Evo Terra (Host): This is Children's Health Checkup where we answer parents' most common questions about raising healthy and happy kids. I'm Evo Terra. And today, I'm joined by Dr. Anna Wani, a pediatric sleep medicine specialist at Children's Health. Our topic, magnesium and melatonin, two commonly used sleep supplements for kids. Thanks for joining me, Dr. Wani.

Anna Wani, MD: So happy to be here. Thanks for having me.

Host: So, let's start with what many parents and caregivers like me are wondering, it's about the difference between magnesium and melatonin when it comes to sleep.

Anna Wani, MD: So, melatonin is what our body naturally produces, and it's actually a hormone that's released by our brain to signal darkness, and that it's time to sleep. Magnesium is just an essential element that is a part of many different neurotransmitters and different chemical reactions in our body, mainly for muscular relaxation and gut relaxation.

Host: Got it. Got it. Let's talk about melatonin first. How does it work specifically in kids' bodies and when do you recommend it?

Anna Wani, MD: So, melatonin works like a hormone and it works pretty much the same in both adults and children. It's secreted by the pineal gland in our brain. In Australia, in Europe, in Korea, Singapore, it's a restricted medication. It needs to be prescribed here. In the US, it's not FDA-regulated and it's over-the-counter. So, I really want to highlight that point, because we should use it where we feel that appropriate. But it is not something that you should be reaching for first.

Host: You said earlier it signals darkness for the brain. Anything else it does inside of the kid's body?

Anna Wani, MD: So, melatonin does not do much else inside the kid's body, but it is a byproduct also of the sex hormone cascade. So, the release is actually delayed when children transition from being kids to adolescents. That's why you see that sudden shift in sleep timing in kids, as they're getting older and teens to wanting to sleep much later. So, that's an interesting point about melatonin. And the American Association of Sleep Medicine actually recommends that middle and high school sleep times start at 8:30 PM or later for that reason.

Host: Yeah. Except I don't think that's ever going to get passed. I know when I was kid, I felt like I was going to school awfully, awfully early in the day. Well, let's talk about magnesium, that mineral you mentioned that's good for muscular relaxation. What's the role that that plays in sleep? And is it something that kids basically need more of?

Anna Wani, MD: So in a well-balanced diet, magnesium is present, and does not actually need to be supplemented. Magnesium is present mostly in legumes and leafy green vegetables. And if a child's eating a well-balanced diet, you don't really need to supplement magnesium. In sleep, its role is more of a mineral that helps the cascade of many different neurotransmitters that are part of sleep. But specifically for sleep, magnesium doesn't really directly help sleep. The most direct way that magnesium does help is magnesium helps the muscles to relax. And when your muscles are relaxed, you're more conducive to go to sleep. So, that's where that link is made.

Host: These two compounds, we're talking about magnesium and melatonin. Are they generally considered safe for children? I know you mentioned that there are several countries where they are actually prescribed. So, let's talk about overall safety. What's going on in there?

Anna Wani, MD: So for magnesium, you may have side effects like diarrhea from having too much of a relaxed gut. And the normal physiological systems, the checks and balances that our body kind of puts us through keeps our muscles from not getting too relaxed. So, magnesium overall is pretty safe. It doesn't really cross the blood-brain barrier in its forms that are available over-the-counter as much. And so, it's pretty safe. At most, it's going to make your kids pee very expensive.

With melatonin, on the other hand, that is something that has to be balanced a little bit more. The side effects of melatonin are nightmares, GI upset, obviously excessive sleepiness, headaches. And it can, in certain situations, lower the seizure threshold. It's been known to do that.

Host: Wow. So, definitely something to be aware of before you give to anyone really, honestly. What about appropriateness? So like, I mean, they're not used interchangeably, it sounds like they do totally different things. Is there a situation or maybe an age for children where one's more appropriate than the other?

Anna Wani, MD: So, not necessarily. I think that, overall, different developmental milestones come with different sleep challenges and knowing what's normal and what's not can really help us distinguish where we can supplement melatonin where appropriate, supplement magnesium if appropriate. And then, if that's not working, to further investigate whether there's something else going on. So, it has to be very tailored to what you feel like is going on specifically with your child.

