I’ve got three boys and a puppy. Poop talk is kind of central to my life. Let me lay some truth on you, mom to mom. To start: just say no to Miralax.
Last week’s news included the tidbit that Miralax — never having been approved for use in children or studied for long-term negative effects and despite the fact that the FDA placed Miralax on its Adverse Events Reporting System in connection with “neuropsychiatric events” back in 2011 — is associated with neurological problems in children. This nugget of information has been floating around the online alternative health groups I’m part of for years, with many anecdotal reports of the problems it can cause in children. My own son had trouble with it.
Miralax is in the top five “Things I Learned About the Hard Way.” It made my son very dehydrated and “not himself,” for lack of a better term. “My kid is being weird” isn’t really an acceptable complaint, especially when your kid has autism and the toe walking and humming marked him as different the second he walked into the gastroenterologist’s office and the GI can’t tell the on-Miralax kid and from the off-Miralax kid for squat. After the Miralax, we had to rehydrate him, let his nervous system resettle to baseline and then deal with the constipation, which the Miralax hadn’t actually touched.
Miralax works by drawing water into the bowel, softening the stool. The problem seems to arise from the fact that Miralax contains PEG — polyethylene glycol, a.k.a., a constituent of antifreeze. I’ve read the argument that the PEG molecule is too large to pass through the intestinal barrier, but . . . I don’t think we’re dealing with intact, healthy gut linings here. Kids who are chronically constipated can have chronic GI inflammation and a highly permeable gut lining.
Kids with gut dysbiosis — more bad bugs than good bugs in the intestinal flora — are more likely to be constipated. In my experience and what I’ve seen with friends, anyway.
Disclaimer: I’m not a medical professional. I’m a mom of three boys, and this is an issue we’ve dealt with on and off for 15 years. If I mention a product, it’s because I have personal experience with it. This is just what I’ve done and what I’ve found helpful. If you have any questions, please seek out a qualified medical professional.
Okay, now to the core of our situation: the kid who can’t poop and what you can try at home.
- More water. Sparkling water, ice water, water with a drop of lemon juice or lemon essential oil, Hint-brand “fruit essence” water, water with a drop of stevia, herbal teas like hibiscus or peppermint. More water, more water, more water. Minimize juice to a few ounces for mixing supplements, no milk. And it should go with out saying: no soda.
- Vitamin C. Too much Vitamin C causes loose bowels, so ramp up slowly because it can be too much of a good thing, as they say. I give my kids 500-1000 mg when they need it. Raspberry-flavored Emergen-C in 6 oz of water with a couple of ice cubes and you’re good to go.
- Magnesium. To supplement, I always use magnesium citrate or magnesium glycinate. I’m not talking about the nasty, salty magnesium citrate solution in a glass bottle at the drug store that will clean you out in a heartbeat. I’m talking slow, steady, no cramping. Natural Calm is a powdered supplement that you mix with warm water to make a nice, lightly flavored drink. I pour it over ice and add a drop of vanilla stevia, and my kids call it Special Water. Epsom salts in the bathtub can raise overall levels of magnesium, and some kids get a swallow or two of the bathwater anyway. I don’t give Epsom salts orally because the results are a little harsh and, erm, explosive. I do know a few other Thinking Moms like Oxy-Oxc, but I haven’t tried it with my kids.
- Prune juice. It’s famous for a reason. Cut it with a little pear juice and put it in an opaque cup.
Aloe vera. I have had the best luck with George’s aloe vera juice. It has the consistency and taste of mineral water, and I can hide it easily in a drink. It soothes and decreases inflammation.- Green smoothies. These are basically fruit and veggie smoothies made of about 50% greens, like baby spinach, romaine, or kale, and 50% fruit (usually frozen) and enough water to make sure the whole thing mixes well in the blender. I have found that using blueberries or frozen cherries as one of the fruits in the mix covers the green color very effectively. Using half of a banana makes the texture creamy.
