Last week we received a number of questions about a statement released by a group of parents of children with disparate neuropsychological issues. The parents claimed that their children’s symptoms began after they began taking the over the counter laxative Miralax (polyethylene glycol 3350) and that the medication was at fault. Miralax is approved only for use in those age 17 or above, and the parents have expressed concern that they were instructed to give their children the laxative not approved for use in their age group.
This was cause for concern for many parents, especially those whose children have dealt with constipation. To answer our reader questions we reached out to François Lavallée, a pharmacist in the province of Quebec, Canada and who is also the father of two young children. Matthew Hartings, a professor of chemistry at American University in Washington, DC (and a dad as well), helped out with some of the chemistry.
We have received a number of questions from concerned parents about this story. Thank you for taking the time out of your schedule to speak with me.
I can see why parents would be concerned. I’m a parent myself and nobody wants to put their kids at unnecessary risk. I don’t doubt that the children of the parents coming forward have neuropsychological issues. When you are the parent to a child with neuropsychological issues, depending on the severity, it is very hard both physically and emotionally. I think what they are doing is noble because they want to prevent other children from experiencing something similar, but I’m not sure that the chemical component in Miralax, polyethylene glycol (PEG) 3350, is what has caused the symptoms they are describing.
Right now the symptoms that are being disclosed publicly by the parents are a little vague and aren’t consistent with each other. Some describe, the development of aggression and paranoia, others describe motor issues such as ticks. Usually when symptoms are caused by something children are exposed to there’s an identifiable pattern. It would be so simple if it were the case here, we could just ban that substance and be done with it.
In reality, considering the diverse symptoms reported at this time there is probably more than one cause. What makes it more difficult is that in some cases the individuals are now adults and are claiming the exposure as toddlers caused their symptoms. It is incredibly difficult to pinpoint a cause ten or fifteen years after the onset of symptoms. There may have genetic predispositions to some of these issues or the symptoms may have been acquired through another exposure through food, air, water, or other drugs.
I think parents need to exercise caution when they read things like this online. These articles often lead to really shocking information that’s completely out of context. The important context is usually at the bottom, but they know that most people don’t read articles all the way through. These websites prey on parents’ fears for clicks, and can cause them to panic when they don’t have to.
I think part of what makes this so shocking is the claim that the same chemical that’s in anti-freeze is also in a laxative that parents have been giving their children. Can you tell me a little more about PEG 3350 and antifreeze?
First, it’s important to know that this is not the same chemical that’s in antifreeze, but it is easy to confuse the two. Their names sound very similar. A number of the articles have confused the two chemicals which is why I really think parents need to exercise caution when reading things like this online.
Ethylene glycol is the chemical that is in antifreeze, it is highly toxic and we see kids sometimes ingest it accidentally if it’s in the garage or not properly secured because it has a sweet taste to it. Polyethylene glycol or PEG starts with “poly”, a prefix meaning “many” or “multiple”. In this case, it means many ethylene glycol molecules linked together, which makes it a different chemical, with different properties. As you can see here, the two chemicals have the same basic ingredient, simply repeated “n” times in the case of PEG:
Ethylene glycol: C2H4O + H2O → HO–CH2CH2–OH
Polyethylene glycol: HOCH2CH2OH + n(CH2CH2O) → HO(CH2CH2O)n+1H
Even though it is the same basic molecule as ethylene glycol repeated many times, PEG molecules have very different properties, depending on how many are linked together. The number 3350 refers to the weight of the molecule, which is an indication of its size, in this case, it’s a large molecule. PEG can be as small as 400 and as large as 15,000, but 3350 is a large molecule. The larger a molecule, the less likely it is to be absorbed by the body.
The weight of the molecule is very important. PEG 3350 behaves differently than PEG 400 does, and differently than Ethylene glycol does. What is applicable to one molecule may not apply to another. PEG 3350 is a very stable molecule, which means that it doesn’t change its state (or break down) easily.
Is it possible through some mechanism, that Polyethylene glycol is responsible for the development of the neuropsychological issues in children?
