Toddlers accounted for the greatest number of accidental ingestions.


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Pediatric ingestions of melatonin, an over-the-counter sleep aid for adults and children, increased from over 8,000 in 2012 to more than 52,000 in 2021, according to an analysis published in the June 3 Morbidity and Mortality Weekly Report. About 94% of ingestions were unintentional, and the vast majority of these were in children younger than age five. Nearly 15% of those with overdose symptoms required hospital care, and two children died.

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Relying on poison control center data, the researchers found that the largest annual increase in reports of melatonin ingestion (37.9%) occurred from 2019 to 2020, coinciding with the onset of the COVID-19 pandemic. This finding stands in contrast to an overall decrease in pediatric ingestion-related calls to poison centers during the pandemic.


Teenagers with intentional ingestions of melatonin-a small fraction of the cases-were most likely to be hospitalized. The majority of pediatric ingestions occurred in the home among young children (< 5 years). Most of these cases were asymptomatic, and even children with mild or moderate symptoms could be treated outside of a health care facility. Only a few hospitalized children-about 1%-needed intensive care.


The use of melatonin supplements by adults has been growing, and public demand today is high. Reports of sleep disturbances also increased during the pandemic, according to researchers, which could partly explain the increased demand. The supplement is also inexpensive, perceived to be safe and nonaddictive, and widely available without prescription. The research team offered several theories as to why unintentional ingestions and overdoses increased so dramatically during the pandemic, among them school closures, which left children spending more time at home, and wide variation in the chemical composition of melatonin supplements, especially in the chewable formulations most often used for children.


The authors recommend improved child-resistant packaging for melatonin products, initiatives to raise public awareness of overdose dangers, and education of parents by health care providers on the possible toxic consequences of melatonin exposure.-Gail M. Pfeifer, MA, RN