Miralax is one of the most commonly prescribed drugs for infants, toddlers and kids. It was available by prescription only until 2006. Even then, it wasn’t FDA approved for use in kids. Despite this, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) heartily endorses its use in babies, toddlers, kids and teens. It contains ingredients found in anti-freeze. Concerns for its toxicity have mounted – which is warranted: 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 (polyethylene glycol 3350) to clear a fecal impaction. So many parents have voiced concerns for reactions to Miralax that there is even a Facebook group just for this, a class action lawsuit, and consumer advocates who have pressed the FDA for answers on how often and freely doctors place children on Miralax.
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, not to mention side effects like bloating, gas, or psychiatric changes – is not healthy.
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The Truth About Miralax Use
The truth is, besides reaching a dangerous level of toxicity for some children, Miralax does not treat causes of constipation. 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 – which is indeed uncomfortable or painful, and important to resolve, since this encourages toxins from stool to be reabsorbed – to expelling some mushy stool regularly. Even still, kids can be left with blobs of sticky festering fecal matter throughout the colon, despite using more, more, and more Miralax.
For kids on Miralax for a long time, a common problem that I’ve encountered in my pediatric nutrition practice is “overflow diarrhea”. In this scenario, blow outs of loose stool happen every few days, with or without firm, hard, or dry plugs of stool. This overflow seeps around impacted stool matter, causing staining in pants that kids (and even 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.
There are other solutions! They are non-toxic, safe, and effective. My top three interventions for constipation are…
1 – Assess and clear fungal infections in the gut.
Prevailing thought in gastroenterology today dictates that fungal infections rarely warrant attention, unless a person is showing clear outward signs – like thrush at tongue, persistent itchy dry patches on skin, vaginal yeast infections, and so on. Even then, a topical medicine may be the only offering. People who are immune suppressed may also need anti-fungal medication. It’s hard for them to fight off any infection, and having a fungal burden makes this even harder. In that case, an oral dose may be prescribed.
It’s rare for a gastroenterologist to regard fungal infections in the gut as a problem or to prescribe an oral medication for it. A pediatrician usually won’t either. The belief is that fungal microbes (yeast, Candida, mold) are normal residents in human intestinal micro-biomes, and relatively harmless.
True enough – if there is little to no fungal growth in there. A lot of fungal microbial overgrowth is not healthy, and can cause problems like constipation, leaky gut, bloating, gas, sugar cravings, picky eating, or behavior issues especially in kids. Without testing stool specifically for fungal burden, this problem can continue unaddressed. Kids can have fungal infections in the gut while not otherwise showing signs like recurring rashes or thrush. Antibiotics, C-section delivery, prior thrush, and long term use of reflux medicine or steroids are just a few ways that a fungal burden can take a commanding posture in a child’s gut microbiome!
If your baby or child 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. Yeast and fungal microbes can occur in the small intestine under certain circumstances, as well as in the colon. 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.
Stool tests that screen for fungal dysbiosis are not routine in pediatric gastroenterology, but many functional medicine providers offer this test. I often use these in my pediatric nutrition practice too. Why? Because fungal overgrowth in the gut can be very constipating. A simple but thorough treatment with anti-fungal medicine may fully resolve years of Miralax-dependent constipation. I have observed this many times in cases where a patient’s prescribing MD was willing to give it a try. Anti-fungal medications like Nystatin or azole antifungals can do this.
There are few anti-fungal drugs available, which is one reason why doctors are hesitant to use them unless they really have to. They don’t want resistance to develop against these drugs. But if a child is so constipated that they’ve spent years unable to eliminate normally or painlessly, they suffer side effects from Miralax, or they can’t eat well, grow, or thrive, and quality of life is greatly compromised, then your doctor may be willing to help.
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. Capsules and liquid tinctures are available – these are best used with guidance. See my e book Peaceful Pooping for more details, and set up your own access to my nutrition dispensary here to browse.
Probiotics can often resolve milder constipation. But for kids with a longer history of constipation severe enough to require clean outs and medication, I have not found probiotics alone to be effective. Combining a probiotic regimen with herbal or prescription treatment can work best.
Here’s a clinical pearl: A popular probiotic used for intestinal fungal infections is Saccharomyces boulardii (“Sacc B” for short). I see most success in my pediatric nutrition practice when using this short term, that is, for 2-4 weeks. Sacc B is itself a yeast species. When used for longer periods, in my experience, it starts to act like more of a burdensome fungal microbe than a helper. An ideal product for this is Klaire Labs ABx Support. You can join my professional grade FullScript dispensary here to view this product.
While Miralax is not FDA approved for youngsters, anti-fungal medicines like Diflucan and Nystatin are. They can do a good job of clearing constipation from fungal infections. Explore this with your doctor if your child has been constipated for a long time.
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. Prilosec (omeprazole), a proton pump inhibitor (PPI) reflux medicine, is one of the top ten drugs prescribed in the US. The FDA has not approved PPIs for use in infants or children, unless a diagnosis of erosive esophagitis has been made (this requires endoscopy). Still, I routinely encounter infants and toddlers in my pediatric nutrition practice who are given reflux medicines with no diagnostic testing. As is often the case with Miralax, kids stay on these drugs for months or even years. This will worsen constipation and exacerbate fungal infections while lowering digestive function overall. Using reflux medicine long term reduces absorption of many nutrients, especially minerals, protein, and B vitamins. I have had some cases in my practice in which children who used reflux medicines for over a year suffered fractures, and others have experienced stunting and delayed bone age. They were not absorbing minerals or protein normally, and could not grow bone as expected. The FDA has issued a warning about elevated fracture risk in adults using reflux medicines. The same problem has been noted in children.
Talk to your doctor about weaning off reflux medicine if your child has used it for more than a month. There are many ways to improve digestion and diminish reflux without drugs. 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 help wean off Miralax. A product called Mag O7 is easily available. It’s ozonated form of magnesium that has worked well for some of the most constipated children in my practice. But take note!! The label instructions are intended for adults. This dosing is too high for most children. Safe upper limit dosing of magnesium for a 40-80 pound child is only 350 milligrams (mg) of magnesium. For smaller children, even less may be all that is needed. Check with your health care provider and pharmacist before using this product, to make sure it can be safely used.
Besides drawing water into the colon, magnesium is calming. It can help with sleep, mood, muscle cramps, or may even fix heart palpitations or arrhythmias. This is great, but too much is sedating and may slow heart rate. It’s best to use magnesium 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 two teaspoon gives 350 milligrams of magnesium citrate. This is too much for a baby or toddler, but may be perfect for a school age child weighing more than 40 pounds. More than two teaspoons daily is not likely to be necessary and may be too sedating for any 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 nutrients, building a healthier gut microbiome, and eradicating the cause of constipation. For even more help, check out my e book on Milk Addicted Kids (another constipation situation!) and stay tuned for Peaceful Pooping, my upcoming e book and protocol on getting off Miralax. Thanks for stopping by!