Some of our patients have told us that they heard information about Miralax on the news. They had some questions and were looking for our feedback.

Miralax is a medication that was studied in adults for relief of constipation through a non-stimulant method. It dissolves nearly completely in water and is tasteless which makes it a good option for children. Many medications approved for adults are not studies in children. It is more difficult to study them in children and takes longer for FDA approval. Hence the manufacturers release them with adult only studies. Given its good safety profile in adults, doctors have prescribed Miralax for children for over 15 years as a gentle treatment for periodic constipation. It is now available without a prescription.

Some families saw information on the news about the safety of Miralax and complaints from parents that it might be the cause of their child’s behavior problems.  CHOP is doing a study about the safety of Miralax. There have been discussions about the safety of the ingredients of Miralax for some time (2010) in children. However, there is NO data to support that Miralax causes illness. In part, that’s why CHOP is doing this study. To gather data and make sure our recommendations are based on science.

The chemicals in Miralax are called “PEG” or polyethylene glycol. These are pretty large molecules and PEG of similar molecular structure/size have been given intravenously to animals in research settings and the molecule is excreted into the urine completely unchanged. Miralax is not given IV, but taken by mouth. The molecule is large and not absorbed into the blood stream. It works like a sponge within the stools to help them absorb water and prevent constipation. We have no reason to believe it’s changed in the gut either. 

The controversy is really about lower molecular weight ethylene glycols (a chemical found in antifreeze) that can cause harm. They can be found as contaminants in many things including foods and cosmetics. There is no data to say there is significant amounts of ethylene glycol present in Miralax.

Untreated constipation can cause long term problems including chronic abdominal pain, stool holding, soiling in pants due to overflow incontinence that can last into preteen years and urinary tract infections. All medications have a risk/side effect profile as well as benefits. Many of the alternatives have problems that are more frequent than Miralax. If Miralax is working for your child, we recommend that you continue to use it while you work on other ways to naturally relieve your child’s stooling problems.

The MOST important ways to treat constipation are diet and lifestyle routine. What does that mean? Lots of fiber and water in the diet. 5 servings of nutritious fruits and vegetables every day. Daily exercise (moving the body, helps the GI tract move.) And one of the biggest problems: Scheduled POTTY- TIME – twice a day for 15 minutes after breakfast and after dinner to allow the body to go the bathroom when you feel the urge. Rushing out the door 45 minutes after breakfast when your child begins to feel the urge, but you don’t allow them time to go, teaches the child to not listen to body cues which then causes stool retention, chronic stomach aches and can lead to long-term overflow incontinence – stool leakages. This impacts your child’s self-esteem and can lead to behavior problems.