Melatonin is now the most widely used sleep aid in children. A new JAMA Network Open study examined polysomnography in 684 propensity-matched children and found that melatonin users had slightly less REM sleep, 16.7% versus 19.0%. Total sleep time, sleep efficiency, N3 sleep, respiratory measures and arousals were essentially similar.
What the Study Does — and Does Not — Tell Us
That finding should produce neither panic nor reassurance.
The study is cross-sectional. Dose, timing, actual adherence and circadian phase were unavailable. Residual confounding is very plausible. A small association with REM does not establish that melatonin harms the developing brain.
The More Important Signal
But I think the more important signal is cultural.
We have normalized giving children a biologically active circadian hormone while often paying far less attention to why they cannot sleep.
Late light exposure. Irregular schedules. Neurodevelopmental disorders. Anxiety. Academic pressure. Family routines. Circadian delay.
Melatonin can be entirely appropriate, particularly when used thoughtfully as a chronobiotic. But when the default response to a child struggling with sleep becomes a gummy purchased beside the multivitamins, we have converted a systems problem into an individual prescription.
When a Hormone Becomes the Workaround
Ivan Illich wrote extensively about medicine’s tendency to medicalize problems that may originate in the way society is organized. Pediatric sleep offers a modern variation: a hormone can become the workaround for an environment that has become hostile to sleep.
And parents should not be blamed for choosing the option that is cheap, immediate and available. Behavioral sleep care often requires time, expertise and access that families simply do not have. The accompanying JAMA commentary makes precisely this point.
Ask What Is Keeping the Child Awake
Before asking what can make a child sleep, we should get much better at asking what is keeping that child awake.
Pharmacology can change the night. Wisdom requires us to understand the day that produced it.
References
Juginovic A, Rodman L. “Melatonin Use and Polysomnographic Sleep Architecture in Children.” JAMA Network Open. August 6, 2026.
