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Is Miralax safe for kids?



Local expert discusses controversy over laxative use and children


When it comes to chronically constipated children, there may not be such a thing as a “miracle drug.” But for many parents, the laxative Miralax comes close.

It’s available as both a prescription and over-the-counter, so it’s easy to get a hold of. It’s odorless, tasteless, and dissolves easily in juice or water; so even finicky children have no problem drinking it down. And most importantly, it works time and time again.

But over the past few years, questions have been raised about the drug’s safety when administered to children, especially over a long-term period. In fact, the Food and Drug Administration recently commissioned a research team at The Children’s Hospital of Philadelphia to study whether active ingredients in Miralax might be might be harmful to kids. With all the controversy surrounding the drug lately, many parents and pediatricians are now hesitating to use it.

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We asked pediatric gastroenterologist Dr. Puneet Gupta of the Digestive Disease Center of the Hudson Valley what he thinks of the this oft-prescribed treatment for constipation in children and adults.

“Miralax has been out for a long time,” says Gupta. “It’s been used extensively in both children and adults, not just for constipation but for colonoscopy prep and things like that. There’s lots of evidence and studies that say it’s safe.”

Miralax, as well as similar generics distributed under different names but containing the same active ingredient known as PEG 3350 (short for polyethylene glycol 3350), was never actually intended to be used by children. It’s an adult laxative, meant to be used for no more than a week. That means that children who take the laxative regularly may be absorbing an enormous amount of PEG 3350 into their bloodstream.

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Researchers are now looking further into Miralax’s safety after receiving reports that some children who frequently take Miralax have developed a host of neuropsychiatric side effects including seizures, tics, anxiety, lethargy, aggression, and obsessive-compulsive behavior.

The alternatives however, are far from perfect. Dr. Gupta says he will often prescribe a sugar-based drug known as Lactulose for parents wary of Miralax, but the drug can cause painful bloating and abdominal distention. Magnesium Citrate is another alternative, but the taste is so bad that children often refuse to take it.

“There are lots of options, and none of them are great,” says Dr. Gupta. “They all have side effects. So we’re all waiting on the data from this new study to see what happens.”

In the meantime, what’s a parent to do? Dr. Gupta suggests that the best medicine to take may be no medicine at all.

“If you don’t have to use medicines, it’s always better to avoid using them,” he says. Instead, start by changing your child’s diet: Decrease dairy, increase high fiber vegetables, and drink plenty of liquids — especially prune juice. These will help to soften the stool itself. And the psychological elements behind chronic constipation are just as important as the physical elements.

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“Once children get constipated for any reason, because the poop is large and hard and painful and it hurts to come out, they get fearful of having future bowel movements,” explains Dr. Gupta. “That’s what we call ‘Holding Stool Syndrome.’ It becomes a vicious cycle. So first you have to make the stool soft. Because if it’s large and painful, no matter what else you do, the child is going to be afraid to go.”

Once the stool has been softened, you can work on reestablishing going to the potty as a fun, pleasant activity. If this is bringing back flashbacks of potty training, you’re on the right track. Many of the same tactics you used back then — such as incentivizing bathroom visits with sticker charts and other small rewards — will help you again.

Dr. Gupta also recommends having your child always sit on the toilet after meals, when their colon is the most active. But don’t put any pressure on them: Just tell them they only need to sit there for five minutes, and that they don’t have to actually go if they really don’t need to. Sometimes though, they may end up surprising themselves.

If, after all this, your child is still having chronic problems, then it’s time to pay a visit to your doctor.

“If you can avoid Miralax, that’s great,” says Dr. Gupta. “But there are many children who do end up needing medication.”

He says he’s most optimistic about the newest crop of adult laxatives like Linzess that appear to be relatively free of side effects, and he’s hoping that the FDA will look into doing the requisite studies to determine if they’re also safe for children.

But until all the data comes in, parents may want to deal with constipated kids the old fashioned way: Lots of veggies, lots of liquids; and a calming, supportive environment at home.

Come to think of it, that’s a pretty good prescription for kids who aren’t constipated, too.

 

Brain PJ Cronin is a freelance writer living with his family in Beacon.