Kayla is a bright, round-faced, adorable 3 year-old girl who is having trouble going to the bathroom. She’s often skipping bowel movements for a week at a time, or even more. Like so many kids (and adults!), she gets cranky, uncomfortable, and loses her appetite when she’s constipated. When she finally does poop, it’s painful, to the point that she often avoids going even when she needs to.

Kayla’s pediatrician, like most would, prescribed Miralax for regular daily use, which was working really well. But the parents got concerned after reading a recent New York Times article questioning the safety of Miralax in kids. So they came to me for a consultation.

Miralax: We Give it Like Water

Miralax is the most common medical treatment for constipation in kids. It (or similar generic medications) is recommended by about 75% of pediatricians in the US, according to one study. According to a 2012 New York Times article on Miralax use in kids, one doctor, a pediatrician in Beverly Hills, CA, said, “I’ve had kids on it daily for years” and “We literally give it like water.” The recent article, in January 2015, reiterates the problems.

The New York Times has actually run two articles questioning the safety of pediatric Miralax use in the last two years. The 2012 article also stated, “The way many families use Miralax and its many generic equivalents has strayed far from its original intent. The Food and Drug Administration [FDA] approved the drug for use only by adults, and for only 7 days at a time.”

To date, no long-term studies meeting FDA criteria have ever been conducted on Miralax (or a similar generic product) use in children. Moreover, it has never been approved by the FDA for pediatric use. When it was first approved for adult use by the FDA in 1999, it came with a warning: “Miralax should not be used by children.”

When I was in my medical training, we were in fact, taught that it was basically as safe as water.

Most likely, however, it’s not.

There’s Antifreeze in Your Kids’ Medicine!

In 2012 the Empire State Consumer Project, an environmental consumer action group in New York, petitioned the FDA to more aggressively investigate the use of Miralax in children. Should we be concerned about this medication?

I think so! The FDA admits to years of reports of tremors, tics and obsessive-compulsive behavior in children given laxatives containing PEG 3350, the active ingredient in Miralax. A 2014 FDA investigation into the safety of Miralax discovered that tiny amounts of ethylene glycol (EG) and diethylene glycol (DEG), the main ingredients in antifreeze, were found in all batches of the drug they tested.

Furthermore, an FDA spokesperson admitted that “many of the reported adverse events were classic symptoms of ethylene glycol ingestion.” Some children regularly using Miralax had blood acidity when tested, according to the FDA. This is another known effect of ethylene glycol poisoning.

In spite of this, small amounts of these toxic contaminants are actually considered acceptable in the final product, and are, according to FDA standards, and considered “safe.” However, this is when used in adults, and only for up to 7 days at a time.

There’s still no data on what happens in kids, whose nervous systems are developing well into their teens, when they chronically ingest these toxins.

While a new research group, funded by the FDA, is convening at Children’s Hospital in Philadelphia to investigate the safely of these substances in children, it is disturbing that anyone would ever think it’s okay to consciously include antifreeze in a children’s medication – particularly one that is used daily over a long period of time.

So What’s a Mom To Do?

While I know it works, and a lot of you rely on it, I’d definitely stop using Miralax and similar generic products on a daily basis unless there’s a medical reason to continue using them (i.e., your child gets dangerously impacted without them), reserving them for urgent use only (meaning it’s been a week, no BM, and your child is really uncomfortable). I’d avoid it altogether in very young children, perhaps those under 2 years old, because their nervous systems are still under heavy development. And I’d try natural approaches first.

Natural Approaches to Constipation in Kids

Constipation can be treated naturally. There is reliable scientific data on both the safety and effectiveness of the tips I’m about to share with you. I’ve used these in practice for 30 years.

But first, what is constipation? Most researchers agree that fewer than 3 bowel movements per week, in a child of any age, is considered constipation. Also, discomfort in passing stool, even with regular BMs, is considered constipation.

If your child is often constipated, and then has a big or loose bowel movement, sometimes in inappropriate places (in clothing, bed – i.e., not in the toilet) then this is called encopresis, and it’s a result of chronic constipation. The loose stools are due to “overflow incontinence” and are not intentional or even controllable.

Some children have very hard stools, and others have very large stools – making them difficult to pass. This is also constipation, even if they have a regular BM.

If your child is chronically constipated, has overflow incontinence, blood in the stool, or regular belly pain and difficulty passing stool, please have an evaluation with your pediatrician before using home remedies. It’s important to make sure everything is in working order, and for older children, to make sure they don’t have inflammatory bowel disease (i.e., Crohn’s disease or ulcerative colitis).

