Melatonin Is Over-the-Counter—But Should It Be?

As BCBAs, one question we hear a lot is: “Should I give my child melatonin?”

It’s a fair question, especially when a child with autism or other developmental differences struggles to fall asleep or wakes frequently during the night.

While melatonin may offer benefits for some families, it’s important to understand what it is, what it does, and how to use it responsibly—always in collaboration with a healthcare provider.

Let’s take a look.

🌙 What Is Melatonin?

Melatonin is a hormone that our bodies naturally produce in response to darkness. It plays a big role in helping regulate our sleep-wake cycle, also known as the circadian rhythm.

• Melatonin levels rise in the evening, helping us feel sleepy

• They fall in the morning, helping us wake up and feel alert

However, research has shown that children and adults with autism may not produce typical levels of melatonin.

A systematic review of 9 trials involving over 800 participants found that:

• 7 of the 9 studies reported lower melatonin levels or metabolite concentrations in people with autism

• In the largest study (n = 505), 65% of participants with autism had melatonin levels that were less than 50% of the typical average

With statistics like that, it’s no surprise that many families look to melatonin supplementation for help.

💡What We Should Know About It

Because melatonin is available over the counter in the U.S., it can feel like a low-stakes solution. But here’s what families and professionals should know before reaching for that bottle:

⚠️ 1. It’s Not Regulated Like Other Medications

Melatonin supplements aren’t regulated by the FDA the way prescription medications are. In fact, one study tested multiple brands and found that:

• Actual melatonin content ranged from 0% to 347% of what was on the label

• Some products even contained other unlisted ingredients

If melatonin is being considered, it’s often safer to discuss prescription options with a pediatrician, especially to ensure consistency and accuracy in dosage.

⏱️ 2. Immediate vs. Extended Release

Melatonin can be helpful for falling asleep faster, particularly when used in immediate-release form.

However:

• Immediate-release melatonin may not help with middle-of-the-night awakenings

• Extended-release melatonin may be more effective for maintaining sleep, but is less studied and often requires the ability to swallow pills

Discuss with your healthcare provider what type is most appropriate for your child.

😴 3. There Are Side Effects

While generally considered safe in the short term, melatonin isn’t side-effect-free. Common reactions may include:

• Headaches

• Nightmares

• Increased bedwetting

• Dizziness

• Morning grogginess

• Mood changes

And because melatonin comes in kid-friendly formats (like gummies), it should be treated like any prescription medication and kept out of reach of children. Accidental ingestion can be serious.

⌚ 4. We Know Little About Long-Term Use

Current research supports melatonin for short-term use, but there’s limited data on long-term safety—especially in children.

That’s why the general recommendation is:

✔ Use the lowest effective dose

✔ Use it for the shortest time necessary

✔ Pair it with behavioral interventions

🛏️ So, What’s the Takeaway?

Melatonin may be helpful for some children—particularly those with low melatonin production—but it’s not a magic fix. It shouldn't be the first or only strategy used to address sleep concerns.

As BCBAs, our role is to help families implement behavioral strategies that improve sleep naturally, such as:

• Establishing a consistent bedtime routine

• Fading screens before bed

• Teaching calming leisure skills

• Adjusting the sleep environment for optimal rest

Used in combination with behavioral approaches—and with guidance from a trusted healthcare provider—melatonin can be part of a sleep support plan, but it’s not the whole picture.

Want to support families with better sleep strategies?📥 Download our free resource:

“5 Myths That Might Be Holding Your Learners Back”➡️ subscribepage.io/5Myths