In January of this year the FDA announced it would fund research into the safety of the very popular constipation medication Miralax.
Though Miralax has been approved for use in adults and adolescents for less than 7 days, it has never been approved by the FDA for use in children. Despite this Miralax has been a mainstay treatment by conventional pediatricians for use of constipation in children.
Polyethylene glycol 3350 (PEG 3350) is the active ingredient in Miralax. Just so we are on the same page, ethylene glycol – or antifreeze – is not the same as polyethylene glycol. Though polyethylene glycol is simply a string of ethylene oxide molecules, it is supposedly non-toxic and non absorbable, having no effect other than to loosen stool (poop).
So what’s the problem? The problem is that when the FDA tested batches of Miralax they found small amounts of actual antifreeze: ethylene glycol and diethylene glycol. Not to mention that intestinal absorption of Miralax has never been studied in children, which is very concerning. The FDA has even received reports of psychiatric problems linked to the use of Miralax – specifically tics, tremors and obsessive-compulsive behavior. This would suggest that at least some component of PEG 3350 is systemically absorbed, and we are not sure what the long term consequences are.
I’ve seen countless kids in my office with a chief complaint of chronic constipation, many of whom have seen conventional pediatricians and walked away with a prescription for Miralax. I’m not blaming them – Miralax works extremely quickly and is an easy recommendation to make (we know it will work!) – but it also fails to truly address the underlying cause of why a child is constipated.
One of the main principles of naturopathic medicine is called “Tolle Causem” or Treat the Cause. For kids to have permanent change in their bowel habits we first need to find out why they were constipated in the first place. Read on!
First – how do we know they are constipated? What “counts” as constipation?
Here’s a little guideline of what is normal for kids:
- Babies 1 week old or less usually have 4 or more bowel movements (poops) each day. They are usually liquidy or extremely soft.
- Babies 3 months old or less can have bowel movements as often as several times per day, or as infrequent as once per week. Breastfed babies tend to have less frequent poops because breastmilk is highly absorbable, which doesn’t leave much “left” to make a poop with. If babies are very uncomfortable when passing stool (poop) then I still consider them to be constipated even though it is technically normal to go up to a week. (If it is bothering them, I think it is a problem!)
- By age 2 most children have at least 1 bowel movement per day. They should be easy to pass, formed, no blood in the stool, not pellet-like. Though it is “normal” for kids to skip a day in between bowel movements, I aim for 1 per day.
If your child doesn’t meet the guidelines listed above, or is having painful stools or behavior changes around the time of defecation, then I would consider them to be constipated. Rather than just give a laxative, let’s try to figure out why they are constipated.
Ready to get started? Check out our full guide:
How to Help Your Child with Constipation: Natural Alternatives to Miralax.
This e-book includes:
- A resource guide and checklist for treatment.
- A guide to “What is Normal?”
- Two separate methods and printables for increasing fiber intake and how to guarantee your child is eating enough fiber.
- How much water your child needs to reduce constipation.
- Options for elimination diets and which food is the number 1 cause of constipation.
- What is peristalsis? How does this affect constipation? Tricks to improve constipation, including
- Acupuncture
- Herbs
- Probiotics
- How to teach bowel retraining and why this is so important. This step includes tricks like:
- Abdominal massage
- Movement and positioning to improve bowel habits
- Prune juice – why does it work? Who should avoid prune juice?
- Laxative use and safety
- Use of suppositories and enemas
- When to immediately see a doctor, and when constipation is dangerous or a sign of something more serious.
My son is 13 months old and had severe constipation. I tried prune but he was still having hard time pooping. Now he is getting Toddler magic tea with his formula and goes everyday without struggling.
My great grandson has low muscle tone and has always been constipated. the only thing his Dr ever prescribed is miralax and he was on this until the articles came out about it My grand daughter took him off of it and has been trying prune juice and some herbs without much luck we have to use a suppository or enema to help him out his B.M.’s are the size of a grown man he only goes 1x a week the dr still says to use miralax it is so frustrating .he has a feeding tube
Hi Vicki, have you tried magnesium supplements? It is worth giving a try, plus you get a lot of ther benefits. Good luck 🙂
Hello my daughter has been on Myralx since November 2016 and the xray shows she still has stool compacted which the Dr. just said all test came back fine keep doing the Mrylax and we will see you in 3 months. To this I said NO, I wanted to know when this stool will pass and to get another xray to know is was gone and then to tell me what is causing this. My daughter has ADHD and is on meds for it along with counseling. Everytime her behavior gets worse so does her stomach issues. She also gets rotten egg burps. She was popping Zofran but also is pooping just not passing it all and it was so bad she was having explosive poop. They did tons of blood tests, we are on a dairy free diet completely. I am so frustrated. I want her better.
