02/25/17

February 2017 – Kids and Miralax

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The PEEP Clinic, who has exclusively treated pediatric bowel and bladder dysfunction (BBD) for 10 years, with MiChelle having 17 years of experience in treating BBD. We have had many inquiries about WPVI Action News interviewing a half-dozen parents, all members of the Parents Against Miralax Facebook group, who maintain that Miralax, the world’s most popular constipation medication, caused their children to develop rage, aggression, phobias, anxieties, paranoia, mood swings, and other alarming conditions. This same issue was raised back in 2015 in the New York Times. And back then, we also heard from worried parents. The vast majority, virtually all, of our PEEP patients are constipated (constipation is what causes bedwetting and toileting accidents, our area of specialty) and thus take Miralax, as part of their treatment.

Miralax is used as research shows it is the most effective and is certainly the most well tolerated of the stool softeners. We at the PEEP clinic use it in combination with a med from each of the laxative groups. We have found that this corrects the distended rectum and cures the issues, along with timed voiding and specific water intake, quickly. We discuss this reasoning in detail at your child’s appointment. We also always use all of the 3 meds for the shortest time and in the most effective way we can.

Certainly, it’s wise to investigate whether PEG 3350 causes psychiatric symptoms in children. And there has been an ongoing study at Children’s Hospital of Philadelphia doing just this since 2015. To date, there has been no evidence that there is any substantive connection between Miralax and psychiatric symptoms. At this time, there is not strong evidence to suggest a direct link between Miralax and psychiatric side effects.

More than 100 studies have found PEG 3350 is safe to use in children, and zero published studies have linked Miralax to severe or harmful side effects, psychiatric or otherwise. The most common side effects, detailed in this 2016 review article, are flatulence, abdominal pain, nausea, diarrhea, and headache.
Miralax is an osmotic laxative, which means it draws water into the intestines, softening stool. The intestines are designed for absorption, somewhat like a filter, so the fear with any ingested drug is how much gets absorbed and how that absorbed drug may affect the body. But studies conducted on children and toddlers indicate PEG 3350 does not enter the child’s bloodstream; it just washes out the colon. What’s more, PEG 3350 appears to have no effect on the body’s balance of electrolytes (potassium, sodium, and other substances essential for the body to function).

Over the course of MiChelle’s 17 year career, she has treated thousands of children who have taken Miralax or its generic equivalents. And she has not ever had one case or complaint of any true psychiatric complaints related to using Miralax.
The news report made much of the fact that Miralax is not approved by the FDA for use in children. In short: PEG 3350 was approved by the FDA for adults in 1999, is available over the counter, and is already taken by children all over the world every day. And many studies using it in children have been completed by pediatric specialists showing it both successful and safe. This is the case with a large number of medications in pediatric populations. They are approved for adults and then studied in pediatric populations for safety and efficacy in children that need the medication.

Once the FDA approves a drug for any indicated use, physicians may legally prescribe the drug for patients in other age groups. That’s called off-label use, and it is common practice. In fact, here’s a statistic that may surprise you: Nearly 80 percent of children receive off-label medications during hospitalizations.
Only a small number of drugs have been formally tested in children. Because PEG 3350 is actually one of them and because thousands of our patients have taken this drug without incident, we do not worry that it’s toxic and it is not habit forming.
Many families who are using Miralax to treat their child’s BBD find they are judged and given much advice on how to correct constipation “naturally.” But the reality is, no amount of water, fiber, or prune juice will dislodge a large, hard rectal clog. It is also true that diet is often not the cause of pediatric constipation and many kids who are excellent eaters end up constipated.

So health care providers typically turn to PEG 3350, which is not habit-forming and is easy to give to kids because it has no taste or odor. You can mix it in their beverages or high liquid foods, and they typically won’t complain.

Miralax also is generally effective — more so, according to a 2014 meta-analysis, than magnesium hydroxide (Milk of Magnesia), lactulose, psyllium fiber, and fructose. The authors of that study concluded that is also safe, with minor side effects such as diarrhea, nausea, bloating, and vomiting only happening rarely.

For these reasons, we prescribe Miralax for our patients.

Many parents want a more “natural” treatment. MiChelle has tried many, many treatments and frankly nothing else works like the medication combination that PEEP uses. PEEP providers would not prescribe it if they had any concerns about its safety and wish they did not have to prescribe it. But that said, a rectum and colon full of poop is not natural either and can have serious, long-term consequences. The PEEP philosophy is to safely treat the constipation and bowel and bladder dysfunction well so that a child can be off meds as quickly as possible and not have to go back on medications.

Other long term effects that are not natural include walking around with a tube inserted through your abdomen into your colon so you can flush out poop with liquid laxatives. Yet that scenario, known as a cecostomy, is becoming more common in children whose severe constipation has gone untreated for years. It is important to realize that long term treated constipation can lead to this happening and can even lead to colostomies.

Ultimately, it doesn’t matter what method is used to empty a child’s clogged rectum (as long as that method doesn’t harm the child, of course). What does matter is that the child’s bowels empty completely on daily basis, so the kid don’t show up at the ER with painful urinary tract infections or opt out of sleep-away camp because she wets the bed or end up with permanent surgical procedures in order to poop. It is our PEEP experience that our 3 medicine regimen is the best, fastest and most effective way to not only get our patients pooping, but also to fix the dysfunction that lead to the bowel and bladder dysfunction in the first place.

We hope that this has helped you to understand these important issues that you need to inquire about for your child. Please contact us with any further questions and know that we look forward to completing your child’s treatment with you.

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