How To Get Kids Off Miralax

Posted by on Oct 3, 2015

Miralax_imageMiralax 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 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…

Mycelial form of Candida

Mycelial form of Candida – Why you don’t want to go there

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.

This product blends several herbs to help clear fungal infections in gut

This product blends several herbs to help clear fungal infections in gut

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? Contact me and let’s get started!

 

Digestive Drug Sales 2013

22 Comments

  1. I read this article with interest. My brother was severely constipated as a child. Don’t know if it harmed him, but he has multiple physical and mental ailments. However, what I was wondering, I’ve been taking Nexium for about 8-10 years. I’m 63. Do you think it’s harming me? I would love to get your newsletter if it includes adult information. Thank you. Nancy Cerreta.

    • Hi Nancy, using reflux medicines like Nexium (which are proton pump inhibitors) has been associated with increased fractures in elderly. I don’t think it is a healthy option, in my opinion, though I know nothing of your health situation. I do know that other data show that PPIs diminish digestion and impede absorption of B vitamins and minerals. Using Nexium for 8 years is a long time; these drugs were never intended or approved for this type of use, but it’s common! It won’t work to add vitamin supplements because you simply may not be able to absorb those nutrients, if your digestive function is too reduced. If I were you, I’d discuss a plan to get off this drug with your doctor.

  2. MIRALAX INFORMATION IN MEDIA

    http://www.today.com/video/today/56743393#56743393

    January 2015: brief article about Miralax written by a lawyer:
    http://myadvocates.com/blog/miralax-fears-finally-get-fda-attention

    Facebook site October 2015
    “Parents against Miralax” with almost 2000 members.
    Many parents would like a letter of intent to sue submitted to expose issues with Miralax.

    Miralax@yahoogroups on-line with over 2000 members.

    Almost 10,000 adverse events reported to the FDA as of March 2015.

    In 2009 the FDA held an oversight board meeting in response to increasing complaints.
    The FDA took NO ACTION, but several concerns were highlighted:

    “In 2009 the Drug Safety Oversight Board discussed reports of metabolic acidosis, metabolic acidosis with increased anion gap, and neuropsychiatric adverse events in children using polyethylene glycol (PEG) products. Metabolic acidosis is a disturbance in the body’s acid base balance and causes too much acid in the blood. In some situations, metabolic acidosis can be a mild, chronic condition; however, it may lead to shock or death in severe cases. Neuropsychiatric adverse events may include seizures, tremors, tics, headache, anxiety, lethargy, sedation, aggression, rages, obsessive-compulsive behaviors including repetitive chewing and sucking, paranoia and mood swings.”

    In 2011 the FDA warned against “POSSIBLE NEUROPSYCHIATRIC EVENTS” from Miralax.

    https://www.gutsense.org/gutsense/the-role-of-miralax-laxative-in-autism-dementia-alzheimer.html

    Two New York Times articles have spotlighted Miralax and concerning issues with side effects:
    http://mobile.nytimes.com/2015/01/06/science/scrutiny-for-a-childhood-remedy.html?_r=2&referrer=

    http://www.nytimes.com/2012/05/26/us/miralax-a-popular-cure-but-never-approved-for-children.html?_r=0

    Interview with Carol Chittenden with the EMPIRE STATE CONSUMER PROJECT discussing overwhelming reports against Miralax with minimal action being taken by the FDA.
    50,500+ views on-line.

    After two years a $325,000.00 grant from NIH in collaboration with the FDA awarded to study to investigate possible absorption issues. Several institutions applied for grant, but Children’s Hospital of Philadelphia, a few miles from Merck was awarded the grant. Considering 40-50% of FDA funds come from the pharmaceutical industry this raises ethical questions.

    http://articles.mercola.com/sites/articles/archive/2015/01/21/miralax-laxatives.aspx

    http://grantome.com/grant/NIH/R01-FD005312-01

    http://m.startribune.com/science/287997201.html

    http://www.peoplespharmacy.com/2015/01/08/is-popular-laxative-too-risky-for-kids/

    In 2008 the FDA detected the two poisons di-ethylene glycol and ethylene glycol in all eight lots of Miralax tested, yet this was not disclosed to the public. Ethylene glycol poisoning and polyethylene glycol poisoning present with almost identical symptoms. This information was disclosed in grant award information released by the FDA.

    Per article below: “Those tests were conducted in 2008, but the results were not disclosed. Jeff Ventura, an FDA spokesman, said batches were tested because “many of the reported adverse events were classic symptoms of ethylene glycol ingestion.”

    http://www.empr.com/safety-of-adult-laxative-given-to-children-questioned-by-fda/article/391184/

  3. My 10 month old son has been on miralax since he was 4 months. I am interested in trying the magnesium, but am concerned about giving him the right dose, and nervous about giving him too much. How can I determine the right dose?

    • This would depend on his weight and a few other factors, so check with your pediatrician. Typically safe to use 30-70 mg magnesium citrate daily in ordinary circumstances at this age and stage, but if constipation is fierce, more may be needed. Ask you doc to be sure.

