Dakota Pediatric Associates

Pediatric Gastroenterology Clinic

3284 51 ^st St. South Unit 3

Fargo, ND 58104

Phone:

Date:

Dear Parents of

This letter is to remind you of your child’s endoscopy scheduled on ____________________ at the medical center.

Colonoscopy Cleanout Instructions Using Miralax

What you need to buy:

• One large bottle of Miralax (over-the-counter)/Generic

One Day before the Scope – Your child will need to be near a bathroom for this cleanout.

No Solid Foods should be eaten for the entire day

Starting at 8:00am have your child drink the following:

• One capful (17 grams) of Miralax mixed with one cup (8 ounces) of a clear liquid
• Give the above dose every hour for 10 hours (10 doses)
• If stool continues to have chunks or isn’t clear, continue to give hourly doses
• Stool should become water-like (no solids present, no brown; light yellow to clear in color)
• At least an additional 8 ounces of clear liquids needs to be given between Miralax doses to
• prevent dehydration

Clear Liquids Include:

• Icees
• White grape juice
• Kool-Aid
• Chicken broth
• Apple juice
• Gatorade
• Pedialyte
• Sprite
• Slushies
• Water
• Flavored water
• Jell-O gelatin
• Popsicles

No red, blue, or purple colored liquids

No milk or dairy products

You will receive a phone call from the pediatric unit between 1:00pm and 5:00pm the day prior to the procedure. They will let you know when your child can last drink anything, what time to arrive, and where to check in. If you do not receive a call by 4:30pm, please call our office.

Reminders Prior to Procedure

• • Wear comfortable clothing (sweatpants, pajama bottoms)
• • No aspirin products 24 hours prior (includes Ibuprofen, Pepto-Bismol, Advil, Motrin, Aleve)
• • Notify endoscopy if your child develops a cold, fever, or other illness
• • Child is to be accompanied by a parent or legal guardian
• • No siblings if possible

If you have questions for the provider, please call our clinic at (XXX) XXX-XXXX.

Sincerely,

The Pediatric Gastroenterology Team