Getting melatonin on the NHS for an autistic child

This post explains how melatonin is usually prescribed for autistic children in the UK National Health Service (NHS). It covers the route only. For the different types of melatonin and which ones are licensed for children, see Melatonin types for an autistic child.

Step 1: a sleep plan comes first

The National Institute for Health and Care Excellence (NICE) writes the guidelines that NHS doctors follow. Its autism guideline for under-19s is CG170.

CG170 says doctors should first assess the sleep problem. Then they should make a sleep plan with the family. They should also ask you to keep a sleep diary for 2 weeks.

Medicine should not be used unless the sleep problem continues despite the plan, and it is harming the child or the family.

A sleep plan is a set of steady habits around bedtime. For practical ideas, see Half-term with an autistic child: keeping sleep and routine steady.

Step 2: a specialist decides on melatonin

If medicine is still needed, CG170 says to "consider melatonin". It should only be started after talking to a specialist. That means a children's doctor (paediatrician) or psychiatrist with expertise in autism or children's sleep.

Melatonin should be used together with the sleep plan, not instead of it. It should be reviewed regularly.

CG170 also suggests considering a referral to a children's sleep specialist, and short breaks for the family.

Step 3: your GP takes over

Many areas use a "shared care" agreement. This splits the work between the specialist and your general practitioner (GP).

In a typical agreement:

The specialist starts melatonin.
The specialist prescribes it until the dose is stable.
The specialist then asks your GP to take over the prescription.
Your child is reviewed regularly, with trial breaks from melatonin to check whether it is still needed.

The details vary by area. Here are two examples:

Thames Valley (shared care protocol v4.1, updated July 2024): the specialist may take up to 3 months to settle the dose. The specialist then reviews your child at least once a year, and there is a melatonin-free break at least once a year. The protocol's review date of June 2025 has passed, so it may be out of date.
South East London: for Slenyto, your child is reviewed at least every 6 months once the GP takes over.

What your GP can prescribe depends on your local area's rules

Local NHS areas set their own melatonin rules. These rules decide which products the GP can prescribe.

The rules on one product, Slenyto, show how much this varies:

Norfolk and Waveney does not include Slenyto. The East of England Priorities Advisory Committee does not recommend it, because the case for cost-effectiveness has not been proven.
Humber and North Yorkshire (guideline v1.0, approved 3 September 2025) makes Slenyto the first choice for autistic children aged 2 to 18. For an autistic child aged 6 or over who also has ADHD, Adaflex may be used instead of Slenyto.
South East London allows Slenyto for the licensed group only. Behavioural measures must be tried for at least 3 months first.
Thames Valley prefers generic tablets. Slenyto is used only when a child needs a slow-release form but cannot swallow the generic tablets whole or halved.

So a product used in one area may not be offered in another. If you move house, the options may change.

The Thames Valley protocol says "there is limited published safety data beyond two years of use."

Off-label prescribing is common and allowed. Your doctor can explain why they chose this medicine.

A note on ADHD

Some autistic children also have attention deficit hyperactivity disorder (ADHD). The NICE ADHD guideline, NG87, does not recommend melatonin. It suggests keeping a sleep diary and adjusting ADHD medicine if sleep is a problem.

Questions you can ask

Has the sleep plan been tried for long enough?
Who will prescribe melatonin at the start, and when will the GP take over?
Which products does our local area allow?
When is the yearly review, and how will the trial break work?

References

National Institute for Health and Care Excellence. Autism spectrum disorder in under 19s: support and management (CG170), recommendations 1.7.4–1.7.8. Published 2013, updated 2021. https://www.nice.org.uk/guidance/cg170/chapter/Recommendations
National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87). Published 2018, updated 2019. https://www.nice.org.uk/guidance/ng87/chapter/Recommendations
NHS Thames Valley Integrated Care Board. Melatonin shared care protocol, v4.1, updated July 2024 (review date June 2025 has passed). https://thamesvalley.icb.nhs.uk/media/4960/melatonin-shared-care-protocol.pdf
South East London Integrated Medicines Optimisation Committee. Recommendation 118: melatonin (Slenyto) in paediatrics. Updated 2025. https://www.selondonics.org/wp-content/uploads/dlm_uploads/Recommendation-118-melatonin-Slenyto-in-paediatrics-Amber-2-FINAL-March-25-v2.pdf
NHS Norfolk and Waveney. Melatonin for sleep disorders in children: shared care. 2025. https://nwknowledgenow.nhs.uk/wp-content/uploads/2025/06/Melatonin-for-Sleep-Disorders-in-Children-v8-May-2025.pdf
NHS Humber and North Yorkshire. Melatonin prescribing guideline for children and young people, v1.0, approved 3 September 2025. https://humberandnorthyorkshire.org.uk/wp-content/uploads/2025/09/2025-09-HNY-Melatonin-prescribing-guideline-v1.0-FINAL-children-and-young-people.pdf