News this week from Hasbro Children’s Hospital in Rhode Island: A lot of kids don’t sleep. They needed a study to figure that out?
The study also found that youngsters with insomnia are medicated for it, perhaps too much. Ironically, a day or two before this story came out, CNN announced a study decreeing it “abusive” for parents to give a cold or allergy medicine (like Benadryl), to help a child sleep instead of scream through a long flight. What’s a parent to do?
This is one of the many dilemmas that prompted me to write Special Needs Kids Go Pharm-Free. Kids are medicated for more problems than ever before, but less healthy than a generation ago. And sleep is so crucial to overall health.
Sleeplessness in a baby, child, or teen is one problem you might be able to tackle easier than you think, with nutrition tools instead of medications.There are several options to choose from if you’re wondering about supplements. Melatonin is just one of them. Others include theanine, chamomile, rooibos, ashwaghanda, holy basil, taurine, tryptophan, 5-hydroxytryptophan, magnesium glycinate, calcium lactate, and more. They can be helpful, and are best used with some professional guidance.
Food intolerances and digestive issues can disrupt sleep too. I often work with parents to rule these out, before adding a supplement to improve sleep. I believe it’s best to work at the root cause when possible.
Melatonin is a safe and easy place to start, as long as you’ve ruled out any serious health problems with your pediatrician first. It can trigger intense dreams in children who don’t need it, and may make your child more wakeful. This may imply a need for different supports along the serotonin pathway, which is shared with melatonin. Or it may suggest other supports are needed altogether – for adrenal glands, certain minerals, for reducing inflammation, or for digestive issues. If melatonin is helpful, use only as long as needed and in the lowest effective dose. More is not better. And, know that it’s worth looking more broadly at your child’s functional nutrition picture. Using melatonin long term may reduce testosterone levels or may mask other imbalances needing support. Here’s an excerpt about melatonin from the chapter on sleep in my book Special Needs Kids Go Pharm-Free: Nutrition Focused Tools To Minimize Meds and Maximize Health and Well Being (© contact me for permissions) :
“... As mentioned earlier, melatonin is not a medication, but a hormone we make ourselves to signal the brain into sleep. I have not used melatonin in children younger than eighteen months. Is it safe for infants? Probably, but this is a question to review with your pediatrician. Infants make a lot of melatonin naturally; if they aren’t sleeping, it may be quite depleted, a state that is possibly detrimental for them. Some research suggests that melatonin may be lifesaving when it comes to SIDS: Infants who die from SIDS have very low levels of melatonin in their brains. Because melatonin is a powerful antioxidant, there is speculation that it may play a role in preventing the severe, life-threatening oxidative stress that occurs with SIDS. Discuss giving your baby melatonin with your health care professional.
If your infant is persisting in a stressful, screaming pattern at night instead of sleeping, melatonin may be useful, but ask your pediatrician about dosing first. Prolonged screaming is not healthy for infants. It is extremely costly for them, in terms of energy balance. Young infants need more than twice the calories per pound that a school-age child requires in order to maintain a normal growth pattern. When an infant is awake more than normal, or expending precious energy screaming night after night instead of sleeping, growth and immune function can suffer. This can, of course, also harm an infant’s delicate emotional well-being and threaten normal attachment to his or her parent.
Young children should not need more than 1–2 milligrams of melatonin per night. Start with a very low dose, and as always, inform your provider team before you start. Use the least amount to encourage sleep, and no more. Many preparations for melatonin are available that are suited to children, as drops, melting wafers, chewables, or sublingual sprays. These are given under the tongue and work fairly quickly; they don’t need to pass through the stomach and small intestine to take effect. Some parents give melatonin 30–60 minutes before bedtime, to shorten the time it takes a child to actually drop off. Rules for using melatonin:
- Start with a quarter-milligram dose for young toddlers.
- Start with a half-milligram if your child is two years or older.
- Stop at the lowest effective dose. More is not necessarily better.
- Children with autism may need more. Still start at a low dose, and work up slowly.
- Older children (70 pounds or more) can start with a 1-milligram dose.
- Periodically try weaning your child off melatonin. He may no longer need it.
- An effective dose lets your child fall asleep in about 30 minutes or less, and stay asleep, most nights per week.
- Don’t use melatonin preparations with other supplements in them. If there is a problem, you won’t know which component is causing the trouble.
- Avoid melatonin preparations that include pyridoxine (vitamin B6). This vitamin can trigger wakefulness. Your child may do fine with extra B6 early in the day, but may struggle to sleep if it is given at night.
Children with autism, anxiety, depression, or other mood disorders may benefit from a higher dose of melatonin. If your doctor isn’t sure on dosing, ask for a referral to someone who is sure. This may be a psychiatrist, a naturopathic doctor, or even a neurologist. A clinical trial that used melatonin in children with autism showed no side effects, other than good ones: There was a reduction in compulsive and ritualistic behaviors while the kids with autism used melatonin. Some of the children needed up to 6 milligrams of melatonin to reap benefits. All children are different, so start with the smallest appropriate dose and use only what is needed to elicit the benefit of sleep.“
For more on how to use other supplements for sleep, as well as how to troubleshoot foods that may be keeping a child awake, pick up a copy of Special Needs Kids Go Pharm-Free. Wondering what else is in the book? Click here for table of contents.