  4. Judy, I have read several of your posts and have now read most of your book, Special Needs Kids Go Pharm-Free. MY QUESTION IS WHAT TINCTURE DO YOU RECOMMEND FOR INFANT CONSTIPATION OR POOR DIGESTION? My little girl is almost 9 months old. Her pediatrician (who we switched to because she comes highly recommended) diagnosed her with severe silent reflux at 2 months old, however no testing has been done because the pediatrician has felt confident about the diagnosis and hasn’t felt like testing has been necessary. Reluctantly, we have had her on ranitidine since she was 2 months. We have tried several formulas and have settled with Nutramigen which she seems to handle the best. She has still had issues stooling, which I contribute to the zantac but when I’ve tried to wean her off it she has shown the same painful symptoms from early on. After getting an ear infection and being on antibiotics a couple months ago she got the worst diarrhea and the worst diaper rash I’ve ever seen. It must have been a fungal infection. Right after her antibiotics I put her on the Klaire Labs probiotics you recommend and I feel like they have made a great difference. She did unfortunately get another ear infection and sadly is on antibiotics again but this time around there is no diarrhea or rash. I want my baby to be well, I want her off Zantac, and I want her digestion to work properly. On top of her GI issues she has major developmental delays and she is now in the early intervention program. We have PT/OT lined up as well as an appt with a highly recommended pediatric GI specialist. I’ve asked our pediatrician if we can PLEASE order a comprehensive stool culture, an IgG test, and a swallow evaluation (recommended by the early intervention nurse as well as an MRI). I’m debating scheduling appts with you but want to wait till we see our pediatrician in a week. THANK YOU FOR YOUR BOOK, FOR SHARING YOUR INVALUABLE EXPERTISE AND FOR HELPING KIDS IN NEED!

    • Glad to hear some progress has been had with the probiotic, but you’re right – more direct intervention is needed. If you are lucky enough to have an independent, integrative pediatrician, it’s a good move to ask for those lab tests. Most pediatricians don’t use them for a variety of reasons – from political, to lack of awareness, to cost issues in their practices. If they aren’t forthcoming, the best way for me to advise is to work with you. I truly can’t presume to know what is best for your child without the opportunity to review your daughter’s history, labs, food intake, and signs/symptoms in detail.

  5. Thank you Judy. In corresponding with our pediatrician it sounds like she’s learly about ordering the lab tests so I’d like to schedule an appointment with you, after speaking with my husband about it to make sure he’s on board. Before scheduling through your website I’m wondering if there’s any way you can provide me with the insurance codes that would be used so I can check to see whether or not the cost will go towards our deductible and/or total out of pocket amounts (we are located in Utah and have Select Health coverage).

    • Nutrition care/dietitian service codes have not changed with the ICD-10 transition that happened last fall. Diagnosis codes did change. Your coverage, if any, will probably depend on both these. Dietitian services are usually denied unless a child has a severe enough finding that relates to nutrition, and this is only discernible through an assessment process. Service codes for nutrition may include S9479, S9470, 96869, 96868 – but again, these may only be applicable if your child’s nutrition diagnosis codes trigger coverage. I also accept health savings account cards if this is helpful, and can give coded statements when requested at the time of your care. Hope this helps.

  6. Determining the root case of the constipation is key as well. I realize that is not always possible. However, food sensitivities can sometimes be the trigger.

  7. I have always had constipation issues. I am 67 and using mirolax. Doctors have said I could use it all my life with no problems. I hate the way it makes my stools but I need something. If you know of any other option, for older people, I would love to know. I take a statin drug so lm leary of anything with grapefruit in it. Would appreciate any input. Thank you.

    • Good on you Carol, for seeking better! You can use magnesium citrate (also good for your heart health) and usual adult doses range from 150-600mg daily but this varies with individuals. This is available in many forms: Capsules, liquids, powders – at most any supermarket, pharmacy, or supplement shop. You can also try high dose vitamin C, also widely available in many formats. Effective dose for individuals vary here too. Usual strategy for adults is to try 500 mg and increase to 5000 mg if you like, in split doses. These are safe together if necessary. Of course what you are eating will play into this and it’s likely that this needs attention too, if your doctor gave you a statin. And by the way, statins have also been over prescribed (like Miralax and reflux medicines). Pick up this book to learn about the negative side of statins and how to achieve heart health and overall vitality without them: The Great Cholesterol Myth.

  8. My little one is 9 with constipation. She started with it at 4 months old while exclusively breastfed. We gave her an ounce of prune juice each day which helped until she entered toddlerhood. Then it was back and fourth with ok to constipated. For years it has been a fight. We have always limited or eliminated “binding” foods. We have tried probiotics and digestive enzymes, with no luck. 1/4 capful of Miralax is all that helped. She would have hugh BMs. Her GI also wants her off it, but has only suggested more fiber – which gives her diarrhea, regular sitting on the potty times, more water, and kegal exercises. We took her off miralax and nothing has helped. After a couple with with constant runs to the potty with no sucess we are on miralax again. I would like to try magnesium but am unsure which type would be the best and dosage.