I would be very shocked if the symptoms were caused by PEG 3350. Because of PEG 3350s size, our body isn’t able to absorb it. Given these properties, it is highly unlikely that it causes these neurological symptoms. I did a review of the literature before we spoke and there’s nothing that supports PEG 3350 with lasting side effects or that explains how it could potentially cause it. Most reported side effects are linked to its laxative properties: abdominal discomfort, cramps, bloating, diarrhea.
The hypothesis put forward by some is that if improperly stored PEG 3350 breaks down into ethylene glycol and that this degradation combined with prolonged exposure in chronically constipated children causes the symptoms being reported. I am skeptical of this hypothesis due to the stability of PEG 3350. As I mentioned before PEG 3350 is very stable, so it would take a lot for it to break down due to improper storage.
I do understand that in 2008 trace amounts of ethylene glycol (15 µg/ml) were found in eight bottles of Miralax. This is a very small amount and is essentially harmless to an adult. But the question is, is that amount enough to cause problems in a child, especially if the child is exposed daily and over a long period of time (for example years). This is not something that I know the answer to as ethylene glycol toxicity is usually seen in the hospital, so I asked Matthew Hartings, a professor of chemistry at American University in Washington, DC.
Matthew confirmed what I thought, which is that the dose found in the bottles is not enough to be toxic to a child in a single dose. Matthew calculates that for a child to consume a toxic dose of ethylene glycol at the doses found in the bottles, they would need to consume 1L of the powdered product. The product isn’t available for retail consumer purchases in packages that large. He also says that ethylene glycol does not bioaccumulate so it’s unlikely that prolonged exposure to ethylene glycol could cause problems through that mechanism.
Matthew and I both agree that the ethylene glycol should not be in the bottles period and it’s not a good thing and it’s unacceptable that the manufacturer couldn’t account for how it got there. It’s never a good thing when something that shouldn’t be in a product winds up in it, even if the dose isn’t enough to cause harm.
So what exactly does PEG 3350 do, and why is it in laxatives?
It’s an osmotic laxative, which means that it attracts water. Our intestines are very good at absorbing water, which is part of their jobs, but when a child (or an adult) becomes constipated their stools become very hard with very little water in them, and it makes them difficult and sometimes painful to pass. PEG 3350 holds water in the intestines which allow the stool to soften, which makes it easier to pass normally. It is a passive laxative, which means that it doesn’t cause the intestines to contract or actively push stool through. This is why it has been used so much for children. It is important to note that the main reason why it can express an osmotic force to retain water in the intestines is that it isn’t absorbed by the body. It goes right through, from one end to the other.
Part of the concern seems to be that a medication that is only indicated for adults has been used for children, why has it been recommended off-label for use in children?
We knew that it is safe as a one-time use to empty a child’s bowels before a procedure. As we know it is safe in a large dose at one time, some doctors and pharmacists started to extrapolate that knowledge and say, maybe it is safe in a small dose over a longer period of time.
At the beginning of my career, I didn’t see PEG 3350 used very much in children in part because the product was new to the market. At first I started seeing individual clinics using it and then [a large area pediatric hospital] started using it, shortly after it became much more common.
This isn’t to say that PEG 3350 hasn’t been studied in children. It has been studied extensively and has shown to be safe and more effective than a placebo. But it hasn’t gone through the same level of trials that we require before approving a drug for adults. I know in the United States the Food and Drug Administration (FDA) is funding a study of the long-term safety of the use of PEG 3350 in children with chronic constipation, at the Children’s Hospital of Philadelphia (CHOP), but I don’t know what prompted the study. I see it as a good thing that can help confirm safety in longer-term use. The more studies we have, the more confident we can be in a product’s safety.
I think a lot of parents are wondering why doctors are recommending medication for children that isn’t approved for children.