Many pediatricians will be supportive of trying the following safe and effective remedies once they know everything else is AOK.

Dr. Aviva’s Top 7 Steps for Treating Children’s Constipation, Naturally

Below is a step-wise approach to safely and naturally treating constipation in children. You can try each step for a few days, then add in the next, or you can tackle all the steps from the outset.

Step #1 Go Gluten and Dairy Free

Gluten-containing foods and dairy products can both cause constipation in sensitive kids, and this may be the only sign of a food sensitivity. Gas and bloating or belly aches after these foods increase the likelihood that they are a trigger. I always recommend starting any treatment plan for chronic constipation out with a basic elimination diet for 3 weeks to see if there are dietary triggers. See here for how to do a basic elimination diet.

Step # 2 Add the Right Foods and Fiber

In addition to taking out the triggers, it’s important to add in good quality fiber in the form of plenty of fresh vegetables in whatever form your child is old enough to tolerate (from purees for little ones to whole forms of veggies for older kids). It’s tough when kids are picky eaters, so head to some mommy blogs or even Martha Stewart for creative recipes.

In addition to fiber from whole food sources, fiber supplements have been shown to be safe and effective for children. Pick just one or two of the options below to use at the same time. Too much fiber can be irritating to the gut, and bulk fiber like flax and chia seeds can glum up in the gut and cause constipation if your child isn’t drinking enough water. Each fiber “dose” should be accompanied by about 4-8 oz of fluid

Glucomannan from the Japanese konjac root, which is available in natural food stores (the dose is 100 mg/kg of child’s body weight, to a max of 5 gm per day, with 50 mL of water), has been shown to be safe and effective in children.

Flax seeds, up to 1 tsp. ground twice daily for children aged 2-7, and up to 1 TBS ground twice daily in children over 7, is an effective bulk laxative that can be mixed into a smoothie, mixed into nut butter and spread on an apple of crackers, or mixed into a 4 oz. of water or juice.

Here’s a great recipe for incorporating flax seeds into your child’s daily diet. The dried fruit is also rich in iron and calcium.

RECIPE: Fruit Balls

Rich in nutrients, fruit balls are a healthy treat for kids of all ages and a great laxative. They are really sticky, so get kids to brush their teeth after eating them to prevent cavities.

  • ½ cup raisins
  • ½ cup prunes
  • ½ cup almonds
  • ½ cup shredded coconut or almond meal
  • ¼ cup flaxseed

To prepare: Slowly grind all ingredients except the coconut or almond meal in a blender or food processor. Add a little water as needed to form a slightly sticky dough. Form into 2-inch balls and roll in the coconut or almond meal. Have fun creating your own variations. Kids love making these, too.

Serving size 1-2 fruit balls, depending on your child’s age. These are sweet so consider them a “treat” or dessert.

Chia seed is also mildly laxative. There are some wonderful chia seed puddings online. Chia seed should be used in a ratio of 8 parts liquid to 1 part chia seeds, otherwise it can absorb water from the intestines and add to, not fix, the problem!

Psyllium or plantain seeds can be mixed into smoothies or a small amount of juice, similarly to ground flax seeds.

Step # 3 Reduce Stress

There’s a strong connection between stress and our gut health. In some people stress causes constipation. Do your best to identify stressors at school, at home, or in other settings and help your child to resolve these. A variety of mind-body techniques, including biofeedback, have been found to be helpful for children experiencing stress-related constipation.

Abdominal massage can be very relaxing to children, and according to medical literature review, may be helpful in the treatment of childhood constipation. The technique is simply to massage the abdomen in a circular clockwise direction, firmly but comfortably, in a diameter a few inches from the navel, using the palm of the hand, for about 5 minutes. A small amount of massage oil can make the massage strokes easier to perform.

Sometimes the constipation itself leads to a vicious cycle of stress because it hurts to have a bowel movement, so using prebiotics and probiotics as discussed below, and the herbs, is important to also include in your plan.

A fantastic herbal formula for kids with stress is Herb Pharm’s Children’s Herbal

Step # 4  It’s “Potty Time”

A lot of people just get too busy to bother sitting on the can. This happens to adults, and it also happens to kids, especially if the morning routine at home is a big hectic rush, and there’s no time to just sit and S#it! So carve out some potty sitting time for your child, regardless of the age. About 30 minutes after meals is ideal, as it is the natural time for the body to evacuate. Let them sit for a max of 10 minutes. If constipation is a chronic issue, make it a casual time – bring a book, allow for 10 minutes of video watching on an Ipod – whatever it takes. With little kids, let them have their sitting time on the potty while you have yours. You can have a chat and scat.

