Miralax is one of the most commonly prescribed drugs for infants, toddlers and kids. It isn’t FDA approved for them. It contains ingredients found in anti-freeze. Concerns for its toxicity have mounted (as they should – one child in my practice slipped into a coma during an in-patient, closely monitored procedure to give high doses of the laxative ingredient in Miralax to clear a fecal impaction). The label states it is only to be used by adults for up to seven days – but children have entered my practice who have been on it, with their gastroenterologists’ blessing, for years – which is not unusual. And when I meet these kids, they are still constipated, still unable to move bowels without drugs or suppositories, still picky eaters, and they don’t feel good. Their parents want them off Miralax, and so do I. Having messy, uncomfortable “applesauce” stools every day – or none – is not healthy.
The Truth About Miralax Use
The truth is, besides having potent toxicity for at least some children, this drug does nothing to treat causes of constipation. Like many drugs, it is a bandaid approach. What it does do is turn stool into mush, by pulling more water into the intestine. Children can go from being impacted with hard dry feces (very uncomfortable, and encourages toxins from stool or disruptive microbes to leach back into circulation), to expelling some mushy stool regularly. But, they can still be left with impacted, sticky fecal matter, despite using more, more, and more Miralax.
A common picture that I’ve encountered in my practice for kids on this drug is “overflow diarrhea” – that is, blow outs of loose stool every few days, with or without firm, hard, or dry plugs of stool. This overflow, which seeps around the impacted matter, causes staining in pants that kids (or teens) can’t control. For toddlers, it can explode up the child’s back and and down to ankles. Many moms have described to me the daily chore of stripping kids down, bathing them, and getting fresh clothing because this pattern covers their toddlers or babies in stool. Older kids experience embarrassing stool accidents with this pattern. Needless to day, this is exasperating and concerning for parents – and miserable for kids. Regardless, it’s common for pediatricians to use Miralax indefinitely anyway: In 2013, Miralax was the fourth most popular drug in the “digestive” category, with nearly $180 million of it sold!
There are many other solutions. They are non-toxic, safe, and more effective. My top three interventions for constipation are…
1 – Assess and clear fungal infections in the gut.
Prevailing thought in gastroenterology today dictates that nobody gets fungal infections, unless they are immune suppressed. It’s rare for GI docs to regard fungal infections in the gut as a problem. Your pediatrician usually won’t either. Their belief is that fungal microbes (aka yeast, Candida, mold) are normal residents in human intestinal micro-biomes. True enough – if there is little to no fungal growth there. A lot of fungal microbial growth is not normal. Without testing stool specifically for fungal culture, there is no way to know what is growing in there, or how much of it. Healthy kids can have fungal infections in the gut. Antibiotics, C-section delivery, prior thrush, using reflux medicine or use of some infant formulas can trigger fungal overgrowth in a baby or child’s gut.
Most GI doctors do not screen for this, but many functional medicine labs offer this test. I use it often in my practice. Why? Because fungal overgrowth in the gut can be quite constipating. A simple treatment with anti-fungal medicine can fix it. Drugs like Diflucan, Nystatin, or Sporanox do this. There are not many anti-fungal drugs out there, which is one reason why doctors are hesitant to use them unless they really have to – they don’t want resistance to develop to these drugs. But if a child is so constipated that they’ve spent years unable to eliminate normally or painlessly, or they can’t eat well, grow, or thrive, then it’s time to pull out those big guns (IMO!).
If your baby has had thrush – that is, a white coated tongue, or a diaper rash with white patches in stool – an anti-fungal medication may be offered, because thrush is a kind of fungal infection. But fungal load can persist deep in the GI tract, which, don’t forget, is several feet long. There is plenty of space between mouth and anus for fungal microbes to thrive. Just because the white coating on the tongue is gone, and the diaper rash too, does not mean the fungal infection is all gone. A lengthier course of medication can clear the problem, if it is lingering in colon or intestine.
