Miralax (Polyethylene Glycol) for Constipation in 4-Year-Olds
Polyethylene glycol (Miralax) is safe and effective for treating constipation in 4-year-old children, though it is not FDA-approved specifically for this age group.
Safety and Efficacy in Children
Polyethylene glycol (PEG) has been established as a first-line treatment for constipation in children, with significant evidence supporting its use:
- PEG has been shown to be more effective than other osmotic laxatives like lactulose for treating constipation 1
- Studies have demonstrated PEG's safety and efficacy in children as young as 6 months of age 2
- In children under 18 months, PEG has been shown to relieve constipation in 97.6% of patients with minimal side effects 2
Dosing Recommendations
While there is no FDA-approved dosage specifically for 4-year-olds, clinical evidence supports the following approach:
- Starting dose: 0.5-0.8 g/kg/day of PEG 3350 without electrolytes
- For a typical 4-year-old (approximately 16-18 kg), this would be roughly 8-14 g daily
- The standard adult dose is 17g (one capful) mixed in 8 ounces of liquid 3
- For children, this dose should be adjusted downward based on weight
Administration Guidelines
- Mix PEG powder thoroughly in 4-8 ounces of water or other clear liquid
- Administer once daily, preferably in the morning
- Titrate dose based on response (stool consistency and frequency)
- Continue until regular bowel movements are established, typically for 2-4 weeks
Non-Pharmacological Approaches
Before or alongside PEG treatment, consider these supportive measures:
- Increase fluid intake
- Increase dietary fiber if fluid intake is adequate
- Encourage physical activity
- Establish regular toileting routines
- Consider fiber supplements for mild constipation 4
Monitoring and Side Effects
Common side effects are generally mild and include:
- Abdominal distension
- Loose stools
- Flatulence
- Nausea
These side effects typically resolve with dose adjustment 4.
Important Considerations
- While not FDA-approved specifically for children under 17 years, PEG is widely used in pediatric practice
- The American Gastroenterological Association and American College of Gastroenterology recommend PEG as a first-line treatment for chronic constipation 4
- For severe cases or if symptoms persist beyond 2 weeks of treatment, consult a pediatrician
- PEG works by drawing water into the intestinal lumen, softening stool and increasing bowel movements
Conclusion
Polyethylene glycol (Miralax) is considered safe and effective for treating constipation in 4-year-old children, despite lacking specific FDA approval for this age group. The recommended approach is to start with a weight-based dose of 0.5-0.8 g/kg/day, combined with increased fluid intake and dietary modifications.