Step #5 Fix Potty Posture

Squatting is the most natural position for having a BM; sitting upright, as we do on the toilet, is one of the least natural positions! For little kids, switch to a squatting potty like a Baby Bjorn if you don’t already use one; for older kids, purchase a squatty potty type of toilet stool. It allows them to sit on the toilet but have their legs elevated to more of a squatting position. This is great for pregnant moms and constipated adults, too! 

Step #6 Have the “Potty Talk”

Our society isn’t the most open about bathroom functions, yet kids in school are still required to raise their hands to get permission to leave class to use the loo. Imagine being at a committee meeting and having to raise your hand to ask permission to go poop! You’d probably hold it. And that’s what tons of kids do in school.

A lot of people also don’t like pooping in public bathrooms – they’re embarrassed by making bodily sounds. So yup, that causes them to hold it, too. Enough holding it and guess what, your body just stops giving you the regular signal and soon you don’t even have the same urge to go. Having regular potty time before and after school can prevent the need to go at school, but helping your kids, from a young age, realize that Everybody Poops and that constipation is common and that holding it can cause it, can go a long way to reducing their embarrassment and their constipation.

If your child has a medical issue with constipation, you can also get special permission for your child to leave the classroom to go without having to raise a hand and make it a public spectacle. Most kind doctors would happily write a bathroom pass note for your child’s teachers – you’re not obligated to provide medical details in the note.

Step #7 Try Safe Herbal and Natural Supplements

In this section are my go-to herbal and natural supplements for constipation in kids. I’ve given you a variety of options to accommodate different ages and food preferences — from teas to smoothies, and of course, the Fruit Balls above. The herbs in this article can be obtained online from Mountain Rose Herbs, and the various remedies can be tried singly, or in combination. Generally, give things each a few consecutive days of use to see if they are working.

TRY: A daily probiotic is a must for kids with constipation, and can make an enormous difference. Get a product that ideally contains a blend of Lactobaccilus and Bifidobacterium, species, and give daily. Prebiotics, in the form of fructose oligosaccharide, may be just as important as the probiotic, as they provide the food that the probiotic needs to thrive, and have been shown to lead to healthier, softer stools.

TRY: Magnesium citrate is an osmotic laxative — meaning it works the same way as Miralax, by pulling water into the intestines. It is safe in moderation for even young children. A typical dose range is as follows:

  • 1–3 years 65 mg/day
  • 4–8 years 110 mg/day
  • 9–18 years 350 mg/day

I recommend taking it before bed, which will often lead to a soft BM in the morning. It can be purchased in powder form and mixed into a small amount of almond milk or water and taken in a cup with a straw, which is easy for young kids.

TRY: HERBAL RECIPE 1:

Slippery Elm Sprinkle (for children 1-3 years old):

Mix 1 tsp. of slippery elm bark powder and 1/8 tsp. of cinnamon powder. Sprinkle onto a small amount of apple sauce, into oatmeal, or into water or a small amount of smoothie. Give twice daily for 2 weeks. Discontinue if this does not result in regular BMs; use up to 3 times per week if effective for your child.

 

TRY: HERBAL RECIPE 2:

“Smooth-Move” Infusion (for children 1 year old and over)

Slippery elm provides the bulk and moisture that aid elimination while the remaining herbs ease gas to prevent possible cramping. Fennel and licorice are also mildly laxative.

  • 2 tsp. slippery elm powder
  • 1 tsp. fennel seeds
  • 1/2 tsp. licorice root
  • ½ tsp. powdered gingerroot
  • 1 pint boiling water

To prepare: Combine all the herbs in a glass jar. Add the boiling water, cover, steep for 20 minutes, then strain. To use: Dosage is 2 teaspoons for children under two years, 1 to 4 tablespoons for children ages two to seven, and 1/4 to 1/2 cup for older children. This can be repeated twice daily. You should notice results in a few days.  Omit the licorice root in children with adrenal or blood pressure problems.

Or try this:

HERBAL RECIPE 3:

Cocoa-Licious Smoothie

  • 1 Tbs. organic cocoa powder
  • 2 tsp. ground flaxseed
  • ½ frozen banana
  • 3 frozen organic strawberries
  • 2 TSP coconut oil
  • 1 cup of plain or vanilla almond milk

To prepare: Combine all the ingredients in a blender and mix well. Give 1-2 cups daily. You should notice results in 1-2 hours after drinking the smoothie. This can be taken daily if effective for your child. Coconut milk can be used instead of almond milk if your child doesn’t tolerate nuts. You can vary the fruit as well.

