© 2014 Roy Benaroch, MD
J-Mom wrote: “My 10 year old son often has trouble falling or staying asleep, mostly due to anxiety. My son has not had any help from melatonin in the past. We do several things to help him fall asleep, back scratch, singing softly, white noise machine, but some days are just impossible for him to sleep. His doctor mentioned using a magnesium supplement as a natural sleep aid. Do you have any experience with trying magnesium in kids? Some cursory research I did suggests that it’s effective in cases of a Mg deficiency. Do some people use it even if no deficiency is found? Do you have to test them first? Any thoughts on this? Thanks!”
The best ways to help a child relax and sleep are simple steps that J-Mom is probably already doing:
Have a set, relaxing bedtime routine.
Avoid screens for 1-2 hours before bedtime.
Set a consistent time for bed and waking.
Get plenty of exercise (though not in the few hours before bedtime)
Make the bedroom comfortable and happy.
Still, some kids even with great routines can still have trouble falling asleep or staying asleep. That can be especially so for children who are anxious—sometimes worries become magnified at night. Anxiety that causes significant day or night symptoms really should be discussed with a child’s pediatrician, and may need to be treated to help overcome its effect on sleep.
But to answer J-Mom’s question, what other kinds of sleep aids are there for children?
Melatonin is probably the most popular. What’s widely sold is a synthetic version of a natural human hormone that seems important in regulating sleep cycles and setting our “biologic clock” for the day. We know that children with damage to the part of the brain that makes melatonin have problems with sleep cycles, so why not give a little extra to help everyone sleep better?
In general, melatonin seems pretty safe for most people. It can have interactions with some medications, and there is some evidence that in at least some children it might increase the risk of seizures (though that is not seen commonly). There also isn’t great long-term data on daily melatonin use in kids. So I’d treat melatonin with respect, like any other medication: use it only if necessary, at a minimum dose, for a minimum amount of time.
J-Mom also asked about magnesium supplementation. Deficiencies of both magnesium and calcium have been linked to poor sleep in animal and observational studies, and magnesium supplementation in at least one study did seem to help elderly people sleep better. However, I couldn’t find any good evidence that magnesium supplements will help children sleep. An ordinary-dose magnesium supplement is unlikely to be harmful, so trying one isn’t unreasonable. Blood tests for magnesium levels can be deceptive—a one-time test may miss some people who are truly deficient, so testing children for blood magnesium levels is unlikely to be useful.
Chamomille and valerian are two herbs that have some evidence as sleep aids in adults, though again, studies in children are lacking. They’re both probably safe. One “natural product” that had once been touted as a sleep aid is Kava (sometimes called Kava-Kava), which has been linked to liver toxicity and many drug interactions, and should be avoided.
If a child is having significant sleep concerns, this ought to be discussed with a doctor. In addition to anxiety, medical things including asthma, allergies, sleep apnea, and restless leg syndrome can interfere with sleep. Though sedatives and sleep drugs are rarely used in pediatrics, there are often lifestyle changes and simple steps that can make a big difference. Though some natural sleep remedies are probably safe enough to try, they’re not the best way to help most children sleep better.