As you know, it’s very difficult to get approval to test drugs on children. It’s pretty obvious why. Would you allow someone to test a drug on your child? You don’t know what the drug will do to your child. No one would sign their child up for that. It’s not ethical, so we don’t test drugs on children in large trials. Unfortunately what this means is that we sort of test things in the real world. We take that little bit of information that we have in one area and we extrapolate it and then we report on what we find until we have enough data to have something similar to a clinical trial, then there’s usually a reclassification.
Additionally, and this is unfortunate to say, there isn’t a lot of money in pediatric drugs for large pharmaceutical companies. Kids are only kids for a little while, so it doesn’t offer a good return on investment for them. Another deterrent for companies to invest and develop drugs for kids is that they don’t like to be sued, so they will usually go for the safest patients to treat: Adults with functioning kidneys and liver. Kids, the elderly, pregnant women, people with kidney or liver disease, are all populations that are less researched, so treatment is trickier.
As companies hate to get sued, they will put on their labels only what they studied and they know it is safe. That is common sense. But when a label says “Use for no more than 7 days without a doctor’s advice”, it doesn’t mean the product is poison if used for 8 days. It means if you need to use it for longer, you might have a more serious issue and should be examined by a doctor. Once you’ve been examined and it has been confirmed that everything is in order, under the doctor’s advice, you can use the product for longer, as long as there is a proper follow-up.
What are some things that parents can do to manage constipation at home if they don’t want to use an over the counter laxative like Miralax?
The most important thing is that parents talk to their doctor or pharmacist first if they have concerns about chronic constipation in their children. They best know your child’s medical history and are most familiar with the various treatment options.
With that said, there are some first-line defense options that parents can try at home if they have a concern about acute constipation. These are things like prune or pear juice, or simply adding more of these fruits into their child’s diet, which I know can be difficult if their child is a picky eater. They can also ensure their child gets plenty of water and plenty of exercise, as those both really help with constipation.
Originally Posted at TheScientificParent.org
What Are The Best Colors For Family Pictures Outside?
Picture this: It’s a bright summer day, you’re wearing your best clothes, and your family has gathered together outside for some pictures. Now, what color is best to wear?
This post is meant to give you an idea of the best colors for family pictures outside. It can be tricky trying to figure out what colors will best show the best family pictures outside. Because there are so many different colors, it can be difficult to find out what will best show off your best features.
This is a hard question because every person has his or her best color for photos, which means that everyone should come up with their best colors for pictures outside.
Best colors for outside family pictures.
A color scheme for family photos that works in any season is navy, cream, and tan, which are timeless and work well in any weather. The cream and navy colors go well with the spring pastels and bright greens. They also look good with the green grass and trees in a park.
When it comes to color schemes, most of them have one or two bright colors mixed with one or two “neutral” colors. The outfit’s main color is coral. Navy, gray, white, and other neutral colors help to ground and balance the bright coral in this outfit. They also help to make the coral look less bright.
Wine, cream, and gold
If you want to take a holiday family picture, this color scheme will work well. When we think about holiday family photos, the colors red and green are often the first things that come to mind. For pictures of Christmas, go to the site. However, if you do plan to use them, a wine, cream, and gold color scheme will put you right in the Christmas spirit.
Pink, tan, and cream
The colors that people like the most are pink, cream, and tan. Photos of the family on the beach are good for. Here’s what you should wear on a trip with your family: for It is very simple and monochromatic. The soft, pale pink color of this family set is almost like a neutral. There are a lot of shades of tan and cream.
It’s a good idea to use peach, blue, and denim in your family photos in the springtime. Peach goes well with the pastel-colored flowers that bloom in Northeast Ohio in the spring. As a neutral, jeans keep the outfit from becoming too bright with the new spring colors.
This blue, white, red, and blue color scheme feels right for a Fourth of July family picture. Because red is so attention-grabbing, it can be hard to work within photos because of this. I think it’s great for making eye-catching family portraits. If you want to use red in your color scheme, think about where your meeting will be. It would be best if the backdrop was neutral-colored, like at the beach or in city downtown. This color scheme is why even though there is a lot of greenery, your picture might have a Christmas feel.
Things to consider when picking the best color of clothes for family photos
As soon as you figure out which colors are best for the season, narrow them down to just a few based on where the shoot is taking place.