TRY Senna: Senna is approved by the FDA for children 2 years old and older. It is a strong stimulating laxative so I don’t recommend it for daily use, but it does come in handy in a pinch. To cut down on the belly cramping that sometimes comes along with using senna, use a tea bag combination that contains ginger and fennel seeds, or peppermint leaf. Smooth Move by Traditional Medicinals is a good example of a tea blend you can use. Gaia Herbs Natural Laxative Tea is another.

To prepare: Steep the senna blend tea bag in 1 cup of boiling water as usual, and give 1/8-1/2 cup 1-2 times daily, depending on your child’s age and the extent of the constipation. Expect to see results 5-7 hours after taking the tea.

In Summary

There are many natural approaches to treating uncomplicated constipation in children, from simple steps like changing the diet and adding in a pre- and probiotic, to massage, biofeedback, and herbal medicines. All have a track record of safety with kids.

In a world already rife with toxic environmental exposures, I’d start there and save Miralax for urgent use only.

 

References

Culbert, T and G Banez. Integrative Approaches to Childhood Constipation and Encopresis. Pediatric Clinics of North America. 54(6): December 2007, 927-947.

Louis, C. (2015, January 5). Scrutiny for Laxatives as a Childhood Remedy. Retrieved February 3, 2015, from http://www.nytimes.com/2015/01/06/science/scrutiny-for-a-childhood-remedy.html?_r=0

Louis, C. (2012, May 25). Drug for Adults Is Popular as Children’s Remedy. Retrieved February 3, 2015, from http://www.nytimes.com/2012/05/26/us/miralax-a-popular-cure-but-never-approved-for-children.html?pagewanted=all&_r=0

63 Comments

  1. Love this on many levels! Having natural remedies at hand is wonderful and opening the conversation about bowel function from an early age is just so good… and I love, love, love the discussion of stress – even the ‘small’ stressors of having to ask to use the loo. And the consideration of allowing time… part of a natural rhythm. Yay Aviva!!!

    One question: I had not heard of calcium citrate being used for constipation… have heard of using magnesium citrate. Is mag citrate safe for children?

  2. Hello, Dr Aviva,

    I am a Romanian paediatrician and have followed your posts and activities religiously! I am extremely happy to have stumbled upon your website and secretly consider you my “mentor”… I was very happy to read your post about constipation, which is one of my major problems in practice. I also host a paediatrics blog with its attached Facebook page and was wondering if I could copy and translate your recipes for the mothers in my practice, with due acknowledgment, of course? Thank you again for all the help I have already found in your posts!

  3. Glucomannan makes a great pudding!!! Can be very simple, just 2 cups almond milk (or milk of choice) and a tsp of glucomannan with whatever flavors and sweeteners you like in a blender or food processor or whipped with a hand mixer. I make a chocolate one with cocoa powder and stevia for myself and it’s delish! When I make it for my daughter I put more super foods in it like full fat coconut milk and sweeten with some maple syrup or coconut sugar. The more glucomannan you put in the thicker the pudding AND the more you mix the thicker it gets. The drink is to mix all your ingredients together and then let them set for a minute or two THEN mix again and it thickens right up.

  4. I mostly use natural medicines and herbs with my family, however recently we’ve given several doses of infant Tylenol and Advil to our teething 14 month old (over the last 6 months)… I can’t help but feel concerned when I give it to him, as its chalk full of lots of Ingredients that seem detrimental to overall health- I’d love to hear Dr Avivas insight on this, as well as alternatives to common medicines like these for those of us that would use a natural home remedy.
    I also would like to know what you think of the glycerine suppository option for use with constipated kids?