Steph,
I’m so sorry to hear this. Constipation is super frustrating, and even more frustrating when doctors only have one “tool” to treat it (Miralax). I highly recommend getting our e-book on constipation. I am also working on a webinar series to discuss more constipation tips/tricks. I’ll let you know when it’s ready!
– Dr. Erika
Your daughter and my son sound so much alike!! My son also has ADHD and is/was using miralax daily and only passing pure liquid but was always soiling in his underwear. Each abdominal X-ray would always show stool in his rectum and then we would have to do another clean out which just means increase the miralax to 8 times a day until the doctor was satisfied. I have taken him off the miralax in the last 2 weeks and am using culterelle for kids twice daily…. it has been amazing!! He is having formed soft bowel movements every other day and his soiling has decreased tremendously!! He also gets the feeling to poop which he hasn’t had in a year and a half!! Just wanted to share, maybe this will work for you!!
Try magnesium…
Hi Anna. Is Probiota Sensitive suitable for a 3-year old? I need something for my daughter but am not sure whether to try Seeking Health’s infant or sensitive product. Than you!
My daughter has never had any bowel issues until now at 2yrs old which I’m sure is due to unhealthy eating. She is extremely picky and does not get at all close to the fibers she should be having. Instead of suggesting probiotics or more ways to get fibers for my daughter her doctor told us to start using Miralax which I do not agree with at all. For a child that has never had stomach issues why would our first resort be this. Please suggest food or a probotics if that helps bowels? I’m lost here.
[…] Treatment for Children’s Constipation without Miralax … – In January of this year the FDA announced it would fund research into the safety of the very popular constipation medication Miralax. Though Miralax has been approved … […]
Which one of the Seeking Health products would you recommend for a child who just turned 6 and struggles with severe constipation since she was 2.5? Our pediatrician recommended Miralax, but then she loses the ability to go pee too and it adds to the problem so we didn’t bother with that. We do give her a very good diet so she does not get much junk. She does seem to have slow motility, and I’m guessing too much methane producing bacteria given that she’s often bloated and x-rays have shown gas building. She tested negative for Celiac or thyroid issues but did test positive intolerance dairy (severe) and moderate to high for gluten, chicken, and coconut so we eliminated all of those. She has mild intolerance to others like basil, bacon, etc. Every now and then she still struggles and so we’re thinking now she may have an imbalance of gut flora or SIBO or something and so we’re going to try a regular probiotic for her. Could you recommend a product from Seeking Health that we should get for her that’s appropriate for her age? Does it need to be shipped her refrigerated? I’m seeing negative reviews on Amazon for not probiotics not being shipped on ice? She often screams when she goes but then also says it doesn’t hurt…she’s always been a more emotionally intense child. She will go to the toilet fine on her own but really struggles a lot with being bloated and constipated. The dietary changes have helped – her hair started to grow out and she enjoyed running again and stopped W-sitting so we’ve seen big gross motor improvements by dropping the food intolerances completely out of her diet though she still struggles from time to time.
Hi (sorry for the delay in getting back to you),
We can’t officially recommend anything since your daughter is not our patient. However, I can share my favorite probiotics, and as long as it is okay with her pediatrician I don’t see why you couldn’t try it.
I like the FOS-free probiotics the best for kids with presumed gut dysbiosis (I think it’s listed as “Sensitive” under the Seeking Health site). You can always open up the capsules and mix in food (like applesauce, etc). Ask her pediatrician or naturopathic physician for dosage instructions.
These probiotics are typically shelf stable for up to 2 weeks, so it usually isn’t a problem unless the bottle arrives hot.
I have a 4 year old son who has struggled with constipation since he was an infant. He has been on Miralax consistently everyday for 2 years. It has been the only way he can poop. Lately Ive noticed that his bowels are very thin, ribbon like. I’ve backed off the miralax but not sure what do next to help him?
