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.

Ready to get started?  Check out our full guide:

How to Help Your Child with Constipation: Natural Alternatives to Miralax. 

Naturopathic Pediatrics Constipation Guide. How to help your constipated child without 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.


Learn about natural alternatives to Tylenol and Ibuprofen.

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Erika Krumbeck, ND
Erika Krumbeck, ND
Erika Krumbeck, ND is founder of and the owner of Montana Whole Health, a naturopathic clinic in Missoula, Montana. She received her Doctorate of Naturopathic Medicine from Bastyr University and is a licensed physician in the state of Montana. Dr. Krumbeck is one of few physicians specializing in the treatment of chronic health conditions in children. 

Dr. Krumbeck likes to practice her own healthy lifestyle with her wonderful husband Jason, a physical therapist, and their children Annika and Leopold. 

She is a professional member of the Pediatric Association of Naturopathic Physicians.

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