    • Hi Jane
      Great questions! Glycerine suppositories are, to my knowledge, quite safe, though of course, don’t get to the WHY of the problem. As for tylenol and advil, please see my E-book, which is free on my website. It has a whole host of safe, natural alternatives for common children’s health issues, including teething. Also, my new course, Healthiest Kids University, is going to launch very soon and will help you to raise your little one naturally with as few conventional meds as possible. That said, the few doses of medications you’ve given to your baby so far have, I’m sure, caused no harm. So you can rest assured. 🙂 Aviva

  5. Oh thank you!!! Constipation has been my # woe parenting woe with my 6 year old. Between this and diet and I hope to get him … going! 🙂

  6. Thanks for a great article and all the suggestions. Unfortunately for my son, we have tried many of these. He currently takes 1tsp of Miralax per day. He has Down syndrome which means low muscle tone which probably contributes to constipation. He is already gluten, dairy, nut and citrus free based on food sensitivity testing. And we have tried magnesium, psyllium husk, flax, and probiotics most of which he still takes, but increasing those things usually led to only short term success. After about 3 weeks we would have to result to glycerine suppositories. I felt awful continually experimenting on his body and ending with pain and tears for him. Have you had any success finding long term solutions for kids with low muscle tone? He is also very very unwilling to try new foods. Many things he won’t eat I hide in smoothies which he loves. Any other thoughts to get him off Miralax are appreciated!

    • Hi Julie,
      Yes, this article is really most appropriate for children with garden variety constipation — Down’s with decreased muscle tone presents unique challenges. Probiotics can be promotility, and help slightly compensate, but in your guys case, you might have to use the suppositories, and as I state in this article, use the Miralax, but as a reserve before things get bad for him. I haven’t worked extensively with kids in an integrative medicine setting in your son’s situation. So sorry not to be of more help. Aviva

    • Hi Julie,
      Have a look at the book “Cure your child with Food” by Kelly Dorfman. She talks about using L-carnitine to increase muscle tone in children with refractory constipation. The dose is 50-100mg/kg, but should probably be given under the guidance of a paediatrician.

  7. Thank you! I am looking forward to the Healthiest Kids University!! I am a mother of two (5month and 2yr. old) Greatly appreciate your advise and I always turn to your books and blog with questions concerning my little ones- thank you for providing such great information!!

  8. Thank u for such wonderful info.really love natural meds n thats da best way to go.very intresting article.god bless…..as an adult hv been suffring wth this prob sometimes…so will try ur natural remedies..thank u again….shida.

  9. Hi Aviva, would you consider going every other day once or every 3 days once constipation? My son has not gone daily since he stopped using diapers around age 4 for poop. I’ve always considered this constipation as I thought normal means 2xday. GI Fortify by Pure Encapsulations seems to help. What herbs are safe for long term besides flax? this supplement has psyllium, is that safe?

    • After age 3 or so, I personally feel that kids should generally have a daily BM. But if he’s regular, has no other health issues (i.e. allergies, eczema) and has no discomfort, this might be normal for him and I wouldn’t necessarily treat at all. Hope this helps! ~Aviva

  10. I have been to a specialist for my daughters constipation. She only poops about once every 5 days and they are huge. We have her eat an organic apple once a day and that seems to keep her at once every 3-5 days. I will never give her miralax. It amazes me how many Doctors are all for it.

  11. MIRALAX ADVERSE EVENTS reported to FDA or [email protected]
    by parents of children who were given Miralax
    Over 9,000 reports to FDA as of March, 2015

    FDA petition link:
    http://www.regulations.gov/#!documentDetail;D=FDA-2012-P-0566-0001

    (limited list-more side effects reported since compiled)

    Anxiety
    Phobias, fear
    Extreme nervousness
    Obsessive-Compulsive behavior
    Scratching, biting (self and others)
    Nightmares
    Hysteria
    Memory loss
    Sleeplessness
    Irritability
    Mood swings
    Bipolar disorder
    Withdrawal
    Communication loss
    Loss of concentration
    Vertigo while lying down
    Dizziness
    Anger, often unexplainable
    Tantrums
    Metabolic acidosis
    Clawing sister’s eyes
    Sensitivity to sound
    Motor skills affected
    Fearfulness
    Confusion
    Inability to focus
    Mumbled speech
    Gait disturbances
    Constant throat clearing
    Obsessive finger licking
    Sucking on fingers
    Sucking on objects
    Obsessive chewing on objects
    Feelings of something dripping down face
    Compulsive bad thoughts
    ‘Meltdowns’ over homework
    ‘Meltdowns’ over trivial things
    ‘Panic’ behavior
    ‘Dr. Jekyll & Mr. Hyde behaviors
    ‘Wave pool feeling’ when trying to go sleep
    Tics
    Tremors
    Screaming
    Aggression
    Hepatic enzyme increased
    Jaundice
    Incorrect drug administration
    Memory impairment
    Middle insomnia
    Nervous system disorder
    Pain
    Personality change
    Thumb sucking
    Swollen tongue
    Aphasia
    Oral pain
    Surgery
    hair loss
    Thrombosis
    Hyperkalmia
    low iron and zinc levels
    Lipodystrophy acquired
    Weight increased
    Balance disorder
    Incorrect drug administration duration
    Overdose
    Oropharyngeal pain
    Cough
    Malaise
    Off label use
    Vocal chord disorder
    Robot like speech
    Autism, Autistic Spectrum Disorder
    Akathisia unexplained restlessness
    Burning of skin externally with persistent redness
    (looked like scalding from hot water)
    Stunted growth, delayed weight gain several months to a year after Miralax/PEG stopped