Please speak with his pediatrician! Make sure there is not a bowel obstruction, that is very important.
My son struggles with constipation, and after reading this article I am fairly confident it is because we have unknowingly been feeding him too many constipation foods.
In the article you mentioned an e-handout of a more comprehensive list of constipation and non constipation foods, but upon looking at your store I could not find this list. Could you please leave me a link to where to purchase this list?
My son was prescribed miralax and after only a week we had to stop because it was giving him constant and painful stomach cramps.
Thank you! This article was extremely helpful.
-Lauren
Hi Lauren,
I think we took it offline for a bit – here is the link. https://naturopathicpediatrics.com/product/how-to-treat-constipation-without-miralax/ (We are working on updating all our e-books right now).
Do you know of any probiotics that are good for toddlers and available in the uk? Thanks.
Hi Sally,
I use Klaire Labs brand probiotics in my practice, but I also highly recommend Seeking Health products. I know they do ship abroad.
Hi Dr. Krumbeck,
Our 9 year old daughter has been using Miralax for 2 years now, as prescribed by her Dr as being safe enough for infants. I’ve only recently learned that this is not the case. I came across your excellent article while researching magnesium and probiotics in place of Miralax. I’m wondering if you could council me in my current plan of attack, to see if I’ve got it right.
Can I discontinue the use of Miralax now, or do I need to ween her off?
I found the Klein Kidd Ther-Biotics on Amazon, is that a good option for a purchaser? And do I start her on them one tablet per day, or do we need to work up to the full dose?
I want to start her on magnesium as well, but have heard the magnesium citrate is not a safe option because of the citrate. I was going to order the Calm that you suggested, but do you know of another option that doesn’t have the citrate? She’s almost 90lbs, what dosing should I start her at? Also, do you have and opinion on magnesium spray oils or Epsom salt baths to help with increasing magnesium and decreasing constipation?
And can Kiefer help with this as well? I’m trying to establish good gut flora and eliminate constipation, it seems as though they may go hand in hand.
I really appreciate your very informing article, so much, in fact, that I planted myself in the health food section of our grocery store to read through the entire article, as I was searching for a probiotic. Anyhow, thank you. Reading this has given me hope and comfort that we can get our sweet Juliette’s tummy in good working order, naturally!
Hi Anna,
Magnesium needs to be taken internally to produce loose stools, so doing an oil, spray or lotion probably won’t help. Kefir can be a good source of probiotics, but isn’t always enough for most kids. I believe one of our writers will be coming out with a probiotic guide this month, so that may be helpful. I generally don’t see a problem with doing magnesium citrate in kids – the problem with Mg citrate is that it can be irritating to the gut, but in this case we are specifically trying to create loose stools.
You have a lot of questions, though, and we can’t answer specific health advice, just general tips and tricks. (Otherwise it crosses the line into patient care, and we have to see patients in our office for that.) I highly recommend finding a naturopathic physician near you. You may want to check http://www.pedanp.org to see if there is a pediatric ND near you.
Gosh, thank you for that quick response! I didn’t have luck finding a naturopath Dr near us (sad face) and I’m not confident in taking her to her PCP for help in this area as that’s where the suggestion for Miralax came :/ I don’t know if this is one of thoes off limits questions you can’t answer, but I’ll ask in the hopes that you may be able to offer insight. Is Amazon a good source for ordering Kline Labs probiotics? And do you have a recommendation on a good one from them for adults (specifically me) to use as well? It seems their benefits are many. Or is it not recommended to take them on a regular basis?
Again, so many thanks,
Anna
I never recommend Amazon for supplements, there are a lot of “knock off” products. I generally recommend Seeking Health products – they are available on the web (which is awesome) and are a high-quality source.
You mentioned in this article some brands of pro-biotics you recommend and/or use. I am currently using Seeking Health Probiotic (Probiota Infant). Is that an effective brand?
Yes! I really like the Seeking Health brand, it is one of few high-quality nutraceutical companies that actually sell direct to the patient. (We may start offering their products here soon!)
try home remedies for preventing it.
My concern is a great grandchild…her constipation has become a family problem…I appreciated the information and suggestions
and will alert my Granddaughter re: your findings and suggestions..Thanks you