What is the recommended starting dose of melatonin (N-acetyl-5-methoxytryptamine) for an 11-year-old?

Melatonin Dosing for 11-Year-Old Children

For an 11-year-old child, the recommended starting dose of melatonin is 0.15 mg/kg taken 1.5-2 hours before habitual bedtime, which typically equates to 3-5 mg for most children this age. 1

Dosing Guidelines

The appropriate melatonin dose depends on the specific sleep disorder being treated:

• For children with delayed sleep-wake phase disorder (DSWPD):

  • Without psychiatric comorbidities: 0.15 mg/kg taken 1.5-2 hours before habitual bedtime 1
  • With psychiatric comorbidities: 3-5 mg (weight-based) taken at 18:00 or 19:00 1

• For general sleep onset difficulties:

  • Start with 1-2 mg approximately 1-2 hours before bedtime 1
  • Titrate up as needed, typically not exceeding 5 mg for children 1, 2

Administration Recommendations

• Administer melatonin on an empty stomach to maximize effectiveness 1
• Give 1-2 hours before the desired bedtime 1
• Use immediate-release formulation rather than extended-release, as there is no evidence that extended-release confers advantage over immediate release 2
• Melatonin is most effective when administered 3-5 hours before physiological dim light melatonin onset 2

Safety Profile

Melatonin has a favorable safety profile in children:

• Acute toxicity studies show toxic effects only at extremely high doses (>400 mg/kg), thousands of times higher than recommended doses 3
• No serious adverse effects have been identified in human studies 2
• Common mild side effects may include:
  • Daytime drowsiness
  • Headache
  • Dizziness
  • Changes in mood 1

Important Considerations

• Monitor effectiveness: Assess sleep onset latency and total sleep time improvements after starting treatment 1, 4
• Regular reassessment: Periodically attempt to discontinue melatonin treatment to assess continued need 1
• Long-term use: Consider stopping melatonin treatment at least once a year (preferably during summer holidays) as circadian rhythmicity may change during long-term treatment 3
• Timing is critical: If taken at the wrong time (too early in the day), melatonin can cause sleepiness and delay adaptation to local time 5

Non-Pharmacological Approaches

Always combine melatonin with behavioral interventions:

• Maintain consistent sleep-wake schedules, even on weekends 1
• Create a dark, quiet, and cool bedroom environment 1
• Reduce evening exposure to blue light from electronic devices 1
• Remove electronic devices from the bedroom 1
• Consider cognitive behavioral therapy for insomnia (CBT-I) if appropriate 1

Special Considerations

• Decreased CYP 1A2 activity (genetically determined or from concomitant medication) can slow melatonin metabolism, potentially requiring dose reduction 2
• Use caution in children with epilepsy, though limited data suggest melatonin does not exacerbate seizures and might actually decrease them 2

Melatonin has been shown to be effective in reducing sleep onset latency by approximately 37-45 minutes in children with neurodevelopmental disorders 4, making it a valuable option for children with sleep difficulties.