This guest post comes from Steve J. Hodges, MD, associate professor of pediatric urology at the Wake Forest University of Medicine School in Winston-Salem, North Carolina, and coauthor is not by chance: innovative solutions for your son wetting, constipation, UTIs, and other potty problems and the whole new picture book enuresis and accidents are not your flaws: how potty accidents happen and how to make them stop. It addresses the raised issue this week on the safety of Miralax laxative – that many children take every day and gives excellent advice on how to prevent and constipation address in children.
by Steve Hodges, MD
My phone has been ringing without stopping since the New York Times published an article raising questions about the safety of Miralax in children.
Many, many of my patients take Miralax (PEG 3350) daily and, following my advice, has been so for months, even years.
So when the Times mention “ingredients in antifreeze” and “psychiatric illness”, in reference to the laxative your children are having, naturally parents want to know: is the prescription medication you poison my son?
The short answer: Probably not, based on the evidence available. More than 100 studies have discovered PEG 3350 is safe for use in children, and I have found unpublished studies linking Miralax for serious or harmful side effects. (I discuss this research in no is by chance.)
However, I welcome all investigations on the safety of this ubiquitous laxative, and I look forward to the results of the government-funded study that will examine whether PEG 3350 can unleash psychiatric problems in children.
Still, the Times article loses the forest to the trees. Although it is naturally important to know if Miralax contains traces of toxins, no one is asking a more salient question: Why so many constipated American children in the first place?
Constipation Nation
Constipation is an extremely common-I would say epidemic-problem among children in Western countries.
In a small minority of cases, constipation has a medical explanation-a child may have Hirschsprung disease or other rare, congenital conditions. But in 95% of cases, children retain feces simply to avoid the pain of pooping. Feces accumulates in the rectum, making intestinal movements even greater, harder and more painful. And the cycle continues.
This is no way for a benign process. In the absence of eliminating time often leads children to develop painful, harrowing, and embarrassing medical complications that needlessly cost the millions of healthcare system.
What is the most common cause of abdominal pain between children attended in the emergency department? Constipation.
The most common cause of bladder and kidney infections in children? Constipation.
The most common cause of enuresis, both accidents during the day and urinary incontinence, in children? Constipation.
Practically the only cause of encopresis (poop) accidents in children? Constipation.
Children are often subjected to testing, uncomfortable costly and even surgeries that could have been avoided if the child defecated in time and completely. This is a transvestite.
As I explain in it is not by chance, children reasons retain feces are multiple but not complex:
• Our children eat food processed in a way too much.
• Parents of train toilets children very early (and without proper accompaniment), largely due to pre-preschool deadlines.
• Public school bathroom conditions discouragement and misguided policies of childrens bathrooms ready to steer clear of the toilet.
To aggravate these problems, we, as a society, have ignored the first signs of constipation. Not bats an eye one if a child has enormous bowel movements or disco (the first two signals of two blocked points) or not poop, at least, every two days. Were happy as a child goes at some point and doesnt seem to complain.
But kids need to poop every day–soft, soft poop. When constipation passes unnoticed, piles of stools rapidly, in which simple point, drug-free therapies, such as dietary fibers and changes are too little, too late.
The benefits-and limits-of Miralax
We can discuss how to fix these cultural problems until the cow coughs, but a child who already has constipated needs to help now, that is why it is so Miralax often prescribed.
Families with Miralax on the balcony are often judged severely – “The water bottles were the tool of choice for constipation when I was a child. Prunes also help, “wrote a Times commentator. But the reality is, no amount of water, fiber, or prune juice will dislodge a large rectal, hard obstruction. (Another reality: Many children who are excellent Eaters and constipated.)
So, doctors usually turn to PEG 3350, which is not habit-forming and its easy to give for children because it has no taste or odor. You can blend it into your drinks, and they wont normally complain.
Miralax is also generally effective-even more, according to a 2014 meta-analysis, that magnesium hydroxide (Magnesia milk), lactulose, mineral oil, Psilio fiber, and fructose. The authors of the study concluded that it is also safe, with minor side effects such as diarrhea, nausea, abdominal distension and vomiting.
For these reasons, I prescribe Miralax daily, but I do not love this material.
Although it is effective in the softening of stools, PEG 3350, often not to clean completely off a childs rectum. The rectum stays stretched and flexible, like a worn sock, and therefore does not have the necessary tone to evacuate completely or the sensation of signaling to the child that is time to poop.
Just a completely clean-out rectum can recover sufficiently, which is why I usually prescribe enemas for my severely constipated patients. Enemas have been proven in rigorous studies to resolve enuresis and encopresis, and yes, enemas are safe for children. As a whole, my patients receiving enemas get much better results than those who use Miralax.
The problem: Most parents simply wont give their children constipated enemas, insisting that the child will decline. (My experience proves otherwise, its parents designing their fears about their children.) Even a lot of pediatricians arent going to pass near enemas. A doctor told a patient of mine that enemas are “cruel and unusual punishment.” Thats a farce, too.
So I just prescribe Miralax all the time. And while its not as effective as enemas, he does a job OK.
“But Miralax is not natural”
Many people oppose Miralax, alleging that he “is not natural.” Thats absolutely true, and I wish I never had to prescribe it. However, they convey around a rectum full of poop for a whole childhood, a common scenario these days, is not natural, either and can have serious and long-term consequences.
Also unnatural: walking around with a tube inserted through your abdomen into your colon so you can expel poop with liquid laxatives. However, this scenario, known as a cecostomy, is becoming more common in children whose severe constipation has passed without treatment for years.
Getting a clean constipated child is critical, and laxatives can be an effective approach. As one of my colleagues, a pediatric gastroenterologist, said to me: “Parents are afraid of the consequences of giving their kids laxatives, but what about the consequences of taking part of the June 1-year-old colon? Many people dont realize how serious the cost of under management can be. ”
This physician has already conducted more than 100 cecostomies in children whose two extended points are permanently damaged from constipation and sent over a handful of his patients with the worst case to the surgeons to Colostomies.
I dont think parents should stop giving their children MiraLAX just because small amounts of toxins were discovered in eight samples in 2008. At the same time, I urge parents and pediatricians to give enemas a second glance.
Ultimately, no matter which method is used to drain clogged rectum of a child (since this method does not harm the child, of course). What matters is that childs bowels completely empty on daily basis, so that the boy does not appear in the ER with painful urinary tract infections or opt out of the sleep-away field because it wets the bed.
I hope the strong light shone in Miralax will help illuminate our nations epidemic of pediatric constipation, leading to prevention strategies, faster diagnostics, and more effective treatment for these children.
Maybe, then, were all going to need less Miralax