On Tuesday, BBC.com reported that three Chicago-area daycare employees were arrested for administering melatonin to twelve toddlers at nap time, without parental consent. (Aside: Curiously, apparently the British spell it “parentel”? The wonders of variations in English word spellings never cease…) Now, if you’re anything like me, you probably stared at this report, mouth agape, wondering how on earth this sort of thing could possibly happen. But then, I realized that if you look at our culture and the way the melatonin is used and regulated in the U.S., this sort of incident becomes inevitable. And it will probably happen again.
(Side note: I include links to further resources in hyperlinks throughout my articles. I also include a bibliography at the bottom, with summaries and further explanations. We’ll see how long I keep that up haha.) Also I’m sooo sorry about the ads! Working on getting rid of them…
This story comes on the heels of interesting cultural and policy changes, as well as an increasing body of research, including this study published by Colorado University Boulder on Tuesday, that indicates that we mess with childrens’ sleep in ways we don’t even realize.
This post is going to have a few tangents, but that is because stuff like this is a symptom of a larger conversation that needs to happen about kids, sleep, and childcare in America. There are several problems that converge, here.
- We don’t value childcare in America, and it hurts children.
- American parents abuse melatonin.
- And it’s just the latest trend in our long, messed-up history of drugging children in order to get them to sleep.
I am going to take each in turn.
1. We don’t value childcare in America, and it’s hurting our kids.
Whereas in other wealthy nations childcare is partially or completely subsidized, childcare in America is unaffordable for many. Childcare workers are often poorly trained, underpaid, and overburdened. As a result, babies actually die in our childcare centers.
Furthermore, parents who would like to stay home to care for their child themselves can’t—because the cost of providing the basics for their family requires that both parents work, or because health insurance in the U.S. is still largely tied to employment. This, once again, places what is essentially an unnecessary burden on childcare centers.
As a result of these and other related factors, the U.S. has the highest infant mortality rate in the industrialized world and one of the most pathetic parental leave policies in the world.
IN THE ENTIRE WORLD.
2. American parents (and pediatricians) abuse melatonin.
Just as I was about to post this article, a commercial for a melatonin brand aired on my TV, advertising itself as the “100% one drug-free way to promote healthier, more restful sleep.”
“Non-drug”? Melatonin is a hormone that acts on multiple organ systems–including (aside from the brain’s arousal system) the gonads, cardiovascular system, metabolic system, and immune system. Yet–and this is what big deal, here, is–in the U.S. it is classified as a “supplement.” Why do we care? Because supplements are not regulated by the FDA. If your child has a growth disorder or a metabolic disorder, you need to go to the doctor to get prescriptions for hormones that treat those conditions. If your daughter has a problem with acne, you need a doctor’s prescription to give her birth control. And yet melatonin, also a hormone, is not regulated in this same way. And it makes a difference. Some studies have shown OTC melatonin doses to be WAY above the dosage on the label. They have found seretonin in OTC melatonin bottles as well. More than that, who even knows what the “correct” dosage would even be for a child? Most of the research on melatonin has been done on the elderly.
So parents, thinking melatonin is a “natural” supplement, give their kids melatonin in the absence of a sleep disorder diagnosis. And pediatricians prescribe it without first conducting a sleep study on the child, or even recommending an evidence-based sleep hygiene intervention. It is prescribed off-label, and in the absence of sufficient research in support of long-term safety. The recent rise in it’s use on children has prompted expressions of concern in the medical community, but not much can be done as long as melatonin is classified as a supplement, and as long as supplements are not regulated by the FDA. Other than consumer education, of course. (That’s my cue!)
3. Melatonin is the latest trend in our long, kinda messed-up history of drugging children in order to get them to sleep.
Saddle up, kids. Time for a history lesson.
In the 18th century on up through the early 20th century, people gave their kids opium and other drugs to get them to sleep or to curb undesired behavior, a motif which is reinforced in the children’s literature of the time. Remember the song “Spoonful of Sugar” from Mary Poppins? Ever think it was kind of weird that Mary is giving “medicine” to the children when they’re not actually sick? It’s because that was a thing in those times. This content was watered down a bit for the Disney iteration, but there is another song in the Broadway version (originating from P.L. Travers’ sequel, Mary Poppins Comes Back), called “Brimstone and Treacle” about a nasty “medicine” given to the children as punishment. Brimstone (a form of sulfur) and treacle was a popular laxative and tonic of Victorian times.
Ever heard that old wive’s tale about rubbing whiskey on the gums of a teething or colicky baby? That one was popular from around the mid-19th century to the mid 20th century. In the 1990 and early 2000’s, Benadryl was the drug of choice of both parents and pediatricians.
