Melatonin is effective and safe for sleep disturbance in children with cerebral palsy, autism and learning problems
Child Health Monitor, Volume 3, Issue 6
Melatonin, a hormone produced by the pineal gland in the brain, is increasingly being used to treat sleep disturbance in children. Melatonin is most commonly used for jet lag, but claims have been made that it also promotes general health and protects against the effects of ageing. Melatonin helps regulate the body's sleep-wake cycle and its production is determined by light and dark. When darkness falls, the pineal gland produces more melatonin, promoting sleep and regulating the body's sleep-wake cycle with the outside world. Because of its use in promoting sleep, melatonin is increasingly used in the treatment of sleep disturbance in children. However, this particular use of the drug has been studied very little and in fact, melatonin is not licensed as a drug in most countries. Although it's available without a prescription in the USA (where it's sold as a "dietary" substitute), melatonin is not available at all in the UK or Australia.
Sleep disturbance is common in childhood, and is particularly problematic in children with neurological problems such as learning difficulties, cerebral palsy, autism spectrum disorders and epilepsy, as well as children with visual impairment (partial or complete). This is probably because these children have difficulty recognising and attuning their sleep cycle to the outside world's sleep-wake cycle.
Little is known about how useful or safe melatonin really is as a treatment for childhood sleep disturbance. A number of reports describing the use of melatonin in small numbers of children, have suggested that it is useful and probably safe, but no studies have been published where the drug has been used on larger numbers of children. Additionally, no randomised controlled studies testing the safety and effectiveness of melatonin have been performed. These types of studies are necessary to properly establish the effectiveness and safety of the drug in treating paediatric sleep problems. Evidence from adult studies suggests that melatonin generally seems very safe, but potentially it can promote depression, worsen epilepsy and delay puberty. These authors report on one of the largest groups of children with neurological problems using melatonin. (Sadly it wasn't a randomised trial).
The researchers identified all children with sleep disturbances in a large paediatric neurology clinic and offered them melatonin to treat the condition. 49 mothers agreed to give their children melatonin and keep diaries and records of the differences it made to their children's sleep patterns. The children were given 2.5mg of melatonin per night if they were under five years of age and 5mg if they were over five. The dose was increased, if necessary, to a maximum of 7.5mg in children under two years and 10mg over this age. The children with sleep problems also had either cerebral palsy, learning difficulties, epilepsy, autistic spectrum disorders or Down syndrome. Only seven children were also visually impaired.
They found that the melatonin significantly improved almost all aspects of sleep in most of the children and around 93% recorded significant benefits. The average number of hours sleep that the children had each week increased by around 10%, from 54 hours/week before taking the melatonin to 66 hours/week while taking the melatonin. The number of interruptions to sleep each week decreased by 50% from an average of seven interruptions per week before taking the melatonin, to 3.5 interruptions while taking the drug. Also, the number of hours of interrupted sleep decreased by 45%, from nine hours awake each week during a sleep interruption pre melatonin, to five hours per week while taking melatonin.
There were no major side effects from the medication in any of the children and importantly there was no change in the frequency or severity of seizures in children with epilepsy. Boys and girls were equally likely to respond well to melatonin. The visually impaired children were the most likely to have success with melatonin, but around three-quarters of the fully sighted children also responded very well.
This is further support for the effectiveness and safety of melatonin in children with sleep problems, particularly in children with neurological problems. An impressive 93% of children responded positively. However the medical community still requires supporting evidence in the form of a randomised clinical trial before we can uniformly recommend melatonin for this purpose.
Ross & Whitehouse. Melatonin treatment for sleep disorders in children with neurodevelopmental disorders: an observational study. Developmental Medicine & Child Neurology May 2002; 44: 339-44.
* Sleep disturbance is common in children with cerebral palsy, learning difficulties, intellectual disability, visual disability, autism and epilepsy. Melatonin at a dose of 2.5-10mg is a safe and probably effective treatment for sleep disturbance in these children.
Reproduced with permission of ChildHealthMonitor.org, which translates pediatric journal articles into everyday language providing comprehensive information on research breakthroughs ranging from general nutrition to rare diseases. A great resource for busy Pediatricians and also for parents who want to learn how best to care for their children's medical and parenting problems.