Melatonin usage in children and young adults, a registry-based cohort study

Area of Science:

• Pediatrics
• Pharmacology
• Neuroscience

Background:

• Sleep disorders are prevalent in children and adolescents, often co-occurring with neurodevelopmental conditions like attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).
• While non-pharmacological interventions are primary, pharmacological options, including melatonin, are sometimes necessary.
• Melatonin, an endogenous hormone, is increasingly prescribed for pediatric sleep disturbances.

Purpose of the Study:

• To analyze the real-world dispensation patterns of melatonin in young individuals (0-25 years) in Stockholm, Sweden, from 2016-2019.
• To investigate the diagnostic context and co-medication associated with melatonin use.
• To assess the continuity and duration of melatonin treatment in this cohort.

Main Methods:

• A registry-based cohort study utilizing dispensation data from 2016-2019.
• Inclusion of 9980 individuals aged 0-25 years who received melatonin in 2016.
• Follow-up for 3 years to track prescription patterns and co-morbidities.

Main Results:

• Child psychiatrists were the most frequent prescribers (55%).
• Only 20% of individuals had a recorded sleep disorder diagnosis; 65% had a neuropsychiatric diagnosis.
• Half the cohort received melatonin continuously, with dose and volume increases; continuous use was highest in 6-12 year olds (70% adherence after 3 years).

Conclusions:

• The study highlights a significant trend of continuous melatonin use in children and adolescents, often without a primary sleep disorder diagnosis.
• The lack of long-term safety data for pediatric melatonin use is concerning.
• There is a critical need for robust long-term follow-up and safety monitoring of melatonin treatment in young individuals.