    Scoring below age level on test after Miralax started, before all test within normal range
    After Miralax daughter no longer met expected developmental milestones
    Scratching others
    Difficulty falling asleep every night (4-5 hours to fall asleep)
    Wakeful during night
    “falling to pieces” within first four days on Miralax
    Unrelieved constipation
    Worsening behavior as days of Miralax progressed
    Irritable fussy
    Frequent hysterical crying
    Unable to appease, no matter what
    Unable to calm down once upset
    Unable to listen
    Frequent unexplainable loss of temper
    Angry
    “possessed by the devil”
    Refused to get dressed
    Would fight constantly with mother
    Constantly pulling clothes off once mother got them on
    Constantly wanting to be naked, appeared miserable, ‘wanted to get out of her skin’
    Atypical behavior
    Frequent kicking and screaming
    Frequent ‘acting up’
    Communication loss. With robotic like talking (mother states this has not resolved years later and daughter will talk like this 1-2 X week)

    Emesis would ‘bleach’ stains on the carpeting months after Miralax given
    Throat burn
    Esophageal irritation

    Brain swelling confirmed by lab work and pediatric neurologist and treated with Prednisone

    Any doctor suggesting Miralax is safe is uninformed!

    Off label prescribing can be reported to your state medical board. The only way we can get doctors to stop recommending this to children is to hold them accountable.

    Seizures:
    life threatening with a minimum of 3 fatal cases documented and several more suspected

    Violent behavior
    Suicidal thoughts (age 6)
    Paranoia/bizarre hiding
    Anti-social behavior
    Slurred speech, whispering
    Staring
    Skin disorders
    Keratosis pilaris – chicken skin, what appears to be Miralax particles trying to exit the body through the skin, primarily on the arms and legs

    Homicidal ideation

    Homicide (14 year old boy shot and killed his father, stating he did not know why. He reported feeling like he was in a shell and was paranoid. The prepubescent brain in a male is the same size it will be at age 25, however the skull is much smaller. Brain swelling can cause Central Nervous System Irritability. A hyponatremia (low sodium) can cause a metabolic acidosis. In other words Polyethylene glycol, like all other drugs can cause a “substance induced toxic psychosis”.

    Reports of porous teeth
    Accelerated tooth decay

    Is this effecting bone marrow production and bone development?

    Polyethylene glycol is used as a humectant to moisten dog food.
    Many dogs suffer from seizures and must be medicated, often diagnosed with epilepsy…?

    There are other symptoms that have been reported to the FDA…

    In the US Please Call 1-800-FDA-1088 if you have not filed a report.
    There is a global reporting site that all should report reactions to Miralax (polyethylene glycol)to:
    http://www.Rxisk.com

    For busy mothers you can insist on completing a report of an adverse reaction over the phone and request a copy.

  12. I’ve been eager to try magnesium citrate for my 20 month old son, as I use it and find it very gentle and effective with no side effects (he has been on Miralax for the last 6 months and I do not want him on it any longer). However, whenever I ask my pediatrician or the pediatric GI about it, they both say that its fine to use for disimpaction, but not safe for long term use. Since you have it listed it above, I presume you believe it is safe for long-term use. Any idea why the docs don’t want me to use it?

    Thanks!

    • Hi Miranda,
      While I know of no contraindications of long term use from a safety perspective, it doesn’t actually get to the root cause — it’s an osmotic laxative rather than using the right foods, etc, to get the bowels going regularly. I’d ask your pediatrician to demonstrate why it’s not safe in a low modest amount…

  13. Hi Aviva,

    This article was so timely for me. Have been giving my child Miralax for several years, not feeling comfortable with it, but not knowing what else to do. Tried cutting out gluten and dairy to no avail. Finally cut out most refined sugar and that seemed to do the trick. (I didn’t see that in your article, maybe something to add?) I don’t do well with sugar. I figured out that every time I had more than just a small taste of sugar I got an upper respiratory infection, so I tried it in my son and we are now completely off Miralax and not constipated! Yay! Your article gave me the confidence and resources to continue trying safe alternatives to Miralax. We now have also added “potty time” every day and focus on water and fruits and veggies, and will definitely be trying the herbal methods you recommend when and if he gets constipated in the future. Thank you so much for sharing your knowledge!

