Pediatric Melatonin Overdoses Up 530%

According to a new CDC report, the number of children taking too much melatonin increased 530% over the last decade, and pediatric hospitalizations and more serious outcomes are also on the rise, primarily because of an increase in accidental melatonin ingestions in children under the age of five.

The report looked at children under the age of 19 during the 2012–2021 period, with a total of 260,435 ingestions reported to poison control centers, which represented 2.25% of all pediatric ingestions reported during the same period.

The majority of ingestions were unintentional (94.3%), involved boys under the age of five, occurred in the home (99%), and were managed on-site (88.3%). Most children (82.8%) were asymptomatic, and among those with reported symptoms, most involved the gastrointestinal, cardiovascular, or central nervous systems.

Among 27,795 patients who received care at a health care facility, 19,892 (71.6%) were discharged, 4,097 (14.7%) were hospitalized, and 287 (1.0%) required intensive care. Among all melatonin ingestions, 4,555 (1.6%) resulted in more serious outcomes. Five children required mechanical ventilation, and two died. Both deaths occurred in children under the age of two (3 months and 13 months) and occurred in the home. One ingestion involved intentional medication misuse; the reason for the other is unknown.

What Is Melatonin?

Melatonin is regulated by the Food and Drug Administration as a dietary supplement and is a widely available over-the-counter (OTC) sleep aid for adults and children. It is used therapeutically for insomnia in adults and for primary sleep disorders in children, and its use has increased in both adults and children.

In the United States, melatonin requires no prescription, and is subject to less regulatory oversight. Melatonin is widely available in tablet, capsule, liquid, and gummy formulations. It is cost-effective and offers an OTC therapeutic alternative to enhance sleep without the use of potentially habit-forming sedative-hypnotics.

Melatonin Use During the Pandemic

In 2020, melatonin became the most frequently ingested substance among children reported to national poison control centers. The largest annual increase in pediatric melatonin ingestions coincided with the onset of the COVID-19 pandemic, and unintentional ingestions were the primary drivers of this increase.

This might be related to increased accessibility of melatonin during the pandemic, as children spent more time at home because of stay-at-home orders and school closures. Further, reports of increasing sleep disturbances during the pandemic might have led to increased availability of melatonin in the home. This pandemic-related increase in accessibility and availability might have contributed to increased exposures in children.

Increased sales, availability, and widespread use have likely resulted in increased access and exposure risk among children in the home. Public health initiatives should focus on raising awareness of increasing melatonin ingestions among children and on preventive measures to eliminate this risk, and health care providers should advise parents regarding the safe storage and appropriate use of melatonin.