Experts have noticed an "exponential rise" in children being given melatonin to help them sleep but say parents shouldn't buy it online.
Melatonin is a hormone produced by the brain after dark that regulates the circadian rhythm or body clock. In Australia, it's a prescription medication for people under the age of 55.
The Therapeutic Goods Administration (TGA) has approved prescription-only melatonin for use in children between two and 18 with autism spectrum disorder.
While it's generally considered safe, rare side effects include night terrors, irritability, nausea, stomach pain, headache and drowsiness the following day.
In the United States, it's considered a dietary supplement and is widely available, making it available for Australians to buy online where it's sold as flavoured gummies, clearly marketed at children.
There is no research on the drug's long-term effect on children and regulators warn there's no way to know whether unprescribed medication bought on the internet is safe.
Sarah Blunden, a clinical sleep psychologist, professor and head of paediatric sleep research at Central Queensland University, says there has been a "massive increase" in melatonin use among children.
"I have seen an exponential rise in melatonin prescriptions and use, because they are not the same thing, either through a medical professional or online in the last certainly five years," Professor Blunden says.
"It is really dangerous that these children are being given drugs that are not indicated for that particular purpose, and that we can get online that are sometimes not even regulated and [that we] know what is in them.
"Between 50 and 70 per cent of the people I see are on melatonin, which is amazing considering five years ago this wasn't a thing."
Dilemma for parents
Haylie Beckett's son Jayce has autism and for the first five years of his life would only sleep for a few minutes at a time.
Bedtime was a nightmare at their Dubbo home until their paediatrician recommended melatonin.
Now 10 years old, Jayce no longer needs it to get to sleep and Ms Beckett credits melatonin with changing her family's life.
"He went from sleeping from 16 minutes at a time to be able to sleep for the whole night," she says.
"Without melatonin I don't think his body would ever have been able to train itself to sleep."
While Ms Beckett says she understand parents' temptation to buy it online, she's shocked so many people don't consult their GP first.
"I fully understand the difficulties of not having a child who sleeps. I understand the stress and the worries and the impact it has on your everyday life," she says.
"I wouldn't give my child any other drug just because I am having a hard time. I think melatonin should be treated the exact same."
Quality control concerns
The TGA says it is illegal to import prescription medicine without a script and advises "extreme caution" for parents considering it.
"Products that are not regulated by the TGA may not meet Australian manufacturing quality standards and could also contain undisclosed harmful ingredients," a spokesperson says.
"Children suffering from any medical condition should be seen by a doctor, and not given medicines purchased from the internet."
A Canadian study published in the Journal of Sleep Medicine in 2017 found the melatonin contained in over-the-counter products sold overseas varied wildly from the amount listed on the label.
The dosage was incorrect in 71 per cent of supplements, with the actual amount ranging from 83 per cent less to 478 per cent more than the concentration declared on the bottle.
Emergency calls reflect increased use
Paediatric and adolescent sleep specialist Chris Seton says calls to the Australian poison information centre, based at Sydney's Westmead Hospital where he works, received 2,000 calls about children having an adverse reaction to melatonin in 2021.
"It just gets higher each year. I think six years ago it was about 300 calls," Dr Seton said.
"Although we can't accurately measure how many kids are having melatonin I think the emergency calls are a reflection of the increase in use."
Dr Seton says addiction to mobile phones is likely the major cause of the sleeping problem epidemic.
Studies have found 70 per cent of school students are chronically sleep deprived, twice as many as there were 15 years ago.
He says trouble sleeping is usually a behavioural issue and medicating children should only be used as a last resort.
"We thought melatonin as an addition to other behavioural therapy would be helpful but in fact it had the reverse effect," he says.
"We discovered that when we used melatonin as part of our sleep program, teenagers were less likely to do the other parts of the therapy because they had a drug to take.
"It's just human nature. If you are given a choice between hard behavioural therapy and taking a tablet, most people will just take the tablet."
No quick fix
Professor Blunden says one of the greatest predictors of melatonin use is not the syndrome of the child, but the stress level of the parent.
"The quick fix is really very tempting but it does not getting to the crux of the problem," Professor Blunden says.
"Parents say, 'It's a natural compound so I'm OK with giving it to my child'.
"It's not natural. It's in a bottle, it's synthetic, it's a chemical.
"We don't know where it has come from and we don't know what the long-term effects are so we have to use it with caution."
Any melatonin used by children in Australia should be prescribed by a GP or paediatrician, and it's important to monitor progress and side effects.
Dr Seton says the concern is that parents who buy it online might treat it as a "sleep candy" rather than a drug.
"We don't want parents to treat it as a candy, or a lolly or a vitamin," he says.
"We would much prefer they get a script from their family doctor."