    • Our daughter seems to be low tone and her GI has had her on Miralax for over a year and just happy to keep going with that without testing why she needs it to go! We also have tried gluten free and dairy free but showed no results. I was just reading about sugar sensitivities and I’m wanting to try and cut that out next to see if it will make a difference. Can I ask if there are any sugars your child is able to consume without any negative effects?

  14. My daughter does not like Natural Calm…are there other ways to administer Magnesium Citrate easily into a picky eater?

    • Hi Nichole,

      This is Megan from Dr. Aviva’s team. Getting kids to take medicine can be so incredibly tricky! There has been some success with making “gummys” with the calm magnesium. You can do a google search on magnesium gummy to see what comes up! I hope this helps!

      Megan- Dr. Aviva Romm Nutritionist

  15. Hi Aviva,
    To deal with chronic constipation, the pediatrician’s nurse advised we use Milk of Magnesia, and sometimes Ex-Lax. It has been difficult to get him to consume foods that I know will help with having a BM, so a little extra help has been necessary (he has become excellent at holding the poop, but rejoices after he has a movement). What are your thoughts on the use/safety of Milk of Magnesia and Ex-Lax?
    Thank you!

  16. As a parent who is currently helping her child through a terrible, constipated, journey, I’m quite frustrated that your article makes no mention of “encopresis.” As you likely know, it’s a medical condition where, after prolonged withholding, the colon gets so stretched out that it loses the sensation to know (and let the kiddo know) that s/he has to poop. Had I known of this condition two years ago, me and my family would have been saved years of heartache and frustration – and would have known better than to just think that our child was being stubborn or not listening to us. You have a really wide readership; please update the article so that other parents may read/learn of this condition and hopefully avoid years of stress for all. Thank you.

  17. Hi! Thanks for this informative post. My almost 3 year old is having a terrible time with withholding, therefore causing constipation. She had been completely potty trained but after developing a uti she decided she didn’t want to go anymore.

    Just like everyone else our pediatrician advised miralax. She only had a few doses but I didn’t notice any help except for discomfort and she could still hold it in! I then did my own research and found pedia lax chewables (magnesium hydroxide). Would you consider this safe? It says for short term use on the packaging but I have heard of mothers using it longer. I asked our pediatrician but was just told to keep on miralax instead. Ugh!!!
    I just want to take the bull by the horns now so that this doesn’t become a long term issue! It worries me!!! Is magnesium citrate similar to magnesium hydroxide?

  18. My neice 3 yr old, has had tummy issues since birth. Doctors have put her on miralax since “day 1” at one time she was impacted all the way to her diaphragm. GI pediatrician has now put her on 4 cups of miralax daily and 1 tsp of senna q HS. She is having very hard, pasty stools lucky to get 1 q day. She is not eating, drinking, and c/o abdominal pain. We push fluids like crazy and she eats foods high in fiber like cereals, has added flaxseed to smoothies/foods, she eats blackberries, bananas, grapes, apples, etc. She loves fruits!! Nothing is helping and as a nurse, I know all the miralax is not good for her!! Please help with advice…thanks

    • When I raised my children, NO bananas they are binding–if child is constantly constipated.
      Pasta is binding and rice too. Good old fashioned oatmeal each day lots of water and fruit and veggies—prunes and prune juice daily, then adjust this diet accordingly to bowel movement structure; of course along with protein. I feel saddened little ones are suffering so much in the daily rush. Sometimes, the old-fashioned way does work! Good luck everyone, I hope each of you find a good, safe and healthy solution to your little ones constipation, it’s no fun for parents or especially child.

  19. I have a 3 year old who was put on miralax by the pediatrician about 6 months ago. We never gave it to her daily (and never a full dose) but still fairly regularly over the past 6 or so months. I’m now attempting several of the more natural remedies you recommend but am worried sick about damage I may have already caused. Is there testing I should do or things I should be looking out for specifically related to exposing her to toxins through miralax?

  20. Thank you for this article, I will try these things. Is the cocoa powder in the smoothie for laxative effect or just flavoring? I want to give it to my 15 month olf, but am not sure if I should give her that much or any cocoa. Thanks!

  21. Thanks Dr Aviva. Re: the Natural Calm. Will my son’s bowels become reliant on it or is it ok to use and ensure his diet his good too then wean him off it? I’m also going to give him a half teaspoon of coconut oil twice a day as that’s a good constipation cure.

