What the uptick in child melatonin use says about our psychological fragility
Two recent studies showed an alarming upward trend in the use of sleep-aid supplements by children. But they also revealed a common weakness in how we deal with what we can’t control.
A fascinating study was published in JAMA Pediatrics last month by a team from the University of Colorado at Boulder. The researchers got 993 parents from around the United States to fill out an online questionnaire about the sleep habits of their child. They found that almost 20% of kids aged 5 through 13 had received melatonin before bedtime at least once in the past month.
Melatonin is a hormone that naturally occurs in the human body and plays a role in regulating our sleep-wake cycle. Your melatonin levels go up at night, which helps you fall and stay asleep. Some people take extra melatonin as a tool to drift off faster, for instance to reduce jet lag when traveling across time zones. But melatonin is generally not appropriate for long-term use, especially not for kids.
Indeed, it can be dangerous. Since melatonin is not a controlled substance in the U.S., it is sold over the counter—including on Amazon—in fun gummy forms (see picture). These gummies often contain much more of the active ingredient than what the label says. Perhaps because of this, there has been a 530% increase in calls for pediatric melatonin ingestions to US Poison Control Centers between 2012 and 2021.
At first I found the Boulder study hard to believe. Is it really true that we are medicating 20% of children to help them sleep? We should take the numbers with a grain of salt, because the participants were not a representative sample of U.S. parents. The researchers used what’s called a convenience sample, recruiting participants ad hoc by circulating flyers and social media ads. Still, sampling bias could be limited since these study ads only mentioned sleep and not melatonin specifically. Moreover, another recent report—a survey run by the American Academy of Sleep Medicine—listed an even higher prevalence of melatonin use: a whopping 46% of questioned parents said they had ever given melatonin to their kid to fall asleep.
Whatever the precise number, it is shocking that millions of American children receive medication to stimulate a totally natural behavior. Because this is the interesting thing about sleep: it’s one of the few human behaviors that remain beyond our control. Anyone who’s laid awake at night knows that you cannot will yourself to fall asleep. Sleep is all about letting go, relaxing, and trusting your body to drift off—meaning an increased focus on “success” can backfire.
This is the irony of melatonin use, too. While it might help you fall asleep once or twice, prolonged use can make you insecure about going without it. So instead of a better sleeper, melatonin might actually make you (or your kid) a worse one.
To me, this reflects a larger tragedy in modern parenting (and life): a counterproductive need for control. Take the childhood anxiety epidemic. About 1 in every 10 children aged 3 to 17 in the U.S. now has an anxiety disorder. And many parents instinctively respond by supervising their children more, always wanting to know their whereabouts. The idea seems to be that if we reduce the chance that our kid is exposed to danger, the child will experience less fear and their anxiety will go down. But as researchers like Oxford psychologist Lucy Foulkes have pointed out, this can have the opposite effect. The evidence-based intervention against anxiety is not avoidance, but exposure.
An alternative treatment was therefore developed by psychotherapist Camilo Ortiz and his team. The anxious kids in their practice come up with ‘independence activities’ (IAs), which are things they normally find scary to do. A nine-year-old girl, for instance, will go to the bakery by herself to buy bread for her mother. By overcoming her fear, going out, and returning without any incidents, she learns that the outside world is less dangerous than she thought. This is how kids get stronger: not by growing a thicker shield, but by growing confidence in interactions with the outside world.
There was just one practical issue with this intervention: adults. Ortiz writes:
We’ve never had a stranger try to harm a child practicing independence; on the other hand, we’ve seen plenty of anxious strangers stepping in to “protect” our kids by trying to stop the independence activity. Here’s where we have leaned on Let Grow’s expertise. They have handy “Kid Licenses” informing strangers that a child out and about in the world is nothing to be alarmed about. Kids sign them, and then they can flash them like a literal badge of honor if anyone questions what they are doing.
The examples of sleep and fear demonstrate that we can make our psychological health worse by trying too hard. Rather than making sure that our everyday life stays within a narrow band of acceptability, it’s better to learn to function in a wide range of environmental conditions.
Getting there doesn’t have to be difficult. The more we expose ourselves to new and unpredictable experiences, the more confident and capable we become at coping with the unexpected. This is what mathematician and writer Nassim Nicholas Taleb has called “antifragile” design:
Some things benefit from shocks; they thrive and grow when exposed to volatility, randomness, disorder, and stressors and love adventure, risk, and uncertainty. Yet, in spite of the ubiquity of the phenomenon, there is no word for the exact opposite of fragile. Let us call it antifragile. Antifragility is beyond resilience or robustness. The resilient resists shocks and stays the same; the antifragile gets better.
The immediate downside of living antifragilely is that you have more experiences that are uncomfortable in the short term. You might get shouted at on the street, you might be sleepy during a morning meeting. But once you realize that you can live with these minor inconveniences, your need for control will loosen—and that has major benefits for how relaxed you are in the long run. Letting go will help you deal with larger challenges more effectively. And it comes with life’s largest boons, as Foulkes convincingly writes:
People talk about the runner’s high, but I think there is an equivalent for people prone to anxiety – let’s call it the worrier’s high. I still feel it regularly now. It’s the truly amazing feeling of doing something you are scared of and coming out the other side. Every anxious teenager deserves the opportunity to feel this high, again and again, and to watch their comfort zone expand a little bit every time that they do.
Where does this leave us when it comes to sleep? Although you can’t will yourself to drift off, you can set the stage as well as possible. This includes sticking to a tight bedtime schedule, sleeping in a dark, cool room, and shutting off your screens two hours before bedtime. And perhaps most importantly, accept that there will be some short nights, that you will feel tired the next day, and that life goes on anyway.
So this week, ask yourself: where in my life am I exercising control while I should actually let go and learn that I can handle the consequences? Loosening the reins may bring unforeseen benefits—and help you stay off the melatonin, too.
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