6 healthy sleep habits in the age of melatonin

Mother kissing a child goodnight

A pediatrician and father himself, Erik Shessler, MD, knows how challenging it can be for children to go to sleep. He is not at all surprised by the number of parents giving their children the sleep supplement, melatonin. 

“I always ask whether children are taking any supplements, including melatonin,” says Shessler, Associate Medical Director at Dartmouth Health Children’s. 

The hormone, which is naturally produced by our brain, helps regulate the sleep-wake cycle, allowing us to become more calm and tired at night so that we can better sleep. But, while Shessler recognizes that there are times when a melatonin supplement may make sense, teaching good sleep habits should come first, he advises patients.

“The fact that we could be training our children and teenagers to use medicine to fall asleep means they could turn into young adults who need to use medicine to fall asleep. The key to good sleep is not supplements. It is good sleep hygiene and sleep routines,” he says. 

In working with children and their families, Shessler makes a point to help his patients develop good sleep habits. As such, he has contributed to this primer on the growing popularity of melatonin and how best to support your children’s healthy sleep routines. 

Our children need sleep

Sleep is critical to our development. Not getting enough can impact a child in many ways, including behavior, school performance, and physical and mental health. This fact is not lost on parents, nor is the effect of too little sleep.

“Getting children to fall asleep is a challenge we have had for thousands of years,” says Shessler.

As recently as 2011, The American Academy of Pediatrics estimated that sleep problems affect some 25 to 50 percent of children and 40 percent of adolescents. 

The rise in children’s melatonin use

When parents come to Shessler’s office, many confess to turning to supplements. According to research published at the end of last year in JAMA Pediatrics, nearly one in five school-aged children and preteens now take melatonin to help them sleep. 

To explain the rise, some observers point to increased knowledge of supplements and the fact that children’s melatonin now seems to line the shelves of most drug stores. Others stress that during the COVID-19 pandemic, anxiety levels increased dramatically among children, adolescents, and young adults, and that one result was a significant worsening of sleep quality among youth. 

But observers warn against jumping to hard fast conclusions about how, why, and to what extent the pandemic has affected children’s sleep habits. A recent study by authors including Dartmouth Geisel School of Medicine’s Diane Gilbert-Diamond, DMS, and Margaret R. Karagas, PhD, found that while the pandemic significantly impacted children’s sleep health, parent knowledge of the importance of sleep health may have played a protective role in mitigating its effect among certain populations.

How to help your kids sleep

Building parent knowledge is important to Shessler. He encourages all parents to talk with their child’s provider about sleep struggles and to determine the best long-term sleep solution, including whether to use supplements like melatonin for children. 

“I’m never supporting the use of melatonin for kids without connecting it with good sleep habits and sleep routines. It is only an adjunct to use for a defined period of time, usually with children over age five, while we focus on improving sleep habits and routines,” he says.

To help your child get the necessary sleep, Shessler recommends keeping these points top of mind.

  1. Establish sleep routines
    Creating structured nighttime routines can help all of us go to sleep more easily. With children, be particularly clear as to what those routines are. For his own young children, Shessler used a ‘two rule’ approach. At bedtime, he read two books, snuggled for two minutes, sat in a chair in their room for two minutes, and even waited outside for two minutes while they settled.

    Adhere to that routine, he says. “What happens with a lot of parents with young kids is that a two-step or three-step process turns into a 22-step or 23-step process. If that happens, you need to reassess and figure out how to adjust.”

    When it comes to encouraging young children to stay in bed, Shessler also recommends an "I’ll Be Right Back" approach. After you say goodnight, if they insist you stay, tell them you have to do something and then say you’ll be right back. “Say you’ll brush your teeth, for example, and then come back to check on them. When you come back, congratulate them for staying in bed,” he says. If they insist you stay, tell them you have another task, maybe to put the laundry in the dryer, and again, remind them you’ll be right back. Over time, they will begin to feel more secure. “Maybe at first you had to do a task eight times, then it was five, then it was three, and then they're sleeping on their own,” he says.

  2. Be consistent with sleep and wake times
    “Be consistent,” Shessler says. Bodies and sleep cycles thrive on schedules, no matter the age. Establishing consistent sleep and wake times is easier to do and stick with at younger ages and is harder to manage with teens, who can have big variations in their sleep and wake times. 

    “Teenagers might say, ‘On school mornings, I wake up at 6am, but I sleep until 2pm on the weekend. So their brain has no idea what time it's supposed to be tired because of the variations between those time frames. The closer the weekend time frame and the weekday, the better,” he recommends, encouraging teenagers to close that gap as much as their schedule will allow.
  3. Use calming strategies
    We all have to figure out our calming strategy, even adults. Think about incorporating relaxation techniques into the nighttime routine, advises Shessler. For some, warm drinks like chamomile tea or Sleepy Time can be helpful. “Like what your great-grandmother told you about warm milk at nighttime. With something hot, you can't chug it. You have to sip. It’s part of ‘I'm sipping. I'm slowing myself down,’” he says.

    Reading or listening to calming music also can be helpful. But if you're reading books that stimulate you, you may be better served to read ones that put you to sleep. “We use nighttime relaxation techniques so that we're not going from 60 to 0 and then expecting to fall asleep in two minutes. We have got to figure out what our calming strategy is.” 
  4. Associate the bedroom with sleep 
    “The bedroom is not for studying, reading, doing all of your homework, or hanging out in bed all day,” says Shessler. “We want it to switch our gears, so our bedroom becomes more associated with sleep.”
  5. Stay away from screens and electronics
    Use of electronics and accessibility to them during the night can significantly undermine sleep quality. Blue lights or the colors that appear on a screen stimulate your brain. “If you turn off your screen and attempt to go to bed, right afterward your brain is stimulated. Some people also will say that they need the TV to fall asleep. The TV is not putting you to sleep. If you need noise, white noise is better,” he says.

    Shessler recommends no TVs, video games, tablets, or phones in the bedroom during sleep. Charge all family electronics downstairs at night. “The anticipation of a ding or the ability to just check something quickly can distract our brains as well. This is very important,” he says.
  6. Talk with your child’s provider
    Finally, always share the supplements you or your child are taking with your provider. There are times when giving melatonin to your child may make sense, particularly during a change of routine like transitioning back to school after a vacation. At younger ages, from ages three to five years old, Shessler does not recommend melatonin. If he and a parent decide melatonin is appropriate, he talks about dosage and a recommended approach. Any supplement sold over the counter can be short of information due to a lack of oversight. Brand, dosage, duration, and how and when to use a supplement need to be discussed with your provider first, as part of an integrated approach to healthcare, he explains. Shessler always accompanies his recommendation with the implementation of more sleep-healthy habits. Once those habits are strong and ingrained, he then recommends cutting down the melatonin dose.

    “My biggest concern right now is that people are focusing on the supplement as the key piece. The real focus should be on healthy habits and sleep routines,” he concludes.