Skyrocketing melatonin poisonings in children over the past 10 years

The number of children in the United States who have unintentionally ingested melatonin supplements over the past 10 years have skyrocketed to the point where, in 2021, melatonin ingestions by children accounted for nearly 5% of all poisonings reported to poison control centers in the United States, according to data from the National Poison Data System (NPDS).

That compares to just 0.6% of melatonin ingestions reported to poison control centers in 2012, the authors added.

“Basically, the number of pediatric melatonin ingestions increased by 530%, from 8,337 in 2012 to 52,563 in 2021, so this is a 6.3-fold increase from the start of the study to ‘in the end,’ Michael Toce, MD, one of the study authors and participant, Pediatric Emergency Medicine/Medical Toxicology, Boston Children’s Hospital, said in an interview.

“And I think the main driver of that increase is just that melatonin sales have gone up astronomically, so there’s just more melatonin in the home and studies have shown that there’s a correlation between the amount of “an individual drug in the home and the risk of pediatric disease exposure – simply put: the more of a single substance there is in a home, the more likely a child is to enter it,” said he pointed out.

The study was published in the Weekly report on morbidity and mortality.

Melatonin ingestions

All cases of ingestion of a single melatonin substance involving children and adolescents between January 1, 2012 and December 31, 2021 were included in the analysis. During the 10-year study interval, 260,435 pediatric melatonin ingestions were reported to the NPDS. Over 94% of reported ingestions were unintentional and 99% occurred in the home.

More than 88% of them were managed on site; most involved young male children aged 5 and under, and nearly 83% of children who took melatonin supplements remained asymptomatic. On the other hand, 27,795 patients were treated in a health establishment and nearly 15% of them were hospitalized. Of all melatonin ingestions, 1.6% resulted in more severe outcomes; more serious outcomes being defined as moderate or major effects or death. Five children required mechanical ventilation to treat their symptoms and 2 patients died.

The greatest number of hospitalized patients were adolescents who were intentionally taking melatonin, but the greatest increase in exposure rate was among young unintentional patients, as observed by Toce. Interestingly, the largest annual increase in pediatric melatonin ingestions — nearly 38% — coincided with the onset of the COVID-19 pandemic.

“This may be related to increased availability of melatonin during the pandemic as children spent more time at home due to stay-at-home orders and school closures,” the authors speculate. Additionally, sleep disturbances were common during the pandemic, which increased the likelihood of parents purchasing melatonin and thus exposing children to more melatonin at home.

Taken appropriately and in normal doses, melatonin itself is quite safe, as Toce pointed out. However, “for any substance, the dose makes the poison, so taken in significant quantities, everything becomes dangerous”. Additionally, it’s important to understand that melatonin, at least in the United States, is regulated as a dietary supplement, not a pharmaceutical.

“So it doesn’t go through the same rigorous testing as something like acetaminophen made by the FDA and that means two things,” Toce noted. First, if the product says each gummie contains 3mg of melatonin, no independent body verifies whether or not that claim is true, so there could be 3mg of melatonin in each candy or there could be 10 mg.

Second, because there is no unbiased oversight of dietary supplements, there may actually be no melatonin in the product, or there may be something else added to it that could be harmful. . “Just because something is sold over the counter doesn’t necessarily mean it’s safe,” Toce pointed out. To protect children from pharmaceuticals and supplements, he recommended several generic poison prevention tips. This advice could be passed on to patient parents.

  • Preferably keep all pharmaceuticals and supplements locked up to reduce the risk of children and adolescents taking products unintentionally or intentionally

  • If parents do not have a place to lock their products, put them out of reach, high up so that children cannot easily reach them.

  • Store the product in the original childproof packaging instead of taking the pills out of the packaging and putting them in a plastic bag. “We’ve definitely found that when the drugs are transferred to a non-child-resistant container, ingestions increase,” Toce warned.

  • Don’t refer to any medications or supplements a child might take as “candy.” “A lot of kids have trouble taking medicine, so some families will be like, ‘It’s time for your candy,'” Toce explained. Then, if a child discovers the “candy” on a table where they have access to it, they will not recognize it as medicine and may put it in their mouth, thinking it is candy.

Finally, and most importantly, parents considering trying a melatonin supplement to help a child sleep better should first establish a stable sleep routine for their child. “They should also limit caffeinated drinks before bed as well as screen time,” Toce added.

And they should discuss with their primary care provider whether initiating a melatonin supplement is appropriate for their child – “and not just give them melatonin without first discussing whether to do it,” Toce pointed out.

Remarkable rise

Commenting on his own experience with melatonin poisoning over the past few years, toxicology expert Kevin Osterhoudt, MD, of the University of Pennsylvania, Philadelphia, and Children’s Hospital of Philadelphia, noted that it is their experience that has led to a remarkable increase in poison control center reports of children ingesting melatonin in the recent past. For example, the CHOP Poison Control Center received nearly 4,000 calls about melatonin ingestion by children 5 years of age or younger in the 5 years between 2017 and 2021, with the number increasing each year.

“The [current study] supports our regional observation that this is a national trend,” Osterhoudt said. Osterhoudt agreed with Toce that good sleep is healthy and that developing good sleep habits and a regular bedtime routine is very important. “In some situations, melatonin may be helpful as a short-term sleep aid and it’s a good discussion to have with your child’s healthcare provider.”

If parents decide to give their child a melatonin supplement, they should keep in mind that melatonin can alter the way the body handles other medications such as those used to treat epilepsy or blood clotting. They should also know that experts still don’t know how melatonin affects the body long term and whether it’s safe for mothers during pregnancy.

Osterhoudt offered his own recommendations for safe use of melatonin at home:

  • Discuss the intended use of melatonin with your health care provider

  • Buy only high-quality supplements by looking for the “USP Verified” mark

  • Insist that manufacturers sell products in childproof bottles

  • Periodically inspect medicines in your home and throw away medicines that are no longer used

  • Program the telephone number of your regional poison control center into your telephone; Poison Center experts are available 24/7 to answer questions and concerns about melatonin ingestion (in the US the number is 1-800-222-1222)

The study authors and neither Toce nor Osterhoudt had any relevant conflicts of interest to declare.

This story originally appeared on MDedge.comwhich is part of the Medscape professional network.

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