Miralax in kids, and your favorite alternatives?

[TheTruckGuy]

So I saw a profoundly constipated 4 year old, 2nd ED visit for nonspecific abdominal pain with vomiting. Could feel the stool in her belly, and the KUB showed it. I talked to mom about stool softeners, and suggested miralax. She started freaking out about how it's unsafe, and toxic for kids, and I need to do more research on it.

So the next day when I had some time I googled it, and sure enough there's a whole community of parents (FB group of 27k members) that are convinced we're poisoning their kids every time we prescribe miralax. The biggest complaint appears to be that miralax causes "neuro-psychiatric" problems - or in other words their kids misbehave and turn into brats after miralax.

Anyways, to my question - has this happened to you? Do you try and talk to the parents about it or just give another suggestion? What's your next suggestion after miralax? Or do you have something you prescribe before miralax?

thanks

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[VA Hopeful Dr]

I'm a big fan and have had lots of success with lactulose. You can even sell it more by talking about how it removes excess liver toxins

 

[Stitch]

I love the 'do your research' idiots. Comical. The anti miralax people are as crazy at the anti vax. It's pretty insane, and you'll never convince them to see reason.

Lactulose seems a reasonable alternative.

 

[TheTruckGuy]

I'm a big fan and have had lots of success with lactulose. You can even sell it more by talking about how it removes excess liver toxins

Liver toxins? Brilliant!

 

[SurfingDoctor]

Olestra Doritos...

Alternatively...
That Time Gummy Bears Gave Everyone Diarrhea
Kids love em...

 

[Dr. Wexler]

Anyways, to my question - has this happened to you? Do you try and talk to the parents about it or just give another suggestion? What's your next suggestion after miralax? Or do you have something you prescribe before miralax?

thanks

I try to convince them them to do Miralax plus an emema.
I offer alternatives of lactulose or mag citrate or milk of magnesia plus an enema. And explicitly state in my professional opinion Miralax is the safest of the choices. (I think the NASPGHAN clinical guideline states there is inadequate data to support my opinion though.)

 

[calvnandhobbs68]

I think Miralax is definitely the least harsh of all those options. But we would usually go to lactulose next.

And yeah with a kid that constipated, would probably have them do an enema at the same time or else they're gonna end up in the hospital with an NG tube in their nose pumping them chock full of all that toxic PEG 3350....tell mom the enema is "all natural" saline.

 

[TheTruckGuy]

I think Miralax is definitely the least harsh of all those options. But we would usually go to lactulose next.

And yeah with a kid that constipated, would probably have them do an enema at the same time or else they're gonna end up in the hospital with an NG tube in their nose pumping them chock full of all that toxic PEG 3350....tell mom the enema is "all natural" saline.

We actually ended up doing an enema on her after discussion with the mom. However it was not successful, and after more discussion with the mom she asked us to do a manual disimpaction.

 

[captianplanet]

just fyi.... there was an rfa for this...

grants.nih.gov/grants/guide/rfa-files/RFA-FD-14-088. html
As I cannot submit links, just move the .html closer

CHOP GI team I believe was awarded this....heuckeroth.research. chop.edu/peg-3350-study

same with this link

 

[SurfingDoctor]

just fyi.... there was an rfa for this...

grants.nih.gov/grants/guide/rfa-files/RFA-FD-14-088. html
As I cannot submit links, just move the .html closer

CHOP GI team I believe was awarded this....heuckeroth.research. chop.edu/peg-3350-study

same with this link

Number of publications generated on the awarded grant... 0.
Project Information - NIH RePORTER - NIH Research Portfolio Online Reporting Tools Expenditures and Results

Though it looks like they terminated the grant award in only 1 year, so they only spent a couple hundred thousand, instead of over a million.

Good lord, what a waste of taxpayer money. Fortunately, most biomedical research is a drop in the bucket of federal dollar coffers, but still...