What is the recommended dosing of MiraLAX (polyethylene glycol) for pediatric patients?

MiraLAX (Polyethylene Glycol) Dosing for Pediatric Patients

The recommended dosage of MiraLAX (polyethylene glycol 3350) for pediatric constipation is 0.7-0.8 g/kg/day, with a maximum daily dose of 17 grams for maintenance therapy. 1

Age-Based Dosing Recommendations

Children Under 17 Years

• According to the FDA label, children 16 years of age or under should only use MiraLAX under physician guidance 2
• For children with chronic constipation:
  • Initial dose: 0.7-0.8 g/kg/day (approximately 0.5-1.5 g/kg/day range depending on severity)
  • Typical maintenance dose: 0.4-0.8 g/kg/day
  • Duration: Can be safely used for extended periods (studies show safety for >3 months) 1

Children 17 Years and Older

• Standard adult dosing applies: 17 g (one packet or capful) dissolved in 4-8 ounces of beverage once daily 2

Administration Guidelines

• Mix the prescribed dose thoroughly in 4-8 ounces of beverage (water, juice, or other non-alcoholic drink)
• Ensure complete dissolution before drinking
• Do not combine with starch-based thickeners used for difficult swallowing
• Can be administered at room temperature, cold, or hot 2
• Morning administration is often preferred for predictable results

Clinical Considerations

Efficacy and Safety

• PEG 3350 has been shown to be an effective and well-tolerated treatment for pediatric constipation 3
• Long-term studies have demonstrated no major clinical adverse effects with extended use 1
• Laboratory monitoring during long-term therapy showed no significant electrolyte abnormalities or other biochemical concerns 1

Patient Acceptance

• PEG 3350 has superior palatability compared to other laxative preparations
• Studies show high compliance rates (90%) and patient preference over other laxatives 1
• MiraLAX is tasteless and dissolves completely, making it more acceptable to children than many alternatives 4

Dosing Adjustments

• For severe constipation or fecal impaction, higher initial doses may be needed for disimpaction before transitioning to maintenance dosing
• Dose can be adjusted based on clinical response and stool consistency
• Treatment duration should be individualized based on response and underlying cause of constipation

Monitoring and Follow-up

• Monitor for:
  • Stool frequency and consistency
  • Abdominal pain or bloating
  • Signs of adequate hydration
• If no improvement after 7 days of therapy, reevaluate the diagnosis and consider alternative treatments
• For chronic use beyond 7 days, medical supervision is required 2

Common Pitfalls to Avoid

1. Underdosing: Insufficient dosing is a common reason for treatment failure
2. Inadequate dissolution: Ensure powder is completely dissolved before administration
3. Inconsistent administration: Irregular dosing can reduce effectiveness
4. Premature discontinuation: Abrupt cessation may lead to recurrence of constipation
5. Failure to address underlying causes: Diet, fluid intake, and behavioral factors should be addressed concurrently

MiraLAX is generally considered a safe and effective option for pediatric constipation, with excellent tolerability and patient acceptance profiles compared to other laxative preparations.