Herbs can help keep fungal infections cleared out too. Common tools include tinctures or capsules of oregano, thyme, grapefruit seed extract, goldenseal, berberine, uva ursi, caprylic acid, black walnut, garlic, undecylenic acid, and many others. I often support my patients’ gut micro-biomes with herbal tools, so contact me if you need this help.
For entrenched fungal infections, I have not found probiotics alone to be effective. In fact, a popular probiotic used for intestinal fungal infections called Saccharomyces boulardii (“Sac B” for short) is problematic if used incorrectly and may worsen constipation. A more aggressive, multi-pronged approach is more successful: Direct clearing of the fungal infection with an herbal or prescription agent; different food; and, lastly, the right probiotic.
Strangely, while Miralax is not FDA approved for youngsters, anti-fungal medicines like Diflucan and Nystatin are approved for use in infants. They are safer. They can do a good job of clearing constipation from fungal infections, so explore this with your doctor if your child has been constipated for a long time. Don’t be daunted if you are dismissed. Find an integrative health practitioner who will help, and talk to me about non-prescription supports.
2 – Lose the reflux medicine!
Fungal infections worsen reflux, and reflux medicines worsen fungal infections. Click here for more on why you don’t want to leave your child on reflux medicine for very long. Like Miralax, reflux medicines are widely prescribed for babies and kids – some say over prescribed – but are not approved for use in those age groups. There are no proton pump inhibitors (reflux medicines) approved for use in infants age one year or younger. There is only one approved for use in children under age eleven years. Still, I have encountered countless infants and toddlers given reflux medicines only approved for adults, and left on them, for over a year or even two. This will worsen constipation, since it worsens fungal infections, and lowers digestive function overall. Using reflux medicine long term also diminishes uptake of many nutrients, especially minerals. Two children in my practice who used reflux medicines for over a year suffered fractures later on, and others have experienced stunting and delayed bone age. They were not absorbing minerals normally, and could not mineralize or grow bone as expected.
Talk to your doctor about weaning off reflux medicine if your child has used it for more than two months. There are many ways to improve digestion and diminish reflux without drugs. This is also one of my specialties in practice, so contact me if you need help. Changes in foods and use of herbs can gently enhance your child’s digestion while you wean off a reflux medicine. Correcting the gut micro-biome will help as well. Do this with guidance for better, faster results.
3 – Use Magnesium.
This one is so simple. Magnesium is an easy way to pull water into the gut without toxic effects from peculiar ingredients in products like Miralax (dyes, gluten, polyethylene glycol). Magnesium oxide is a stronger laxative than magnesium citrate; magnesium citrate is stronger than magnesium glycinate. There are other forms of magnesium besides these three, and depending on your child’s presentation, there is probably a magnesium option that can get him or her off Miralax. A very effective product, widely available, called Mag O7 is an ozonated form of magnesium that has worked beautifully for some of the most constipated children in my practice. Use this with guidance; the label instructions are intended for adults, and this dosing is too high for most children.
How much? Magnesium is calming, which is great, but too much is sedating and may slow heart rate. So this must be used with guidance, especially for infants or young toddlers. I choose which product and what dose, based on each child’s case. There are liquids, powders, and capsules of various magnesium products. One of the most popular is Natural Calm, available on many supermarket store shelves. A teaspoon gives 350 milligrams of magnesium citrate. This is a large dose for an infant, but may be perfect for a school age child. More than two teaspoons daily is not likely to be necessary and may be too sedating for your child. If you have any questions about using these products, especially if your child takes other medications, ask your pharmacist or pediatrician.
These three ideas are only the beginning. From foods to herbs to drug-free options, there are many ways to clear constipation that are not only non-toxic, but more effective than Miralax – and they create better overall health by replenishing and balancing the cause of constipation, rather than giving it a toxic bandaid.
Click on the graph below, to see the absolutely mind boggling amounts of money spent on “digestive” drugs. These data are only for the year 2103! Which of these has your child used, and which would you like to replace with non-toxic, healthy options? It’s possible. Need help getting your child off of Miralax for constipation? Contact me and let’s get started!