Should I give my child with autism melatonin to sleep? Part 2

Beth Malow
5 min readDec 1, 2023

This blog is part of my series on “Should I Give My Child with Autism Melatonin to Sleep?” The goal of my series is to help you figure out if melatonin is right for your child.

In Part 1 of my blog, I introduced you to melatonin, and we talked about the bright side and the dark side of melatonin supplements. Let’s look at some common questions parents ask. I’ll give a brief answer for each question. For some complex questions, I’ll give a link to take a deeper dive. I’ll also provide links to more resources. You may want to refer to my blog on tools to evaluate media so that you can be a better consumer of the facts that are out there.

1. How much melatonin should I give my child?

You might think how much melatonin to give your child might be based on your child’s age, or weight. But these factors might not matter!

To fall asleep easier, some children need only 1 mg, while others need 3 mg, and only a few need more (most don’t need more than 6 mg). Age and weight may not matter. We like to say “Start low and go slow.” That way you are giving the smallest amount of melatonin to your child. This can limit side effects. It makes sense to start with 1 mg and go up by 1 mg no more quickly than once a week.

2. When should I give melatonin?

Children usually take melatonin 30 minutes before bedtime to get drowsy and help fall asleep. You want to have your child do something relaxing, like read a book or listen to music, while the melatonin works its way into their system. Some doctors say to give melatonin a few hours before bedtime to act on the brain’s internal clock and keep it in sync with the outside world. This can be helpful if your child tends to go to bed very late (past midnight). If used for this purpose, the dose recommended is generally low (0.5 mg). One option is to give a small dose a few hours before bedtime and then a larger dose (1–3 mg) 30 minutes before bedtime.

3. What is the difference between immediate (fast) and prolonged release melatonin?

Most melatonin comes in “fast release” pills, liquids, or gummies. The pills may dissolve under your child’s tongue, or could be swallowed whole or crushed. Liquid can be mixed with juice or milk (or flavored to be tastier for children). The “fast release” type lasts only a short time. This is why melatonin may work better for falling asleep than staying asleep.

Prolonged release melatonin has a coating around the pill. It goes into your child’s body gradually. It may work better to prevent night wakings, because it is goes into your child’s body over a longer time. Be careful not to crush the pill though. Crushing the pill means that the coating will no longer be effective, and will turn the pill into the fast release type.

Many children with autism have trouble swallowing pills. Your child’s therapist can sometimes help with pill swallowing, or your child can practice swallowing smaller size foods, like cake sprinkles (but be careful that anything you give your child to swallow will not be a choking hazard).

4. How can I be sure that the bottle contains only melatonin and not anything else?

You can’t always be sure. Melatonin supplements are not medicines, but instead are dietary supplements, like vitamins. Medicines are looked at by the Food and Drug Administration (FDA). The FDA makes sure that what the bottles say they contain, and what they actually do contain, match up. That doesn’t happen with dietary supplements.

It helps to look for a “USP verification mark” on the melatonin bottle. A USP label means that the supplement follows standards of quality. One of those standards of quality is that you are actually getting what you see on the label. You can read more HERE.

5. What side effects might my child show if they take melatonin?

All medicines, even melatonin, have side effects. Side effects are symptoms you don’t want your child to have. For melatonin, these may include dizziness, stomach problems, or nightmares. But some children can have these symptoms without taking melatonin. You can learn more HERE about how to figure out side effects.

6. Does taking melatonin supplements delay puberty?

The short answer is no. Hormones that go along with puberty do not change if a child is taking melatonin. Click HERE for a deeper dive and to look at the evidence for yourself.

7. Will my child stop making their own melatonin over time? Will they become dependent on melatonin supplements to sleep?

The short answer is no. Children taking melatonin supplements who stop them still make their own melatonin. This is important because parents may want to stop melatonin once a child is sleeping better. (I agree with trying to stop melatonin, or any medicine, once it is no longer needed). Click HERE to learn more.

8. What about caffeine, exercise, and screens? What about relaxing activities at bedtime?

You want to limit caffeine during the day, and turn off any device with a screen at least 30 minutes before bedtime. This will help your child fall asleep. Physical activity can be helpful too.

Relaxing activities at bedtime will help melatonin work better. Relaxing activities can also allow a child to come off of melatonin over time. Children with autism love visual schedules, and using one at bedtime can help promote sleep. Every child is different, and you are the best judge of what your child will need to have to relax at night.

Try white noise, weighted blankets, a night light, and other things until you find what helps your child relax. But don’t purchase sleep aids that cost a lot of money! You can find free pamphlets, visuals, and videos on these habits, and more, at this website.

I hope this blog, and my others, have helped you find answers to the questions about melatonin that you have, and be more informed when you talk with your child’s doctor about melatonin. If you have additional questions, please leave a comment, and I’ll do my best to answer. I will also create more blogs for the complex questions that you ask.

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Beth Malow

Dr. Malow, from Vanderbilt University Medical Center in Nashville, TN, is Professor of Neurology and Pediatrics, Director of the Vanderbilt Sleep Division.