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 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.

Naturopathic treatment of constipation

Naturopathic treatment is always in the therapeutic order.  The first step of treating constipation is always addressing diet.  Many children are consuming shockingly low levels of fiber and fluid.  We recommend having your child consume half their weight in fluid ounces of water per day. (Weight in lbs.)  For example, a 20-lb child should consume 10 fluid oz of water per day.  

Secondly, consider addressing food sensitivities and allergies.  We have more information in our Constipation E-book.  Functional food sensitivities are quite common in children with constipation. 

Third, we recommend addressing peristalsis.  Peristalsis is the normal motion (movement) of the intestines.  It is what allows food to move in a snake-like fashion through the gastrointestinal system.  There are many great naturopathic therapeutics to help peristalsis!  Fermented foods are one great example.  Stress reduction and relaxation is incredibly important for normal peristalsis. 

Finally, consider having your child complete both a bowel cleanout, AND long-term laxative therapy.  There is a lot of misinformation in regards to long-term laxative use.  See this video on a naturopathic approach to laxative use!

We have SO Much more information in our Constipation e-book!