When it comes to urban themes, bright colors work well, but they don’t look good in a field or with trees and grass around them.
In the same way, don’t use pale pastels when you’re in front of a light background, such as the wall of a building or structure. This goes for dark backgrounds, too.
The colors of your home:
Look at the colors in the place where the photos will be shown. If all you see are muted and soft colors, there’s no need to be bold with your clothes. There is no doubt that the opposite is true, too.
The skin tone:
They look best with warm colors like brown and yellow and warm shades of red and orange and brown and yellow and orange and reddish-purple and reddish-purple and cream.
If you want to look good, don’t wear jewel tones or icy shades. Make sure you don’t wear orange and red near your skin.
Top tips to get the colors right for family pictures!
A color that doesn’t match one of your family members’ skin tones but you still want to stay in your chosen palette? Choose a top and pair it with a bottom from your chosen palette.
Consider looking at store displays for ideas. Typically, the windows show off the season’s most fashionable clothes, as well as the best colors in the clothes.
In order to add a little color to your neutral palette, have one member of the family wear a brighter shade, or even a different shade.
It’s important not to go overboard with your desire to add color.
With different textures and accessories, like belts and scarves, you can make the look even more interesting.
Instead of matching, try to add something to each other. This isn’t just true for colors, but also for different styles of clothes. So, if most of you are wearing jeans, add a dress or two to make things even.
As parents, it is important to choose clothes that are not only in the right colors but also the most comfortable. So you won’t have to deal with kids who are fidgety and angry when they want to undress.
When you are choosing the best colors for family pictures outside, it is best to look at what other people are wearing in the photographs. You do not want your group to look bland or have an entirely different color scheme from everyone else in the photos. This could cause confusion over who belongs with whom.
If you have a hard time picking the best colors for family pictures outside, maybe even the best colors for family photos in general take a look at the best color combinations for group photos.
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The oiliness of the scalp:
5 Best Probiotics For Kids – Buying And Health Guide
Probiotics are live microorganisms (bacteria and yeast) that benefit your digestive system. Researchers aren’t sure how they function, but research suggests that they may aid in a variety of health issues, including stomach problems, skin conditions, allergies, oral health difficulties, immune support, and more. Truvani, Klaire Labs, and Mary Ruth’s Liquid Probiotic are among the best probiotics.
Are probiotics okay to use?
Probiotic supplements are generally considered safe. The FDA has certain rules for some, while a third-party organization performs quality testing on others. The majority of people will not experience any adverse effects from consuming a probiotic, however, if your youngster does, they are usually minor and transient, such as bloating or mild digestive discomfort.
Adding a probiotic to your diet is one of the most natural, efficient, and safest methods to improve your family’s digestive health and immunity. And what’s better, probiotics are manufactured specifically for children! But how do you decide which one is best for your little ones?
The 5 best probiotic supplements for kids
1. Children’s Probiotic and Pre & Probiotic from Llama Naturals
This is the only probiotic on my list that includes prebiotics! It’s also 100 percent organic and contains real fruit. There are no added sugars, sweeteners, waxes, acids, food coloring, or gelatin in it. They’re plant-based with 4 billion colony-forming units and vegan. The size is perfect for kids 5 years and older, and the 2 oz. size is great for those over 5 years of age.
2. Garden of Life Raw Probiotics
It is a supplement made from fermented bacteria .Preschool ABCs Organic, vegan form is a powder that may be used to make smoothies more nutritious. This variation has a subtle banana flavor and is available in powder form, making it easy to incorporate into a breakfast smoothie. It’s also gluten-free, certified organic, and contains no sugar.
It’s gluten-free, lactose-free, and vegan friendly. This product comes in the form of a powder that may be mixed with water, milk, juice, or even food. It’s recommended to keep it refrigerated if possible.
3. Klaire Labs
Lactobacillus reuteri NCHH-3112, also known as Reuterin, is a unique probiotic that’s been shown to help prevent cavities. It’s available as a liquid and powder and can be added directly to milk or baby food. It’s hypoallergenic, low in calories, gluten-free, and non-GMO.