- Probiotics. Things that are effective and pretty easy to find include Culturelle, Garden of Life RAW Probiotics for Kids, Nordic Naturals Probiotics, and FloraStor. I rotate probiotics and always come back to Klaire’s Therbiotic Complete. Other Thinking Moms’ favorites include Theralac, Body Biotics SBOs, Ultimate Flora (RTS) by Renew Life, Xymogen, Seeking Health Infant, Gut Pro, Custom Probiotics d-Lactate Free. Note: Read the ingredients. If your child can’t tolerate milk, don’t use a probiotic cultured on milk. I usually start slow and gradually increase to a full dose.
- Castor oil pack. Rub castor oil on lower abdomen, cover with a flannel, layer a piece of plastic wrap or another dry piece of flannel and then cover with a hot water bottle or heating pad on medium. Your little one will need to keep quiet, so it’s a good excuse for movie night or an extra-long story time. Follow up with a gentle massage that follows the direction of the bowel. (And upside down U that starts in their lower right abdomen, up, across, then down on their left.)
- Slippery Elm Bark. A friend of mine had good experience using it in small frequent doses, opening a capsule, mixing it with water and dosing it with a dropper throughout the day.
Gelatin. This is my newest discovery. The Spunky Coconut blog tipped me off to this one. I use a grass-fed beef gelatin from Great Lakes that dissolves very easily and doesn’t have much taste.- Acupuncture. Find a child-friendly practitioner. Acupuncture saved my oldest from being scoped from both ends simultaneously. And if you’d told me my needle-phobic kid would tolerate it, I would have laughed at you. Long and hard.
- Squatty potty or a footstool. Get those little knees up above the hips to let gravity help make things a little easier.
- Regular exercise. Walking, running, bouncing on a trampoline, swimming, bike riding. Anything to get the big muscles moving and the core muscles engaged. Exercise is also beneficial for mitochondria in case your child’s low motility is caused by low muscle tone.
- Cut out milk, wheat, and soy for a week to see if that helps.
- Try an herbal tea called Smooth Move, which contains senna. It’s not a first-line treatment, but it was recommended to me by a holistic pediatrician. A few tips: don’t steep the tea bag for a long time and don’t give a lot. It’s powerful stuff, and it usually works, really works, within 6-8 hours.
- The only time we did enemas was under the direction of a doctor, and he had me empty out the solution and make a mild saline solution at home of warm distilled water and about 1/2 tsp of sea salt per quart of water and refill the empty bottle.
- Once things are moving well, introduce more fiber slowly. Also keep in mind that fiber needs water. There are non-GMO soluble fibers that dissolve in water or juice. Chocolate chip flax muffins and green smoothies with a scoop of ground flax seed (or a teaspoon of chia seed) are a staple in my house.
Other “Things I learned the Hard Way”:
Don’t pour too much fiber in until things are moving well. Don’t push fiber on a seriously backed-up kid. It just makes the problem worse—you’re pouring cement on top of glue.- Those skidmarks—you know the ones I’m talking about in the tighty whities—could be a sign of encopresis. Encopresis happens when there’s a little diarrhea overflow behind a stool impaction, and your child can’t hold it in or get to a bathroom in time. There’s also a good chance your child can’t even feel it. Please let me stress this is not a behavior problem, this is a medical issue. Don’t punish your kids for skid marks.
- Toe walking can be a sign of chronic constipation or bowel impaction. The way you have to hold your core when you toe walk relieves pressure on the lower abdomen.
- Reflux can be a sign of chronic constipation. Think: backed-up drain.
If your child is in constant pain or has become afraid of using the toilet for fear of pain, call your doctor. Ask for a KUB X-ray of their abdomen. Doctors use these to diagnose a condition called mega-colon, which happens when a child’s colon and rectum are so stretched out by a bowel impaction that they don’t trigger the appropriate signal for peristalsis, or movement. They also get to see if your child is FOS — literally Full Of Stool — and if a medically supervised clean-out is warranted.
The standard of care for autism spectrum disorders is changing to include treatment of bowel dysfunction — including reflux, food allergies, chronic constipation and diarrhea, and irritable bowel syndrome. There is a very strong connection between the brain and the gut. Optimizing your child’s digestive process from end to end will support optimization of his or her brain.
So I hope this gives you some ideas on how to alleviate your child’s (or your spouse’s — no judgement!) constipation. If you’re curious about the role of the biome in brain function and what your child’s biome might look like, contact a functional medicine or naturopathic practitioner.