  22. My almost 9 year old son has been on Miralax for the last 3 years. For a while he was taking 2 capfulls daily, but I eventually reduced it down to less than 1/2 capfull. We also are dealing with encropresis. I recently took him off Miralax and we are using a different laxative, but as I read the list of reported side effects from Miralax in an above comment I saw several things that we have been dealing with with my son. Once a child has extensively used Miralax and has been adversely effected by it, is it possible to safely detox their body and reverse these behavioral issues? Thanks for any advice you can give!

    • Hi Alyssa,

      This is Megan from Dr. Aviva’s team. This is a great question. The short answer is YES! You most certainly help your son to detox. The best route to take is to find an integrative or functional medicine doctor to safely lead you and your son through the process.

      Warm wishes,
      Megan- Dr. Aviva Romm Nutritionist

  23. I was so happy to come across this article. My son developed horrible tics when on Miralax. His GI specialist said that was not possible, but every time he went back on Miralax the tics developed. The tics were so bad he was diagnosed with Tourettes. However, he has not been taking Milk of Magnesia for about two years and is tic free. Miralax is horrible stuff!!!!

  24. Is it safe to give a 9 years old child Magnesium Citrate capsules 300 mg daily? For how long can we continue? Does body get used to Magnesium after a while and need higher doses?

    • Yes it is safe, and no there are no concerns even with daily use as that dose. However, if for constipation, it’s not getting to root of the problem – so you want to make sure you do that – then perhaps you won’t need to magnesium indefinitely. Warmly, Aviva

  25. Can you please tell me how much magnesium citrate powder for an 8 year old? We’ve been going to a specialist since birth and he still goes once a week or less! I’ve been chronically constipated since birth and now at age 35 still have the problem to the point sometimes dying seems better than facing this! I hate my poor children inherited this hell!

    • Hi Lori,

      Oh this sounds terrible and I am so sorry that you are your little ones are dealing with this. If you do a search on Aviva’s website you will find both a podcast and a blog that Aviva wrote on the specifics of magnesium and how to work with it. Also, if you are not already, working with an integrative or functional medicine doctor to help you get to the root of what is going on for you could be really helpful.

      Warmest wishes,
      Megan- Aviva Romm’s executive assistant and online nutritionist

  26. How important is it to completely ‘ empty out’ the impaction in the bowel before starting a new regimen to encourage regular bowel movements?

    From what I understand, most paediatricians will suggest using an enema to completely empty out the bowels.

    I must admit I am reticent to Use an enema if it can be avoided. I have used a combination of prunes, flax seeds, smoothiies, and miralax ( which I don’t want to use if possible), over the past week to get to the point where his stools over the past few days have been rather too soft, and he is pooping once every day or two.

    So, have I achieved what an enema would achieve? I am hoping that now I just need to adjust his diet a little so that his stools are a little firmer. Does that sound reasonable? We have had such bad experiences with visiting our paediatrician. He was extremely brusque and said (infront of My son) that he would be ‘ on Miralax for the rest of his life’ . I am so upset with this doctor. I want to ask him whether that was a statement sponsored by Miralax. Anyway, my son becomes very defiant when he is embarrassed by visits to the doctor. It’s just how he deals with embarrassment. So we we had a very unpleasant experience all round. Why is it so difficult to find a nice child friendly pediatrician who can put the child at ease ?!?!?! Anyway..

    He was pooping once a week or maybe twice a week, and getting some encopresis in recent weeks.
    Infrequent bowel movements has been going on for years. I noticed as a baby/ toddler, he didn’t seem to do it as often as expected. He is eight now. We did use Miralax for about a year last year, when we were concerned about him pooping only twice a week if we were lucky, and they were very large stools. We had him sit on the toilet once a day. Then after about a year , he seemed to be able to go to the bathroom when necessary, so I stopped using the Miralax. For about 6 months everything was fine, although I suspect he wasn’t going as often as every two days. Then we started getting encopresis about two months ago, and we were back to pooping once or twice a week.

    Thanks for your comments!

  27. Dr.Aviva,
    I love your blog! I want to give my 3 year old magnesium citrate. You say about 65mg but the bottle says 2-3 oz for children 2-6 yrs old. The bottle also says 290mg of magnesium per fluid oz. So I divided 65 into 290 which equals .22. So that means about 1 tsp of the fluid not 2-3oz. Am I doing this correctly? Thanks for your time!

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