Matthew Hinton, MD, has been providing quality, compassionate care to local children and their families since 2004. He is a member of the YRMC PhysicianCare Ponderosa Pediatrics team, whose focus is honoring parents as the true primary caregivers of their children, and creating a therapeutic alliance to help children reach their healthy potential. We spoke with him recently about the growing concern that children aren’t getting enough quality sleep.
Q: Are you seeing a rise in the incidence of sleep issues among your patients? If so, what do you think the reasons are?
Dr. Hinton: It certainly seems that there is an increasing incidence of sleep issues in the pediatric population. There are likely many reasons for this, but one probable contributing factor is the significant increase in the use of handheld devices such as smart phones and tablets that children have access to. The blue light from the screens has been shown to adversely affect sleep onset in people of all ages.
In addition, simply having a device in the bedroom contributes to participating in online activities that keep children awake longer. For example, gaming into the night, texting friends, or watching movies often delays sleep for children, robbing them of needed rest. Another reason for the increase is related to the rising prevalence of obesity, a known risk factor for sleep apnea.
Q: What questions do you ask a parent or guardian of a child who has difficulty sleeping? What recommendations do you typically make?
Dr. Hinton: First, I like to get a sense of when they actually go to bed and what time they rise. How long do they lay awake until they actually start to sleep? Do they wake often during the night? Do they have a device in their bedrooms, and if so, what rules are in place for their usage? Are they consuming caffeine late in the day or are they on medications that may affect their ability to sleep, such as ADHD medications? Do they snore? Do they have any indication of sleep apnea? If these and other similar questions point to treatable issues, then I make appropriate recommendations. Sometimes more advanced investigations are necessary, such as looking for thyroid or other physical or mental disorders.
Q: What is melatonin?
Dr. Hinton: Melatonin is a natural neurotransmitter-like compound made by the pineal gland in the brain. It plays a role in the body’s natural sleep-wake cycle. It is also widely commercially available as a dietary supplement. As such, it is essentially unregulated by the Food and Drug Administration and is not monitored by the FDA for safety or effectiveness. Because it is a natural chemical in the body, it is widely perceived as being safe. Many people use melatonin for help in regulating sleep cycles and inducing sleep.
Q: How does melatonin work in the body?
Dr. Hinton: We know that receptors for melatonin are found in various places in the body. In the brain, melatonin exerts a strong influence. It is produced and released in response to the absence of light (and, alternatively, inhibited by light entering the eyes) and therefore helps to establish the body’s circadian rhythm. Interestingly, melatonin has other biological roles, including helping to regulate menstruation in women. It is even purported to have anti-aging and antioxidant properties.
Q: Are there side effects and/or adverse interactions with other substances?
Dr. Hinton: The primary effects of melatonin are the ones usually desired—sedation and induction of sleep. In general, there are few known serious reactions. That said, it’s good to be aware that melatonin may induce short-term depression in some people and can cause headaches. Some children may have increased nighttime urination. In addition, melatonin may interact with antiplatelet drugs, like aspirin, to increase the risk of bleeding. It is highly recommended that you talk with your care provider before using melatonin or any medication or supplement.
Q: What considerations are there when recommending melatonin for children?
Dr. Hinton: Because melatonin is an unregulated dietary supplement, clear, scientifically based guidelines for dosing are unavailable. I would usually recommend that doses be low, around 0.5 to 1 mg. nightly for younger children, and perhaps 3 to 5 mg. for older kids and teens. Some experts have observed that these dosages create blood levels that are significantly higher than the normal physiologic levels found in the body, so going much beyond that it probably unnecessary.
Q: Do you think melatonin is safe and effective for children?
Dr. Hinton: Despite lack of clear scientific evidence as to its safety, melatonin has been used extensively for millions of people, many of them children of various ages. Therefore, we can cautiously assume that it is likely safe, although I would encourage more scientific research. I do get concerned when dosages get significantly high, such as above 5-6 mg daily. I am not sure there is much benefit to higher doses than that.
Q: Is it wise for parents to give their children melatonin indefinitely?
Dr. Hinton: As with any medication or supplement, melatonin is probably best taken for as short a time as possible. There are very little data to guide us in extended use, so we really don’t know how effective it is in the long term or how safe it is. If there are specific concerns, it’s probably best to discuss them with your child’s healthcare provider.
Q: Where can we learn more about children’s sleep issues and how to deal with them?
Dr. Hinton: There are a number of articles on the American Academy of Pediatrics website called HealthyChildren.org that discuss sleep. And of course, we always encourage parents to talk with their children’s care provider about any concerns or questions they may have.
YRMC PhysicianCare Ponderosa Pediatrics is currently welcoming new patients. It accepts most insurance plans, including AHCCCS. The office is located at 2120 Centerpointe West Drive, Prescott, Arizona. For more information or to make an appointment, please call (928) 778-4581.