And that’s enough potty talk for me today!
~ Zorro
For more by Zorro, click here.
Hi there! I have been dealing with a constipated little boy for years. After a terrible night last night with my son screaming and crying while trying to poop, I found this post. I took him off Miralax about a month ago because I kept reading of the possible dangers…but now we are back to square one and he just can’t go. My question is do I implement all those tips at once or try one or two. We do prune juice and constipation candy already, can I add epsom salt in the bath, smooth move and castor oil on his belly? Can I do it all to get him going or do you recommend trying one or the other? Thanks for the post, great info!
If you are on facebook, I strongly suggest you join the group “Parents Against Miralax (PEG3350)”. There is a ton of resources and advice from people that have been dealing with the same issues as you. I have found it super helpful. Good luck!
This is amazing and helpful. I find the side effects of Miralax to be horrid and it doesn’t work! Can’t believe how many people put their kids on it for ages.
Don’t judge – it’s the only thing that has worked in years for my son. Trust me, I’ve tried many alternatives – I’m a 32 yr. Veteran of a child with severe disabilities.
Hi Zorro! Thanks for the explicit details. Truly helpful. Personally, I usually eat a lot of fermented foods over week’s period and it does help lessen my constipation. Have you also tried probiotic supplements?
My 12 year old daughter ended up with mega-colon as you describe near the end. She was embarrassed to tell me she couldn’t go and ended up in a world of hurt. She has now been under the care of a GI doctor for over a year, taking Miralax every single day. During this past year that she has been on the Miralax, she has been sick very often, had strep throat twice, had multiple bouts of stomach flu, and on and on.
I don’t know what took me so long but I am finally waking up and realizing that my once healthy, never sick girl is not doing so hot. This same doctor wanted to put her on an appetite stimulant since she is so small and not gaining weight well–we chose not to give this to her (and the doctor was not happy about this choice).
I appreciate this post and it’s advice. I am so scared of her ending up with mega-colon again though. I am also not sure how to wean her off of the Miralax. We are starting a paleo diet for her today.
Thank you for your post!
I too am VERY worried…My son is 7 years old and has been on a capful a day of Miralax for over a year…it all started when one night he was curled in the floor screaming and crying with stomach pain we took him to the ER and found out he was extremely backed up in his body/ constipated. They prescribed Miralax he started moving I was told his colon was stretched because backed up and it would take time for it to go back so keep him on it…we did…we began to see his stomach swell like a balloon and everytime he went to the bathroom there was an unbelievable amount of gas he would pass sounded bigger than any grown up…i questioned could this be from Miralax they said no. They ended up doing an upper endoscopy on him.That is where they put him to sleep and run tube down his throat to see what is causing issues. They found nothing..we were told keep on Miralax and follow up few months we did. ..and after a year of this and us asking over and over is this safe and being constantly told it is…because we kept pushing they said cut back to 2/3 capful everyday during week but give capfuls on weekend to make sure he dont back up…my mother instinct says my child was constipated but doesnt need this and I horrified at what it is doing? My friend just told me about Essential Oils and they are all natural and she swears by them she has used them for everything they have an oil for all kinds of sickness etc..she said fevers drop immediately and dont come back like they do with tylenol and ibrophen every 3 hrs she said there is so much medicine masking over and not treating the problems. Her children used to have horrible asthema they never left house without a nebulizer she has used Essentials oils for last 6 yrs and hgot a raving great report from the doctors their health has done a 360 and she just told me there is an oil for constipation also. She said these all come from the plants that God created on the earth to heal us. She said parents dont believe it till they try it. One lady had a baby with reflux she was screaming head off and she called her and said how do i use this she told her and within 2 min baby was fine and sleeping she said I am sold!!! I dont know about you but I am sick and tired of Doctors drugging our babies and padding their pockets. I am taking him off of this and trying something natural
Periactin/cyproheptadine (the appetite stimulant they sometimes recommend) was life-changing. The stomach empties faster, and for the first time ever, we achieved daily BMs. He had megacolon and sometimes 5 days of constipation.
We also discovered he was having gastric migraines. Also helped by the periactin.
