Sleep-related melatonin use in healthy children

A mother brought her 12-year-old son into my office because she is concerned that he has difficulty falling asleep almost every night. Her job involves shift work and she uses melatonin herself to help her fall asleep. She asked if her son could take melatonin. What are the recommendations and considerations for using melatonin in otherwise healthy children and adolescents?

Insomnia is reported in up to a quarter of healthy children and in three-quarters of children with neurodevelopmental and psychiatric conditions, resulting in negative consequences. For children with delayed sleep phase syndrome, melatonin can be a useful treatment together with insomnia evaluation and regular follow-up. For children with otherwise undiagnosed insomnia and healthy sleep hygiene, melatonin use should be considered. While melatonin seems to be safe, there is a lack of evidence for its routine use among healthy children.