Melatonin (Paediatric — Sleep Disorders)

How it works

It is an analogue of the endogenous pineal hormone melatonin and acts on MT1 and MT2 receptors to reinforce circadian sleep-wake signalling and shorten the time taken to fall asleep.

Prescribing in practice

• The most important paediatric point is that melatonin should be used as part of a structured sleep-hygiene programme and reviewed regularly, as it is largely unlicensed in this age group and long-term effects on development are not fully established.
• Modified-release and immediate-release preparations behave differently and are not interchangeable, so the specific formulation must be specified.
• Caution is advised with concomitant medicines that affect its metabolism and in children with hepatic impairment or autoimmune disease.

Monitoring

Monitor sleep latency, daytime functioning and the continued need for treatment at regular review, with planned attempts to reduce or stop.

Counselling the patient

• Give the dose a set time before the desired bedtime and maintain consistent bedtime routines and a screen-free wind-down.
• Modified-release tablets that need to be swallowed whole may be unsuitable for young children, so check the formulation.
• Treatment is usually reviewed periodically to see whether it is still needed.

Evidence & guidelines

NICE guidance on conditions such as autism and ADHD supports melatonin for sleep problems only after behavioural approaches, reflecting its largely unlicensed paediatric status.