Common Sleep Aid for Children Raises New Questions About Developing Brains
A commentary by Miller School sleep expert Dr. Azizi Seixas highlights reassuring findings about melatonin use in children while calling for more precise, evidence-based approaches to pediatric sleep care.
As sleep problems continue to affect children and adolescents worldwide, many families have turned to melatonin as a readily available solution. But while the hormone is often viewed as a benign sleep aid, a new analysis highlighted in JAMA Network Open suggests that important questions remain about how melatonin may interact with the developing sleep system.
In an invited commentary, Azizi A. Seixas, Ph.D., professor of psychiatry and behavioral sciences, director of the Media and Innovation Lab (MIL), co-director of the Center for Translational Sleep and Circadian Sciences and interim chair of the Department of Informatics and Health Data Science at the University of Miami Miller School of Medicine, examines new research evaluating whether melatonin use is associated with changes in sleep architecture in children. The findings offer reassurance in some areas while underscoring the need for more precise, evidence-based approaches to pediatric sleep care.
A Growing Reliance on Melatonin
Sleep disturbances affect roughly one-third of young people globally, creating a significant public health burden. Yet access to pediatric sleep specialists and behavioral sleep interventions remains limited. As a result, melatonin use has increased dramatically among children and adolescents. Recent national survey data cited in the commentary found that nearly one in five preteens and school-aged children had used melatonin in the previous month, with use doubling between 2017 and 2020.
Despite that rapid adoption, melatonin is regulated in the United States as a dietary supplement rather than a pharmaceutical drug, meaning it is subject to different standards of oversight. According to a recent systematic review cited by Dr. Seixas, long-term safety data remain limited, benefits appear most established among children with neurodevelopmental conditions and virtually no efficacy trials have been conducted in typically developing young children.
Looking Beyond Falling Asleep
The commentary accompanies a study that examined 684 children referred to a pediatric sleep laboratory. Researchers compared 342 melatonin users with 342 nonusers using propensity score matching, a statistical technique designed to reduce bias between groups. Their primary focus was rapid eye movement (REM) sleep, a stage closely associated with memory, learning, emotional regulation and brain development.
Investigators found that children using melatonin had a slightly lower percentage of REM sleep than nonusers. Median REM sleep accounted for 16.7% of total sleep among melatonin users compared with 19.0% among nonusers. However, researchers observed no significant differences across 14 other objective sleep measures. When additional factors such as psychiatric diagnoses and concurrent sleep medications were considered, the REM finding was no longer statistically significant.
The results suggest that melatonin was not associated with broad disruptions in sleep architecture. At the same time, Dr. Seixas cautions that the absence of major differences should not be interpreted as proof that routine pediatric melatonin use is harmless or universally appropriate.
Why REM Sleep Matters
One reason researchers remain interested in the REM signal is the critical role this sleep stage plays in childhood development. REM sleep has been linked to emotional memory, affective processing, learning and neurodevelopmental plasticity. During childhood and adolescence, brain maturation, hormonal changes and sleep patterns are undergoing rapid transformation. This period particularly important for understanding how interventions may affect long-term health.
Dr. Seixas notes that melatonin is often misunderstood as a general sleep aid when it is more accurately described as a “chronobiotic,” a biological signal that helps regulate circadian timing. Its effects can vary depending on dose, timing, formulation, developmental stage and an individual’s internal body clock. Future studies must investigate melatonin’s influence on sleep onset and whether it affects sleep architecture and neurodevelopment over time.
Toward Precision Sleep Medicine
A major takeaway from the commentary is that sleep problems should not be treated as a single condition requiring a single solution. Similar symptoms can stem from very different causes, including circadian rhythm disorders, anxiety, environmental factors, neurodevelopmental conditions or inconsistent sleep habits.
Dr. Seixas advocates for a precision-medicine approach that begins by identifying a child’s specific sleep phenotype. Under this framework, decisions about melatonin would be individualized according to clinical indication, dose, timing, formulation, duration and monitoring. Behavioral interventions including structured bedtime routines, stimulus control, sleep scheduling and cognitive behavioral therapy would remain the foundation of treatment whenever possible.
Implications for Families and Health Care
The findings also highlight a broader systems challenge. Melatonin’s popularity may reflect not only demand for sleep solutions but also insufficient access to scalable, affordable alternatives. Families often face long waits for specialty care, while behavioral sleep programs remain unavailable in many communities.
For patients and parents, the message is nuanced. The study offers reassuring evidence that melatonin is not associated with widespread disruption of sleep architecture. However, it should not be viewed as a universal answer for childhood sleep difficulties. Rather, melatonin may be most effective when used under clinical guidance, targeted to specific sleep disorders and paired with evidence-based behavioral strategies.
Looking ahead, Dr. Seixas argues that improving pediatric sleep health will require stronger safeguards around melatonin use and greater investment in accessible sleep care. Long-term studies, enhanced product quality standards and clearer public education may help ensure that children receive interventions that are both effective and developmentally appropriate.
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Tags: Department of Psychiatry and Behavioral Sciences, Dr. Azizi Seixas, obstructive sleep apnea, precision medicine, sleep, sleep apnea, sleep disorders, Translational Sleep and Circadian Sciences