An article in the New York Times has raised the the question for many parents: Is it safe for my child to take Miralax (Polyethylene Glycol 3350) for the long term treatment of constipation?
I think it’s important to recognize that the concerns are for children who are on long term maintenance therapy for constipation, not for short term use in an acute situation. Miralax works by drawing water into the colon, which softens the hard bowel movement and quickly helps the child who is in pain to “go”.
Miralax became available about twenty years ago for children and was immediately popular with pediatric gastroenterologists because it was a more palatable alternative to other laxatives. Persuading an uncomfortably constipated child to take mineral oil was not easy! Miralax could be used in higher doses for an initial clean out and then in gradually tapered lower dosages for maintenance. In a few months, most children were back to having daily soft bowel movements.
Once Miralax became available without a prescription, medical evaluation and follow up was not needed. It’s often recommended for every type of constipation. It still works for many children, but sometimes it is recommended without an individualized plan to treat the cause of the constipation. Over the years I have seen many children who have been on Miralax for months or even years despite having continuing problems with holding in BMs, leaking, and soiling (encopresis). For them, more Miralax is not the right solution.
In my opinion, the questions being raised now will have the benefit of encouraging health care providers and parents to be more cautious about jumping to a medication before addressing underlying causes of the problem being treated.
Here’s a link to my website article on Constipation: http://www.bringingupkids.com/blog/constipation-the-poop-on-poop.html
For children whose chronic constipation has led to stool withholding, soiling and a distended colon, an initial laxative clean out is absolutely medically necessary. The use of Miralax for the initial clean out has not been called into question, although parents who are concerned can substitute other medications. The same is true for maintenance therapy.
What is most important for parents to understand is that most children should have one or more soft bowel movements every day, unless that was not their pattern before toilet training or the beginning of the constipation problem. A child who withholds and then has extra large bowel movements days later has a problem that should be treated, because even if the BM is soft the withholding causes stretching of the muscle wall and desensitization to the nerves that stimulate bowel movements. Diet, liquid intake, toilet routines and other environmental factors should always be part of a treatment plan.
If you have been giving your child Miralax and would like to make changes, I am happy to help you reevaluate his or her bowel pattern and find other solutions.