Melatonin poisoning in kids is on the rise, according to the Centers for Disease Control and Prevention. From 2012 to 2021, there was a 530 percent increase in the annual number of children taking melatonin, either knowingly or unintentionally (for example, a curious kid sneaking into the melatonin bottle on the nightstand). In that decade, 27,795 cases required treatment at a hospital or other health care facility. Two children died.
This might be surprising because melatonin is marketed as a “natural” sleep aid (it’s even found in some foods!). Indeed, our pineal glands, found in the brain, produce the stuff themselves when the sun goes down. That melatonin triggers the “sleep” part of our sleep-wake cycle (otherwise known as the circadian rhythm). In healthy adults, the pineal gland makes between 10 to 80 micrograms a night. Over-the-counter melatonin could give you an assist if your pineal gland doesn’t make enough, or override your body’s own idea of when you should go to bed. It comes in doses ranging from 0.3 milligrams to up to 60 mg—or about a thousand times as much as the body produces as night—though the largest dosage most grocers and pharmacies carry is around 5 to 10 mg. But even 10 milligrams of melatonin can be too much.
Just look at how the rest of the world views the use of melatonin. OTC use has been banned for years in much of Europe, the U.K., Japan, and Australia. And it’s prescribed mostly in low-dosage, slow-release tablets for a few weeks in order to treat acute insomnia—not chronic sleep problems. Patients might be instructed to take it two or three times a week, rather than every night. This is because with melatonin, less can be better; taking too much can actually disrupt our circadian rhythms, thereby making our sleep worse.
Because it’s sold on the shelves of CVS and at vitamin stores in the U.S., it’s easy to assume that you should just take it in whatever dosage is readily available, and even that it’s safe to give to kids as well without much thought. But even American sleep experts and physicians recommend starting with the smallest available dosage, often 0.5 mg or 1 mg, for a few days before increasing the dose if the smallest dose has had no effect. When an adult body gets too much melatonin for it to handle, the side effects are generally mild; headaches, nausea, and dizziness can occur. For children, though, the threshold for an overdose might be much lower. Though its worth noting that most of the kids in the CDC study on overdoses ended up perfectly fine, larger overdoses can lead to high or low blood pressure, which can be dangerous for people with cardiovascular problems. They can also cause vomiting.
If it’s regulated in other countries, and it can have such negative effects, why do manufacturers here sell it in such high doses? My guess is that a huge dose of melatonin offers a quick fix. Taking 5 milligrams of the stuff can make you instantly sleepy, in the same way that actual sleeping pills or antihistamines do. (By the way, you shouldn’t be taking Benadryl to fall sleep.) And it’s a lot easier to grab melatonin at the drugstore in order to knock yourself out than to get a doctor’s appointment and an Ambien prescription. The common complaints that I’ve heard from my friends about taking melatonin, such as a “melatonin hangover” or intense dreams and nightmares, are actually the side effects of taking too much.
Manufacturers can get away with high doses because in the states, melatonin is considered a dietary supplement, not a drug, and the Food and Drug Administration doesn’t regulate supplements. Then, there’s also the fact that the melatonin label might be lying to you: Independent studies show discrepancies between what the packaging says, and the actual amount of the compound in the bottle. Researchers at the American Academy of Sleep Medicine tested melatonin levels in more than 30 supplements from different brands; they reported in a 2017 Journal of Clinical Sleep Medicine paper that more than 70 percent of them contained doses anywhere from 83 percent less to 478 percent more than what the label claimed. Imagine—your physician thinks you should be taking 0.5 mg, you think you’re taking 5 mg, and you’re really taking closer to 30 mg!
Melatonin is generally considered perfectly safe to take short term, in small doses (and again, the symptoms of an overdose, even in kids, aren’t typically that bad). But there’s not enough research for an evidence-based recommendation for long-term usage. Because it is a hormone, experts have concerns that it could affect hormonal development in adolescents.
Plenty of expert sources recommend considering short-term use of melatonin for kids’ sleep issues, though you should check with your pediatrician before doing so (really, anyone taking melatonin should check with a doctor first). One in 17 children were taking melatonin at least once a week in 2019. At the start of the CDC’s study, it was the “second most popular natural product used by children in the United States,” topped only by fish oil supplements. If people are buying more and more melatonin, as the CDC’s report suggests they are, it’s likely that those stats will only continue to rise.
So how do you keep your kids safe while balancing your own “coronasomnia”? First, consider if you (or they) need the stuff at all. Many cases of acute insomnia can be cured with lifestyle changes and better sleep hygiene. If you can’t live without melatonin on hand, consider buying brands with smaller dosages, and, if you have small kids around, going with a brand that can’t easily be mistaken for candy. You might not need as high a dose as you think, and this way, even if your child gets into the bottle, the risk of overdosing is lower. Personally when I scan the shelves, I look for the number 300, since some lower-dosage pills are marketed in micrograms, rather than milligrams. Just make sure it is in fact 300 m-c-g, not m-g. Choose pills that you have to swallow, rather than chewable tablets, gummies, or tinctures, so they appeal less to kids looking for something tasty. Finally, keep that melatonin on the highest shelf or even better, a locked cabinet that kids don’t have access to. That is, do yourself what the FDA won’t: treat it like a drug.