    • It’s likely that there is more to this story than magnesium – if your daughter has been struggling with this for nine years, some investigating is in order. You can try magnesium if you like – but without knowing her weight, usual food intake, use of other meds or history, I don’t know if magnesium is appropriate in her case, in what form, and at what dose. That said, dosages for school aged children for magnesium citrate (there are other forms, but this is commonly used as a laxative) can typically be safely used in the 150-350 mg range. Higher doses can be used but I would not recommend it without supervision. Happy to help out more, contact me for an appointment if you would like.

  9. My 9 yr old son has been taking 1/2 top of miralax twice a day for the third day now. He had been in pain and throwing up for 1 1/2 weeks. It got to where he couldn’t keep anything down. He was, also, having diarrhea in the morning. I finally had them do an X-ray on his abdomen. It showed he had constipation. Being on miralax he has passed pebble sized ones and also long very mushy ones. My problem is, I have no idea when he will be cleaned out so I can stop the miralax. What advice do you have about when I could stop the meds?

    • This situation needs and deserves assessment and individualized care, which is what I offer for kids who work with me. Make an appointment and we can get started. As long as he is on Miralax, your doctors will hope for him to have mushy (abnormal) stool and in many cases this still builds up in the colon (as you saw on X ray) because it is hard to expel mush. The task is getting at the root cause of the constipation and diarrhea, which is what I work on with families to discover and redirect. There is no way to advise without those pieces up front. Restore normal bowel function and your son won’t likely need Miralax anymore, but continue to bandaid the symptoms with a medication and his symptoms will persist.

  10. My 14 year old daughter has battled constipation and encopresis since infancy. She has been on MiraLax for about 12 years now. She still supplements it with Dulcolax because the Miralax isn’t working! When we discuss this with her Ped GI, they get aggravated at me, saying things like “Well, IF she was taking her TWO ADULT doses every day like we said, it would be working. You must not be following our prescribed methods.” She just barely weighs over 100 lbs and has been on 34 grams of Miralax/day for almost 2 years now. I am DESPERATE to get her off Miralax, but nothing else we try works either. When I suggest additional testing to see if there is something else causing the constipation, I am told point blank that they do not do colonoscopies on anyone under 18. My 14 yr old daughter is even asking them to do one. I’m at my wits end. Are there any Ped GI dr’s in my area (Louisville, KY) that follow along with your medicine philosophy? I am so tired of my daughter hurting because of this. Thank you!

    • Most pediatric GI doctors would give the same advice, unless they are trained in functional medicine. You don’t need another GI doctor to tell you the same thing, and I don’t know the resources in your area. I’d suggest working tools for gut health instead, and there are many, but first some functional stool microbiology and nutrition assessment is needed on the triggers for this constipation. Mainstream pedi GI’s don’t do this, but some functional MDs do. I am happy to help you with this and work with kids often with constipation this severe. If you would like that help, set up an appointment and we can work via Skype or phone. You can also visit the Institute for Functional Medicine website and enter your zip code for a nearby MD, but these are likely to be more costly and less detailed in approach than the nutrition and gut health care I provide.

  11. Hi, my son is 21 years old and has autism (so developmentally, he is much younger) He suffered with overflow diarrhea when he was much younger and then battled it off and on which impeded toilet training for bowel movements until he was 14. Once we developed a motivational bathroom chart, he became much more regular. However, for the last couple of years he goes through bouts of constipation. We have always used Miralax off and on since he was little. The last few weeks, I’ve been giving to him several times a week. Tonight, I heard him trying to go with extreme straining which then resulted in two small rock hard stools. He usually experiences HUGE normal consistency bowel movements which can and often do stop up the toilet. He takes a probiotic with L Rueteri and has taken that since he was around 5. We’ve also had him off and on various supplements. Thankfully, he takes pills without much fuss. I would like to stop the Miralax completely but often times it is the only thing that helps. But it only helps if I give it to him often. Based on your article above, I think maybe we should start him back on Vitamin C and Magnesium. Could you recommend a dosage? He is 6’1 and 180 lbs. Thank you for your time and assistance.

    • Hi Shelly, I can’t recommend individualized care plans or supplement dosing in this forum. If you are needing specific guidance for how your son can use magnesium and vitamin C, best option is to schedule an appointment.

  12. Hi Judy, What would be an appropriate dose of Mag 07 for a 60 lb 7 year old child? Adult dose is 3 pills, would 1 be ok for him? Thank you.

    • Hi Nicole, I can’t and don’t give individual dosage recommendations in this forum. I have no way to know if this measure is appropriate in your child’s case. For specific nutrition care support like this, it’s best to work with a licensed provider and you are welcome to make an appointment anytime – then I am able to assess your child’s nutrition needs and confidently make recommendations.

Leave a Reply

Your email address will not be published. Required fields are marked *

Subscribe To Our Newsletter

I invite you to sign up for my newsletter. Every couple of weeks I will share tips on how to help your child learn, grow, and thrive through nutrition.

You have Successfully Subscribed!