Host: What are some common misconceptions that parents or grandparents like myself might have about giving our kids sleep supplements?

Anna Wani, MD: Common misconceptions for melatonin, one is that melatonin is just a Band-aid solution and it fixes all sleep problems. What we know melatonin to do is that really it can help, sleep latency or how quickly it takes you to fall asleep to be shortened. But if you have issues with sleep maintenance, meaning your child is having trouble staying asleep, melatonin is not really going to help as much with that.

The second misconception is that magnesium is a proven sleep aid. Like I mentioned in our conversation earlier, magnesium helps with muscular relaxation, and it's readily available already in the body. And so, it's not going to help as much. In certain settings where a child's anxious and isn't clinically anxious, magnesium may help some of that muscular relaxation, but it's not really going to make a huge change. Finally, a lot of parents believe more is better. And that's not always the case. There are very specific doses that help with both melatonin and magnesium that are age and weight-based, and giving more can actually cause more issues rather than help.

Host: It sounds to me like parents who are curious about this or concerned about things or taking measures in their hands, maybe they should be chatting with their doctors. So, I'll ask you, when should parents be talking to a child's doctor before giving them the magnesium and/or melatonin?

Anna Wani, MD: So, I am passionate about sleep medicine, and I really think that all of us spend about a third of our lives sleeping. And so, your child's sleep should be a regular check-in and conversation. Just like we're looking at what our child's eating, how they're doing in school, what their mood is like, what their vital signs are, we need to be checking in regularly with our primary care physicians and clinicians about our child's sleep. When we're talking about it, we can uncover any issues that may be occurring that your primary care clinician can bring to our attention. And there's common knowledge things, techniques that help regular, normal, typical sleep. But when there are issues, we're here to kind of step in and help.

Host: And let's end this conversation talking not about supplements, but other sorts of strategies that work, that have shown effectiveness to help improve a child's sleep before we resort to supplements.

Anna Wani, MD: Yeah. So, I'd like to start the non-supplement conversation off with an important report that came out in April of 2023 from CNN that actually looked at over-the-counter melatonin, sleep aids, and looked at what the ingredients were. And what they found was that because the FDA doesn't regulate melatonin, there was CBD in these melatonin supplements there were higher amounts of melatonin than advertised in these supplements.

And so, I would really encourage our listeners, who care about their children's health, to be very discerning on what sleep aids they're using. And for the most part, if your child is developing typically, it's going to be all about consistency. So, a consistent schedule in their day and a consistent night bedtime schedule is going to be the name of the game.

So, a lot of non-supplement behavioral kind of interventions is going to be surrounded by that. Cutting down the amount of screens a couple of hours before bedtime, turning down the lights, so making your sleep environment be more conducive to sleep. The National Sleep Foundation says the colder the better. They don't live in Texas, so they recommend 65 degrees Fahrenheit as the ideal sleep temperature.

Other things that really help are white noise. So, there's obviously in a home going to be little things that wake us up, little sounds that are going on. And white noise really drowns out those sounds and keeps the child asleep.

The other thing is, instead of screens, to have a wind-down, kind of very predictable sleep routine. You can use reading, you can use audio books, podcasts that really help cue the child that it's time to sleep. And then, finally, the sleep time. So, a lot of times with my patients that come in with their parents, I'll ask them if they're older. If you're waking up on a Saturday afternoon at noon or 1:00 PM for school the next day, how are you going to be sleeping Sunday night at 9:00 or 10:00? It's just not going to happen. Your brain's not tired enough. And so, that irregularity and inconsistency between weekdays and weekends can have a huge impact on sleep

Host: Wow. Okay. Well, Dr. Wani, I want o just say thank you so much for all this wonderful information you shared today. And it confirms that my wife and I are doing the right things by making our granddaughter read with us before she goes to sleep.

Anna Wani, MD: A hundred percent.

Host: And for more information on how to help your child get a good night's sleep, visit childrens.com/sleep. And thank you for listening to Children's Health Checkup. If you found this podcast episode helpful, please rate and review or share the episode. And please follow Children's Health on all your social channels.