It wasn’t until 2007 that the medical community showed any concern, after over 1500 adverse incidents associated with administering cold medications to children were reported over the course of 2004 and 2005. A 2009 study that focused on cold medicines expressed explicit concern about its findings, stating, “It is important to understand that many of the cases in which the intent was to produce sedation occurred outside the child’s normal bedtime.” This study also found that outsourced care was the highest risk factor for an incident. Another much larger-scale study published in 2010 focused on non-therapeutic administration of drugs to children (that is, in the absence of symptoms that warranted the use of the drug) agreed that the problem was widespread, but went even further, urging law enforcement and social services to include administration of drugs to children in their definition of “child abuse” (because apparently that wasn’t a thing yet) and to prioritize it in suspected abuse investigations. It wasn’t until 2015-16 (you probably remember) that medical authorities really started to enthusiastically warn parents about the use of cold medicines for children, completely discouraging its use in children under two years of age.
During the period of obliviousness followed by inaction that characterized the turn of the century, while everyone was giving cold medicines to children, 1994’s Dietary Supplement Health and Education Act of (DSHEA) was enacted. After a few years of lobbying by the health food industry (which included the clever leveraging of an incident involving Mel Gibson) DSHEA de-regulated “dietary supplements.” Melatonin, having managed to escape being classified as a drug and, riding the wave of the “natural” medicine craze, enjoyed a 500% increase in the sales from 2003-2014. Et, voila. A new era in drugging kids to get them to sleep.
Comprehensive solutions to complex problems.
Now for the disclaimer: None of this is meant to bash parents of kids with diagnosed sleep disorders or developmental disorders for whom pharmaceutical therapies are part of their treatment. You will find no chemicophobia* here. That’s not what this is about. What this is about is the larger discussion we need to have, about what drives American parents to use drugs off-label like this in the first place.
In our culture, we love to talk a big talk about “family values.” But our behavior tells a different story: we don’t really value families. We don’t even provide fundamental services—such as adequate parental leave, childbirth and breastfeeding support, quality subsidized childcare, and high-quality early public education—that our European counterparts seem to have have no problem providing for their citizens. (And if you don’t see how all of these things are connected to the decisions an exhausted parent makes at bedtime, you haven’t thought hard enough about these problems.)
I am no policy expert, but we may be well-advised to look into the way we regulate (or don’t) the supplement industry–a multi-billion dollar industry, especially since DSHEA was enacted. And on the consumer side, we need more public education about this idea of “natural” medicine. That word—“natural”–doesn’t even mean anything, scientifically. Not in this context.** As chemists will often point out, there is a “natural supplement” that many of us use regularly, which is derived from the leaves of a willow tree. Scientists call it “acetylsalicylic acid,” a type of non-steroidal ant-inflammatory drug (NSAID). You know it as aspirin. It’s natural. So is formaldehyde, which your body actually produces in small amounts as part of a crucial metabolic process in the cells.
In my view, policy changes and changes in cultural attitudes towards the (often unpaid or underpaid) labor burden that the parents and caregivers in our culture undertake would go a long way towards addressing this problem. But physicians, healthcare professionals, and anyone else who participates in educating young parents, need to step up, here, as well. I often criticize parents and professionals alike for not thinking critically or creatively enough about health issues with complex social components, but I tend to be harder on the medical community—and physicians in particular—because they’ve chosen to bear a particular set of responsibilities. By their privilege and education, I feel I can expect a certain standard from them in this regard. And to this end, it is incumbent upon physicians and nurses to read beyond their own field or branch of medicine and understand the complex social components of human sleep behavior. Parents deserve quality, evidence-based info/education about what normal infant and young child sleep looks like for our species, so they know there is nothing wrong with their kid. Or if there is.
You see, my field—anthropology—has told the story of humans as being evolved as intensely social sleepers. Humans’ homes didn’t really have separate chambers until a few hundred years ago. It is understandable, then, that the evolved biology of infants and small children is resistant to this new paradigm. They resist solitary sleep. Night waking, simply put, is NORMAL for infants and toddlers and, occasionally, even young children. And it is biologically expected that they seek parental contact at night. That is the story that their physiology–their still-developing neurology–tells.
I am therefore inclined to make the radical proposition, here, that parents, by and large, can be trusted with the evidence on what normal infant and child sleep behavior looks like, and what the actual evidence is on various nighttime parenting strategies. That maybe introducing more comprehensive parental education to the mix might actually help them navigate nighttime parenting more deftly, more confidently, and–perhaps most importantly–with more confidence that their child is normal, and that they’re doing just fine.
* You will hear many self-identified science-minded folk reduce this topic to “everything is chemicals!” While technically true, it is quite obviously a little more complicated than that.