I feel SO blessed to have stumbled upon this website and article! My daughter just turned 1 yesterday and we have struggled with chronic constipation since she was 7 months old…I couldn’t understand why I couldn’t get this under control…I used probiotics, flax oil, several servings of fruits and veggies which should “clean you out” while avoiding/removing “compacting” veggies and fruits. I added 1 tablespoon of bran to her yogurt make her drink 9+ oz of water a day put her on an infant potty to squat to help her movements all to NO avail. My daughter passing a bm would make her cry and scream along with myself I usually always had to pull her stool out and rock and soothe her from the traumatizing event which happened every 3 days. My husband couldn’t believe this is how horrible things were for her. We also tried Lactulose and glycerin suppositories thy helped for awhile but she was never regular either loose with several movements or plugged up with hard stool every 3 days. I’m frustrated and heartbroken. Today our ped put her on Mirolax I had no idea how dangerous this drug was! She has thankfully just had one dose. I asked ped about taking her off whole milk and trying an alternative and he said if we use Miralax we can continue whole cows milk and I asked how confident are you this will work he said VERY to come back in 3 mths for follow up and refused to give me milk alternative options he stated she’s user weight and MUST have whole milk. I left feeling shut down and with questions unanswered but hopeful that this “miracle” drug Miralax would help and save my baby from utter grief and discomfort. Nobody believes the level of constipation I’m dealing with my daughter and accuse me of not giving sufficient fruits veggies water etc…I buy puréed prunes and fruit and veggie blends and add it to every meal. I plan to take my Olivia to a naturopathic daughter and follow up more on the numerous suggestions I’ve read about here! Can anyone suggest what to serve in place of the whole milk for appropriate fat and nutrition? I was thinking almond milk? Thank you for reading I’m sorry it was so long I feel happy to have connected with other moms who have first hand experience dealing with this. Prescriptions aren’t always a solution but rather a band aid on the problem. I want to cure my daughter from constipation forever! No parent should have to deal with this. Kind regards Jamie
Ohmygosh! I have had the same problem with my little Olivia too. (I blame genetics!) I have tried almost every natural suggestion, we unfortunately had to switch to formula (Holle) when she was 8.5 mos and even before that on breast milk she wasn’t that great with her bowel movements. Her ped suggested Miralax and now I am so upset that I have given her that garbage for so long. Were you able to find anything that helped you?
Hi Heather,
My Olivia is 18 months old now! I had a referral to a paediatric gastroenterologist recently and we have to keep using a cap full of Miralax per day and add 1/4 cap if it’s not working as it should. I told her I felt bad using this drug every day and how uneasy it made me. She was very kind and professional and said its the best and safest option for a laxative out there for her. She wants to keep seeing her every 6 months and truly wants to find why Olivia can’t go naturally. My daughter doesn’t walk yet and her neurologist and neurosurgeon and paediatrician suspect it is linked to her bowels not working properly which makes perfect sense. We don’t know if it’s muscular, neurological or just tricky functional constipation she could outgrow. We will continue to see specialists and follow their recommendations. Olivia had an MRI to ensure she had to head or spinal cord abnormalities. It came back clear but they found a syrinx unexpected. This is a cyst filled with spinal fluid sitting on the top of her spinal cord. This could or may be pushing on her nerves and causing re constipation but it’s still unknown at this time if it’s a factor. Our Ped GI said her best hope is that once Olivia walks her vowels will start working normally! We see a physiotherapist and she knows Olivia will walk but it’s anyone’s guess. I’m sorry you are struggling with your sweet Olivia. It’s a hellish ride for mom and the whole family. Everything revolves around her poop or lack of poop schedule. When they scream in discomfort we have to leave because nobody understands what’s wrong and people think we’re hurting our sweet girls. My Olivia doesn’t scream hardly at all anymore since using Miralax daily. Did you try dairy and gluten free diets for at least 6-8 wks? We also worked with a Naturopathic Dr and followed some of her recommendations although unsuccessful. Aloe Vera juice, senna tea(small doses can be toxic) boiled dates figs and cornmeal with water makes a paste you can hide in puréed fruit or yogurt is supposed to help clean you out. Don’t give up keep pushin for referrals and help. I don’t like that Miralax is our answer for right now but it is. I don’t plan on it being permanent though. It’s a temporary fix and I want to keep pushing for regularity. Also forgot to mention they are sending her for a rectum biopsy. Celiac test came back negative. At the very least push your Dr to run basic blood work, thyroid and celiac. Best wishes I pray your Olivia will be well soon.
