a nutritional supplement of GABA – a “relaxing-calmative” neurotransmitter
- Clean up the diet: eliminate all forms of hidden caffeine and simple sugars found in foods including coffee, ice cream, desserts, etc.
- Provide a multivitamin
- More fruits and vegetables
- Morning yoga
- Morning exercise that is fairly rigorous – can help calm the nervous system down
- Have specific laboratory tests (i.e., blood work) to look for specific deficiencies and fix them including: vitamin D3, all of the B-vitamins, amino acids, essential fatty acids, etc.)
Dr. Wald: Although I believe that melatonin is generally safe and effective for adults and children, I recommend that it is taken under supervision by a trained clinical nutritionist. Considering the high prevalence of anxiety, stress, sleep issues and attention deficit and hyperactivity among children and adults, melatonin’s place in health care is secured.
About the author: Dr. Michael Wald, DC, MD, CDN is director of nutritional services at Integrated Medicine of Mount Kisco, P.C located in Westchester New York. He can be reached at 914-242-8844 (Ext. 1) or at: www.intmedny.com and www.blooddetective.com.