** Scientists do speak of “natural selection” and “natural killer cells” (a type of immune cell), but they don’t use “natural” in the same sense that “natural medicine” or “natural parenting” enthusiasts do. Unfortunately owing to its intersection with linguistics, philosophy, and complex cultural variables, it is far too involved to go into in this post. But I do plan to explore this issue, as well as “chemicophobia” in later posts, because I think this is an important conversation that we need to have if we are to be truly informed about the health decisions we make every day.
“Nursery staff arrested for giving sleep aid to toddlers.“ BBC.com, 6 March 2016
Infant mortality in the U.S., daycare deaths, and paid parental leave policies. “Moms whose infants died in day care petition for 6 months parental leave.” USA TODAY, 30 Aug 2016.
“Melatonin Natural Health Products and Supplements: Presence of Serotonin and Significant Variability of Melatonin Content.“ Journal of Clinical Sleep Medicine Volume 13 No. 02. — This study analyzed the contents of 31 OTC melatonin brands and found a wide variation in the dosages compared to what was advertised on the bottle. Some bottles had over 400 times more melatonin in them than was advertised on the bottle. 71% of them were found to have dosages that weren’t even within a 10% range of what was advertised on the bottle. They also found another hormone, seretonin, in a whopping 26% of them.
“Preschoolers exposed to nighttime light lack melatonin.” Science Daily. 5 March 2018. — This study, out of University of Colorado Boulder and published in Physiological Reports this month, found that melatonin is suppressed in preschoolers for up to 50 minutes after exposure to a screen such as a television or tablet. This supports the implementation of “sleep hygiene” practices such as restriction of screen time in the hours before bedtime.
“Potential safety issues in the use of the hormone melatonin in paediatrics.” Journal of Pediatrics and Child Health. 3 February 2015. — Melatonin is not registered for pediatric use. There is no evidence to support it’s long-term safety in children. Concerns about potential interactions with other drugs used for children. Affects on various organ systems.
“Tales Told With a Spoonful of Sugar.” Pharmaceutical Journal. 11 Dec 2009. — Fascinating review of the use of medicine in children’s literature, from Mary Poppins to Peter Pan to Harry Potter.
“Alcohol and Teething: An Oral History.” Jessica Sillers, for VinePair.com. 7 December 2016. — Several quality primary sources linked within.
“Medication Use in the Treatment of Pediatric Insomnia: Results of a Survey of Community-Based Pediatricians.” Pediatrics. May 2003. — Use of Benadryl and antihistamines in children in the late 90’s/early ’00s.
“Use Caution When Giving Cough and Cold Products to Kids.” FDA.gov — A brief history of the issue and guidelines for parents.
“Pediatric fatalities associated with over the counter (nonprescription) cough and cold medications. Dart, RC et al. Annals of Emergency Medicine. 2009. — Found intent to sedate and use of outsourced care (among other factors) to be high risk factors for fatalities associated with adult administration of a cough and cold medication to a child.
“Poor Quality Control of Over-the-Counter Melatonin: What They Say Is Often Not What You Get.“ Journal of Clinical Sleep Medicine. 15 Feb 2017. — Increased sales of melatonin in recent years. Use in children. Variability in dosage and content of OTC melatonin.
“Malicious Use of Pharmaceuticals in Children.” by Shan Yin. The Journal of Pediatrics. November, 2010. — A large-scale study exploring the prevalence and uder-reporting of non-therapeutic drug administration to children, including but not limited to antihistamines and other cold medications, and their associated outcomes.
“U.S. Issues Rules on Diet Supplement Labels.” New York Times, 2003.” — Mel Gibson arrested for possession of Vitamin C. Cue the outrage.
“The $37 billion supplement industry is barely regulated — and it’s allowing dangerous products to slip through the cracks.” Business Insider, November 2017. — Thorough overview of how the regulation (or not) of the supplement industry affects public perceptions about health science, and their purchasing patterns.
“Toxic formaldehyde is produced inside our own cells, scientists discover.” 17 Aug 2017. — Your body is a wonderland…OF POISON.
“Toward a Comparative Developmental Ecology of Human Sleep.” Worthman, C. and Melby, M. From Adolescent Sleep Patterns: Biological, Social, and Psychological Influences (pp. 69-117). Cambridge: Cambridge University Press. — A really great overview of the complex social and evolutionary components of human sleep behavior. Also noted is the medical community’s failure to acknowledge these components.
Soon to be featured on the Raising Wonder blog!
- The fascinating science behind Luke Skywalker’s colored milk
- The case for “evidence-based” parenting
- A brief overview of the anti-breastfeeding science movement and their tactics
- What to do when you disagree with your spouse about whether to use “cry-it-out”
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