A 2012 study published in the “Journal of Clinical Nursing” found that, when schoolchildren took a L-reuteri preparation for eight weeks, their dental health improved dramatically. A 2014 study published in “The Scientific World Journal” confirmed the findings. Researchers concluded that taking L. reuteri.
This vitamin might be a wonderful addition to your baby’s formula-fed diet. The choice is vegan, including vitamins B and D as well as iron, making it a supercharged multi-vitamin for your child. This option is in powder form and may be mixed into food or drinks. It’s flavored to taste like orange fruit punch for a slightly sweet flavor, but there are no artificial chemicals, colors, or sugars added to it. 5 billion colonies forming units per serving.
4. Mary Ruth’s Liquid Probiotic
It’s a liquid best probiotic that’s also 100 percent Organic, Raw, Non-GMO, Paleo, Wheat Free, and Corn Free, Ketogenic, Gluten-Free,. Bariatric and Celiacfriendly It’s shelf-stable and flavorless, so it’ll last for a long time and can be used in almost any recipe. It’s a great option for those who don’t like taking pills. 5 billion colony-forming units per serving.
This supplement is a great choice if you or your child is lactose intolerant or has an allergy to cow’s milk, as this powder contains no dairy
The capsules are simple to consume. The contents of the capsules may be readily blended into food or beverages for children. With a unique blend of 15 probiotic strains, this little work might pay off big time. This probiotic is GMO-free and does not contain any additional chemicals.
Organic Pre & Probiotic Powder for Kids by Preschool ABCs
This is the only probiotic on my list that also includes prebiotics! It’s also 100 percent organic and made with real fruit. There are no added sugars, sweeteners, waxes, acids, food colorings, or gelatin in it. They’re plant-based and vegan as well as GMO-free.
Rainbow Light Probiolicious Gummies
These delicious cranberry-flavored gummies are free of milk, soy, eggs, fish, wheat, gluten, shellfish, and lactose and contain no artificial flavors or colors. The gel in this supplement is animal-based; therefore it’s not suitable for vegans. 1 gummy contains 500 million CFUs and combines both probiotics and prebiotics.
This supplement was formulated to help those with lactose intolerance, as the digestible carbohydrate in it helps to break down lactose and ease its digestion. Best used daily, this supplement is a great way for adults or kids that have trouble keeping track of pills to get their necessary 5+ strains
Consider giving your child probiotics in addition to his or her regular diet. Similar health advantages for adults — from aiding the development of healthy digestive bacteria to strengthening their immune system — may be gained by giving children probiotics. However, before you start adding this to your child’s diet, talk to their doctor about whether probiotics are right for them. Use the following list of seven probiotics for youngsters as a guide once you’ve gotten the green light to begin supplementation.
Do I need to refrigerate my probiotics?
Probiotics should be stored in an area that is not exposed to direct sunlight. If you have a probiotic pill, it can be stored anywhere because it does not require special storage conditions. Probiotic liquids however will need to be refrigerated if they are kept for any period of time longer than 5 or 6 days.
How can you tell if probiotics should be kept in the refrigerator?
Typically, they should. The labels on the packaging of all probiotics tell us where we can store them and how long we can expect them to be viable outside that range (the usual shelf life). Usually, this is 5 days to 2 weeks – but keep in mind that “best by” or “expiration date” doesn’t really apply to probiotics. They are more akin to food, not medication. If the product gets old but isn’t bad, it’s still good for you. When in doubt though, give it 5 days and see what happens!
Are there any dangers of refrigerating probiotics?
Probiotics are not sterile products. In fact, they’re filled with living microorganisms! More specifically, there’s a whole colony of bacteria. Another step to examine if you should chill your probiotics is by thinking about how you initially purchased them.
Probiotics that need to be kept cold are generally located in the refrigerator section of the shop or pharmacy, while probiotics that can be stored at room temperature are more likely to be found in the non-refrigerated sections.
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