Maintenance Therapy for Constipation

• Miralax should be continued for at least 1 month, but may need to be continued for 6-12 months, at a dose to have 1-2 regular mushy stools a day. After 1 month of maintenance therapy, Miralax can be decreased to an as needed basis only if your child’s bowel habits allow. The goal is to produce a regular soft bowel movement every 1-2 days. Some children require 9-18 months of Miralax to break the cycle of abdominal pain from constipation or if stools become hard, painful, large of like “rabbit turds”, Miralax should be restarted or increased.
• The doses below are suggested starting doses. The dose of Miralax should be adjusted up or down to have 1-2 regular mushy stools a day without diarrhea. 1 capful of Miralax should be mixed in 4-8 oz of fluid based on desired texture.
• In order to prevent further constipation, your child’s diet should include lots of fluids, fruits, vegetables, and fiber rich foods. Increased amounts of dairy can worsen constipation and juices such as apple, pear, and prune can improve constipation. Daily exercise is also very important to help prevent constipation. Sugar free gum with sorbitol or xylitol can be used in older children who are non-compliant with medications.
  • Recommended grams of fiber / day = 5 grams of fiber + age of child (e.g. 15 grams of fiber for a 10 year old). Maximum of 25-30 grams per day.
  • Recommended daily fluid intake:

• Your child should also develop good daily bowel habits. Daily toileting routines should be practiced including:
  • Establish toileting sessions at least twice a day (e.g. after breakfast and after dinner). Session should be timed and last 5-10 minutes even if your child does not feel like they have to go. Emphasis is on sitting on the toilet, not producing a bowel movement. Books are ok to read on the toilet, but no video games.
  • Regular meal times should be established with minimal snacking in between meals.
  • Do not strain to have a bowel movement. Legs should be propped on a stool to improve positioning while toileting.
    

    General Starting Dose Guidelines for Daily Miralax Maintenance Therapy

Miralax Cleanout

• Moderate to severe constipation requires a child to have their bowels cleaned out prior to maintenance therapy. Follow these instructions if you were told to have your child complete a Miralax cleanout.
• Miralax can be mixed in any fluid including water, orange juice, sports drinks, Crystal Light, or others (not soda). You can adjust the texture to your child’s preference by using the suggested range of oz. 
• Which cleanout should I choose?
  • Single dose cleanout – can be completed over a weekend and usually gives fast results. You should start this cleanout on a Friday afternoon or Saturday morning when your child is able to stay home near a toilet. The goal is to have multiple bowel movements followed by yellow watery stools or diarrhea. If your child has diarrhea right away or does not produce yellow watery stools, the cleanout has not been successful. This cleanout can be repeated once a day until yellow watery stools are achieved. Your child may experience some abdominal cramping with the single dose cleanout. Cramping usually means your child needs to pass a stool. Ibuprofen or Tylenol may be used for discomfort. Make sure to keep your child well hydrated for the entire weekend.
  • Multiple dose cleanout – this cleanout is meant for children who are unable to tolerate the cramping from the single dose cleanout or for children who are able to complete the cleanout over multiple days in a row (2-7 days). Cleanout should be continued 3 times a day until multiple bowel movements followed by yellow watery stools are achieved.