Is Miralax Safe for Kids?

While Miralax is generally considered safe and effective, there have been some recent concerns about potential side effects, such as gastrointestinal issues and behavioral changes, leading some parents to question its use.

To provide parents with the best options for their child's constipation, we've consulted with pediatrician and pediatric emergency medicine physician Dr. Christina Johns, MD, MEd, FAAP, and Jennifer House, MSC, RD, a registered dietitian, nutritionist, and author. Together, we explore the pros and cons of Miralax and other remedies, including dietary changes and alternative laxatives with potentially fewer side effects.

Is Miralax safe for kids?

Miralax is a type of osmotic laxative that has polyethylene glycol 3350 as its active ingredient. According to the Prescription Drug Journal, it helps treat constipation by drawing water into the bowels, which makes the stool softer and easier to pass. Although primarily for adults, House says Miralax is also approved for use in children aged 2 and older in the UK under the name Movicol, with a recommended dose of 6.9g.

In the United States, Miralax is not FDA-approved for children under 17, according to Dr. Johns. Therefore, she recommends that parents talk to a pediatrician before giving children any laxatives.

What are the concerns with Miralax for kids?

While Miralax has received FDA approval for adults, its side effects in kids have been a growing cause of concern in recent years. According to a 2015 University of Rochester Medical Center article, Miralax has been linked to side effects like nausea, stomach aches, diarrhea, and gas.

Additionally, the Prescription Drug Journal reports that there are concerns about psychiatric side effects, including anxiety, mood swings, aggression, and rage. Research on the safety of Miralax is ongoing, so parents and caregivers need to discuss the potential risks and benefits of using Miralax with a doctor before giving it to children.

How much Miralax is safe for kids?

House states that the safety of Miralax for kids varies depending on the circumstances and should always be managed under the supervision of a doctor. "Some doctors might suggest the same dose as for adults, while others could recommend a lower dose," she tells Today's Parent. "So, it's a good idea to start with a small amount and increase if necessary."

However, if your child has any concerning side effects while taking Miralax that don't go away in three to four days, it's a good idea to talk to a doctor. "If your child experiences more rare serious side effects, like dehydration or an allergic reaction, seek professional medical help immediately," advises Dr. Johns.

What is the safest laxative for children?

House says a healthy and balanced diet is the safest laxative for children. The National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends foods like whole grains, legumes, fruits, and vegetables to get enough fiber. The NIDDK also advises making sure your child drinks enough water and avoiding constipating foods like chips and processed foods.

What can I give my child instead of Miralax?

House suggests trying apple, pear, or prune juice if your kid is having trouble going. These juices can help by bringing water into the bowels, making it easier to go, and avoiding painful trips to the bathroom. "You can also try a powder like Metamucil, which has psyllium fiber and comes in cookie form," she adds. "This can boost your child's fiber intake and make it easier to go."

House says there are several other medications to treat constipation instead of Miralax, like magnesium oxide. The National Library of Medicine says it contains a form of magnesium, which is a mineral our bodies need to work properly. “Magnesium oxide works like Miralax,” House explains. “Since it’s the type of magnesium that our bodies absorb the least, most of it ends up in our poop, bringing water with it to soften hard stools.”

Another option you can get from the pharmacy is lactulose, another type of osmotic laxative that helps soften your stool. "Lactulose works by drawing water into your stool, making it softer and helping you have more frequent and easier bowel movements." As with other laxatives, lactulose should only be given to your child if it's been advised by your doctor.

FAQs

Are there any long-term side effects of using Miralax in children?

House suggests that there's no evidence demonstrating any long-term effects linked to Miralax, but she does warn that it might lead to dependence or become necessary for regular bowel movements. But just like with any medication, if your child experiences any alarming side effects, it is recommended to report them to your pediatrician, the FDA, or Health Canada — they are responsible for monitoring the health and safety of such medications.

Has the Food and Drug Administration (FDA) funded a study to investigate the safety of Miralax in children?

House says that many FDA-funded studies indicate that PEG 3350 is safe. "A 2021 study published in the peer-reviewed Journal of Pediatric Gastroenterology and Nutrition with 83 children found kids taking PEG for an average of 8.7 months had normal serum electrolyte levels, osmolality, albumin levels, and liver and renal function test results," she says.

Despite this, House emphasized that research on the topic is still ongoing, citing the CHOP study, which is currently recruiting for an FDA-funded investigation into the safety of PEG in children. This study, which is being conducted in collaboration with the Children’s Hospital of Philadelphia, Ohio State University, and the US Food and Drug Administration, is scheduled to be completed in June 2024.

What are the best habits to help a child stay healthy and avoid constipation?

One simple way to help your child avoid constipation is by getting them to drink plenty of water. She says, "From what I've seen, drinking more fluids makes the biggest difference. The American Academy of Pediatrics suggests that a one to three-year-old should have four cups of fluid a day, and a four to eight-year-old should aim for five cups." Some changes to their diet can also help. "For example, you can add more fiber-rich foods like beans, fruits, vegetables, and whole grains," adds House. "Oats, ground flax, kiwi fruit, and prunes are other great options to consider."

It's not just about what they eat and drink but about how your child uses the bathroom at home, too. House explains, "If kids are sitting on a large toilet with their feet dangling, this does not support their bodies to have a comfortable bowel movement. A squatting position with knees above our hips will make it easier for the poop to come out."

She also emphasized the importance of a good toileting routine. "Having a routine where your child sits on the toilet for a few minutes at a time they often poop (like right after breakfast) can be beneficial. This will help your child's body get used to this routine and know when it's time to go."

Is it safe to administer Miralax to children for a prolonged period?

While some doctors prescribe Miralax for kids long-term, Dr. Johns advises it's not meant for long-term use. The drug information leaflet for Miralax also states that it should be used for up to 7 days.

Instead, Dr Johns highlights the need to explore and tackle the underlying causes of constipation, with the aim of eventually discontinuing any constipation medication and establishing a regular pattern of bowel movements.

Experts

• Jennifer House, MSC, RD, a registered dietitian, nutritionist, and author
• Dr. Christina Johns, MD, MEd, FAAP, a pediatrician and pediatric emergency medicine physician