What is the recommended dose of magnesium glycinate (Mg) for a pediatric patient with sleep disturbances?

Magnesium Glycinate Dosing for Pediatric Sleep Disturbances

For children with sleep disturbances, start with 5-6 mg/kg/day of elemental magnesium (approximately 100-165 mg daily depending on age and weight), using magnesium bisglycinate formulation, administered 1-2 hours before bedtime. 1, 2

Age-Specific Dosing Guidelines

For Children 6-10 Years Old

• Starting dose: 100-130 mg elemental magnesium daily 2
• Maximum safe dose: 110-130 mg per day to minimize gastrointestinal side effects 2
• Formulation: Magnesium bisglycinate (glycinate) is strongly preferred over other forms due to superior gastrointestinal tolerance 1, 2

For Children 11+ Years Old

• Starting dose: 110-165 mg elemental magnesium daily 1
• Maximum dose: Can tolerate slightly higher doses than younger children, though should not routinely exceed 165 mg daily 1

Critical Administration Details

Timing is essential: Administer magnesium 1-2 hours before the child's habitual bedtime for optimal sleep-promoting effects 1, 2

Mandatory Safety Assessments Before Starting

You must assess the following before initiating magnesium supplementation:

• Renal function: Magnesium is primarily renally excreted and is absolutely contraindicated in severe renal impairment 1, 2
• Cardiac history: Screen for complete heart block or severe cardiac conduction abnormalities 1, 2
• Gastrointestinal status: Rule out active gastrointestinal obstruction 2

Monitoring During Treatment

Watch for these dose-limiting adverse effects:

• Gastrointestinal effects (diarrhea, abdominal cramping) are the primary concern and most common reason to reduce dosing 1, 2
• Signs of hypermagnesemia: muscle weakness, hypotension, or bradycardia, though rare at recommended doses 2

Important Clinical Caveats

Avoid magnesium chloride in high doses due to increased risk of anion gap and metabolic acidosis 1

The evidence base for magnesium glycinate specifically for pediatric sleep is limited compared to melatonin. Consider melatonin as first-line therapy instead, as it has stronger evidence for pediatric sleep disorders with dosing of 0.15 mg/kg (approximately 3-6 mg for school-age children) taken 1.5-2 hours before bedtime 1, 3

When Magnesium May Be Preferred

Magnesium supplementation may be particularly appropriate when:

• The child has documented or suspected magnesium deficiency (common in children with poor dietary intake) 4
• Parents prefer avoiding melatonin due to concerns about hormonal effects
• The child has inflammatory conditions that may benefit from magnesium's anti-inflammatory properties 4

Formulation Selection Algorithm

1. First choice: Magnesium bisglycinate (glycinate) for best gastrointestinal tolerance 1, 2
2. Avoid: Magnesium chloride at higher doses due to metabolic concerns 1
3. Alternative if bisglycinate unavailable: Magnesium citrate, though may cause more GI effects 4

Duration of Treatment

The guidelines do not specify maximum duration for magnesium supplementation in children for sleep, unlike melatonin which has specific time limits. However, periodic reassessment every 3-6 months is prudent to determine ongoing need and assess for any adverse effects 2

Absolute Contraindications

Do not use magnesium glycinate in children with:

• Severe renal impairment 1, 2
• Complete heart block or severe cardiac conduction abnormalities 1, 2
• Active gastrointestinal obstruction 2