Mon. Apr 15th, 2024

Sharp rise in ER visits by kids ingesting melatonin products

The number of young children accidentally ingesting melatonin in gummies, tablets and other forms has sharply increased in the last two decades, according to new data from the Centers for Disease Control and Prevention.

There was a 530 percent rise in calls to poison centers for pediatric melatonin exposures between 2012 and 2021, the CDC reported. Also, there were an estimated 10,930 emergency room visits — a rise of 420 percent — based on 295 cases of children younger than 5 ingesting melatonin between 2019 and 2022.

They accounted for 7.1 percent of all visits to the emergency department for medication exposures for this age group, according to national data, the CDC said.

This increase in pediatric melatonin exposure coincided with higher melatonin use among adults, the CDC noted. A survey conducted between 1999 to 2018 suggested that the proportion of adults using melatonin rose from 0.4 to 2.1 percent, according to the National Institutes of Health.

“What we tend to see with these pediatric melatonin exposures among young kids is that if you have more of something around in a home, then you’re going to have more incidences of kids getting into it,” said Maribeth Sivilus, an epidemiologist with the CDC.

Attractive and accessible to children

Melatonin — a hormone produced naturally in the body and released by the brain — influences sleep. It is available as a supplement. The flavored formulations such as gummies and chewable tablets are appealing to children, Sivilus said. And they may be able to easily access these products.

Unlike standard medications, there are no rules regulating packaging of supplements, so most don’t have childproof caps. Parents also may not put as much care into storing supplements as they do their medications, Sivilus said. She noted that in the same period that melatonin exposure among children rose, unsupervised medication exposures overall declined.

“Perhaps there’s a perception that there’s not as much risk,” Sivilus said.

Melatonin can pose a risk for children

But there is a risk. What’s stated on the label is not necessarily what’s in the bottle, research shows. In a study published as a letter in JAMA last year, researchers from Cambridge Health Alliance and the University of Mississippi tested 25 supplements of melatonin. They found that most of the products contained 20, 30 or 50 percent more melatonin content than what was listed on the label.

“We really don’t know what’s in it,” said Darria Long Gillespie, an emergency physician and spokesperson for the American College of Emergency Physicians. “They got some bottle of melatonin that somebody bought from, you know, a gas station now, and it has melatonin, and it might have some CBD in it.”

The vast majority of children exposed to melatonin do not require hospitalization, and if symptoms occur, they are usually mild and include somnolence, nausea, vomiting or headache, experts said. When more severe symptoms arise, doctors question whether there has been possible contamination in the product, given that supplements are not regulated like medication, said Cora Collette Breuner, a professor of pediatrics adolescent medicine and the medical staff president at Seattle Children’s Hospital.

“I do not recommend melatonin at all for anyone under 12. Even for those over 12, the problem is the product, itself, is very poorly regulated,” she said.

She also stressed that melatonin is not an herb, as many people think, but rather it’s a hormone, and there are questions about its effects on the body.

“We do not know, with a developing body and brain, what happens to it in the long term if you take a hormone that could affect glucose metabolism, puberty and a number of other things that are in the endocrine axis growth,” she said. “I’ve seen people give their kids 10,15, 20 milligrams a day, and that’s very alarming because who knows what that means.”

Rising number of melatonin exposures among children

During the pandemic, parents sought over-the-counter remedies to address their sleep disruptions, and that resulted in more melatonin in the house, said Kaitlyn Brown, clinical managing director for America’s Poison Centers, which represents 55 poison centers across the country.

There were 8,337 pediatric melatonin exposures reported to U.S. poison centers in 2012. Those numbers hit 51,400 in 2020 and 52,589 in 2021, though they’ve dipped since then to 46,756 last year, according to the America’s Poison Centers’ National Poison Data System.

“It’s actually one of the leading substances of exposures reported to poison centers in children,” Brown said.

The melatonin exposures follow the typical age distribution, she said, with ingestions among infants and 1- to 12- year-olds being largely unintentional, while the majority of ingestions for 13- to 19- year-olds are intentional and possibly related to self-harm.

Melatonin exposures may not require hospitalization, but they can stress the health-care system by tying up emergency room personnel, emergency medicine doctors say.

“It is a ‘big problem’ in the sense that it consumes resources,” said Michael Toce, an assistant professor of pediatrics in emergency medicine and medical toxicology at Boston Children’s Hospital, in an email.

Exploratory melatonin ingestions by young children can add to wait times in the emergency department, while the intentional or self-harm poisonings they see in teenagers can land them in the hospital for days, as they await transfer to an inpatient psychiatric hospital, Toce wrote in an email.

There also is a “significant cost to patients and families,” said Maryann Amirshahi, a professor of emergency medicine at Georgetown University School of Medicine and an emergency medicine physician at MedStar Washington Hospital Center.

“If you’ve ever sat in a waiting room for 12 hours with a child under 5, that really puts a lot of stress on the family,” said Amirshahi, who is also co-medical director of the National Capital Poison Center. Parents may also have to pay a portion of the hospital bill, as some insurers require.

Poison control officials would like to see the rising melatonin exposures bring about better packaging.

“Packaging reform is something that we’re certainly looking into and initiating discussions with our own legislators,” said Varun Vohra, a clinical toxicologist and director of the Michigan Poison & Drug Information Center at the Wayne State University School of Medicine.

“We see a lot of the brunt of these exposures, with calls to our poison centers, so part of our duty is to help manage and treat those exposures in an acute manner but also to look for ways to prevent exposures upstream,” he said.

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