“During 2019–2022, melatonin was implicated in approximately 11,000 (7%) emergency department visits among infants and young children for unsupervised medication ingestions,” according to a new article in the CDC’s Morbidity & Mortality Weekly Report (MMWR). “Many incidents involved ingestion of flavored products (e.g., gummy formulations).”
That “highlights the importance of educating parents and other caregivers about keeping all medications and supplements (including gummies) out of children’s reach and sight,” the authors advised.
Background information in the report noted that the prevalence of melatonin use by U.S. adults quintupled from 0.4% during 1999–2000 to 2.1% during 2017–2018. “This rise coincided with a 530% increase in poison center calls for pediatric melatonin exposures during 2012–2021 and a 420% increase in emergency department (ED) visits for unsupervised melatonin ingestion by infants and young children during 2009–2020. CDC analyzed public health surveillance data to describe circumstances involved in these ingestions to help guide development of interventions,” the authors pointed out.
The researchers used data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance Project to identify cases of ED visits for unsupervised melatonin ingestion by infants and children aged younger than 5 years during the 2019–2022 period, based on the treating clinician’s diagnosis and supporting documentation in the ED record. The authors used case narratives to code circumstances and details about ingested melatonin products. The 295 cases were weighted to allow calculation of national estimates and corresponding 95% CIs.
The melatonin cases accounted for 7.1% of all ED visits for unsupervised medication exposures by persons in the group aged younger than 5 years. “Approximately one half (52.4%) of all estimated ED visits for melatonin ingestion by infants and children aged ≤5 years involved children aged 3-5 years, and most (93.5%) did not result in hospitalization,” according to the study. “Melatonin was the only medication involved in 90.2% of ED visits for melatonin ingestions.”
In nearly all the cases, 95.7%, a solid dosage form product was accessed by infants and children who ended up having an ED visits. Gummy formulations (47.3%) were the most commonly documented dosage form. The authors added, however, that an unspecified solid formulation was documented in about one-half (49.2%) of visits.
In addition, the study documented access to 10 or more units (e.g., gummies or tablets) in more than one-third (35.8%; 95% CI, 28.6%-43.0%) of visits for solid melatonin ingestions.
“Ingestion of adult or family formulations of melatonin was documented in 47.7% of visits; however, intended age group of formulation was not specified in 45.0% of visits,” according to the MMWR article. “At least 32.8% of infants and children accessed melatonin from a bottle; however, container type was not documented for 56.6% of visits.”
The study pointed out that melatonin products do not require child-resistant packaging, although such packaging can be voluntarily implemented. “Among ED visits with documentation of container type, approximately three-quarters involved melatonin accessed from bottles, suggesting that infants and children opened bottles or that bottles were not properly closed,” the researchers advised. “Selecting products with child-resistant packaging might be advisable in homes with young children.”
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