Thank you so much for your response. I really appreciate it. We’re going to the doctor in 2 weeks and I will recommend to him all the things you mentioned. Thank you again, and I hope everything turns out well for your little peanut. (I’m sure it will, because you sound like a wonderful mother)
milk can certainly cause constipation. Test for allergies before switching… didn’t know we had a nut allergy! Glad we tested first.
Flax milk is one we could use… and coconut milk was ok. I finally just ditched milk at 20 months. there are additives in all of them 🙁
Zorro’s advice is excellent. Determining what foods and nutrients to consume less of can be as important as what to add in cases of constipation. A number of minerals contribute to constipation in excess. One that appears to be particularly problematic is calcium. Yet in much of the developed world many foods that we consume are fortified with calcium or have large amounts of calcium naturally such as milk products. To be clear, everyone needs some calcium but the large amounts consumed in much of the developed world can cause dysfunction. There aren’t many experiments on calcium restricted diets possibly from fear of inducing osteoporosis but I think it is interesting that one affect is to decrease bed-wetting which is often a problem in autism. See: http://ajprenal.physiology.org/content/283/5/F895
Relatedly I think large doses of vitamin D can cause constipation too. In fact constipation can be one of the symptoms from excessive supplementation: http://www.healthline.com/health/hypervitaminosis-d#Overview1. I believe in some people this symptom occurs at fairly low doses. Possibly this may be partly due to vitamin D’s affect on calcium retention. Yet vitamin D supplementation is quite common in the young and especially in cases of autism. If your child has constipation and the diet that he or she consumes includes significant sources of supplemental or fortified vitamin D, it may be worth considering a trial to decrease consumption. In my son I think sources of supplemental vitamin D contributed to constipation and worsening behavior.
Bless you for these recommendations!! We have to do a strong laxative regimen for my 5 year old son with a fecal impaction and once that X-ray clears I’m moving right to your strategies and not a childhood of miralax that has been recommended. That just can’t be the answer. This list helps me so much!
We had this problem, Miralax worked pretty well for us, we also used all the different flavors of Natural Calm, aloe vera juice, Dulcolax, and, once a week, Smooth Move tea. All of them together. What completely solved the problem was the special diet, the GFCF diet solved the problem within two days. It came back when we tried chelating with DMSA and ALA, the DMSA had sulfur in it which made the problem worse again, so I took my daughter off that and just continued with ALA. I put her on the grain-free (Paleo) diet, and, once again, the problem was solved within two days. The SCDiet wasn’t that great, she didn’t do well on the homemade goat yogurt and dry cottage cheese, so we took out all dairy products again, and just went with meat (from Lucy’s Cookbook), all veggies except things like rice, corn, and potatoes, all fruits except bananas, and a lot of homemade baked goods with almond flour, almond bread for sandwiches (from Healing for Little Tummies), also almond muffins for breakfast and almond flour pizza once a week. So Delicious coconut yogurt once a day. She did great and enjoyed the food, and, best of all, after a year the yeast etc. was gone and now she eats a normal diet again with no recurrence of the horrible permanent constipation.
Also see Pecanbread.com for great information and recipes.
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Love the potty talk…such an important body function. And then you have the homeopaths who want to know the color, the texture, the smell, the frequency, the size…for chronic problems a homeopath can help but lots you can do in acute poop situations! Thank you for your work TMR…again!
Hell0. I wanted to write you a message privately, but could not figure out how to do so. I wanted to tell you how great I thought your post was about constipation. I am going to write a post script to my “Spotlight on Miralax” post and direct people to this post. It gives so many great ideas about how to help with this very common and vexing problem. Your whole website and blog look very interesting and I am looking forward to exploring. All my best, Judy Tsafrir
Hi, Judy! Thanks. You can always send us a private message on our Facebook page. Sometimes we don’t monitor it too well as we’re pretty much all volunteering our time and we all have busy lives.