DENVER — Many of the most popular herbs and supplements that families might want to try in their children lack evidence on effectiveness or safety in pediatric populations, according to a session presented at the American Academy of Pediatrics (AAP) 2025 National Conference. 

Even for supplements that do have reliable evidence in children, such as melatonin, long-term data do not exist, so it’s wisest to try most of them for short periods, Cora Breuner, MD, MPH, a professor of pediatrics and adolescent medicine at Seattle Children’s Hospital and the University of Washington, told attendees. Her co-presenter, Jillian Hagerman, DO, a pediatric and adolescent medicine specialist at Kaiser Permanente-Washington, noted that ashwagandha is another supplement that has been researched in children but lacks evidence on long-term use or outcomes. 

Breuner and Hagerman reviewed some of the most popular supplements that families may ask about, including the safety and efficacy data that exist for use in children. Breuner urged caution in trying any of these supplements, advising that clinicians always check the most up-to-date studies on safety. 

She also emphasized the importance of asking families about what they’re using, noting it in the chart, and following up on side effects. 

Leslie Pelinka, MD, a pediatrician from Eugene, Oregon, found that the discussion of melatonin was particularly helpful because it’s so popular. “Using it at low doses short-term can be efficacious in at least helping families get over that hump while we then can emphasize sleep hygiene and getting kids off screens,” Pelinka told Medscape Medical News.

Melatonin

This hormone has been used to treat various sleeping conditions, such as insomnia and circadian rhythm disorders, as well as benzodiazepine and nicotine withdrawal. Evidence suggests that melatonin is more effective in children than in adults, with dosing beginning at 0.5 mg daily and never exceeding 3 mg in children and 5 mg in adolescents. 

There are no long-term studies on melatonin use, Breuner said. Despite being a hormone, melatonin is not regulated, “and there’s some concern that it could disrupt endocrine functions, including inhibiting ovulation, impairing glucose utilization, and adversely affecting gonadal development in children,” she said.” 

Possible adverse effects of melatonin include daytime sleepiness and sedation when used with other sedative drugs. 

Turmeric

The active ingredient in turmeric, curcumin, has anti-inflammatory effects, and the supplement is used today by people for a wide range of conditions, including abdominal pain, autoimmune conditions, gastrointestinal issues, fatigue, and fibromyalgia. But most evidence — such as pain reduction in knee osteoarthritis — is in adults. 

It also has a high pill burden, with studies testing it at 500 mg four times a day. “Adverse effects include constipation, dyspepsia, vomiting, diarrhea, and urticaria,” plus safety concerns about lead levels. 

Coenzyme Q10

This fat-soluble molecule acts as an antioxidant and has been used for congestive heart failure, fatigue, chemotherapy cardiotoxicity, and other conditions. One review found that coenzyme Q10 reduced fatigue in adults, and another suggested a theoretical basis for improving age-related fibromyalgia in adults, but Breuner could not verify if the evidence included randomized controlled trials (RCTs) with third-party testing. Without third-party testing in pediatric populations, “we can’t recommend it,” she said. Side effects can include nausea, vomiting, diarrhea, appetite suppression, and heartburn.

Ashwagandha

This plant product has been promoted for improving sleep and treating stress and anxiety. “Ashwagandha is kind of very trendy right now, and a lot of teens come to me and want to try this,” Hagerman said, and there are studies in youth. An RCT in college students found that ashwagandha improved sleep, stress, and mental clarity, but the study didn’t note whether the product had been third-party tested to ensure it contained what the label claimed. Another small RCT in children aged 6-12 years found that 150 mg twice daily for 8 weeks improved cognition and sleep scores.

Side effects of ashwagandha seem minimal, but there are no long-term safety data, and some case reports suggest effects on liver and thyroid function.

5-Hydroxytryptophan

This chemical comes from the seeds of a tropical West African shrub and has been used for depression, anxiety, and premenstrual dysphoric disorder. Again, most evidence is in adults, but in a small 2004 trial in children it appeared to help reduce night terrors. Side effects can include nausea, vomiting, diarrhea, and abdominal pain, and use with selective serotonin reuptake inhibitors could increase risk for serotonergic side effects. 

Fish Oil or Omega-3 Fatty Acids

These essential polyunsaturated fatty acids (PUFAs) include three types: alpha-linolenic acid (ALA), found in plant oils such as flaxseed, soybean, and canola; eicosapentaenoic acid (EPA); and docosahexaenoic acid (DHA), found only in seafood. The supplements have been promoted for depression, attention-deficit/hyperactivity disorder (ADHD), and heart disease, but it’s important to pay attention to the type of fish oil in the supplements.

One meta-analysis found improvement in depression from supplements with at least 60% EPA but not supplements with only DHA. A 2024 Cochrane review found five small studies suggesting that PUFAs may help with self-reported depression symptoms in children and teens, but it concluded the evidence was uncertain. Dosing is 1000-1500 mg daily, and adverse effects include a fishy taste with belching, nausea, and loose stools, plus decreased blood coagulation with high doses. 

Other Supplements 

Attendees asked questions about several other supplements that have come up in their practice, including creatine, magnesium, and L-theanine. Breuner said it’s not generally dangerous for teen athletes to take creatine before a sports event, but there may be risk for renal failure in kids with a family history of renal disease. Creatine does appear to improve performance, but athletes need to be sure they adequately hydrate to avoid cramps. 

Magnesium has some data for stabilizing neural functions in teenagers, Breuner said, but there are no long-term studies on its use and it can increase stools; she does not recommend it for younger kids. 

A handful of studies have suggested that L-theanine, with and without caffeine, may improve attention and cognitive performance in children with ADHD, but data are still limited. Breuner said it may be worth trying, but only for a couple of weeks because no long-term data exist.

The presentation did not use external funding. Breuner, Hagerman, and Pelinka had no disclosures. 

Tara Haelle is a science/health journalist based in Dallas.