Colonoscopy 4 day prep with MiraLax (1863)

Your child has been scheduled for a colonoscopy at Children’s Wisconsin Hospital in Milwaukee for (date)__________________ at (time) _________ a.m./p.m.

• Day Surgery will call you 1 to 3 days before your procedure to let you what time you need to be at the hospital and when to stop eating and drinking.
• When you get to the hospital, stop at the Welcome Desk to get a badge and directions. Allow a few extra minutes to stop at the Welcome Desk in the morning.
• If you have questions or need to cancel the test, call your child’s doctor or nurse at the GI Clinic at (414) 266-3690.  If you have questions concerning the time of the test or your child’s health on the day of the test, please call Day Surgery at (414) 266-3536.

What is a colonoscopy?

A colonoscopy is a test that looks inside your child’s colon or large intestine A flexible tube with a light and tiny camera is put in through the rectum and into the colon to look for abnormal growths or inflamed tissue. A small tissue sample called a biopsy may be taken during the procedure. 

What needs to be done before the test?

• Your child will need to cleanout (empty) the bowel before the test. The directions for the cleanout are listed on the back of this form.
• It is very important that you follow these directions.  If your child eats or drinks anything after they are supposed to, the colonoscopy may be cancelled. Stool can block the camera.  This means the doctor will not be able to see the bowels.

What is okay to use as a clear liquid?

• White grape juice
• Jell-O®
• Apple juice      
• Water
• Popsicle®
• Tea
• Gatorade
• Kool-aid®
• Pedialyte® or Infalyte®
• No broth, loose tea, milk, formula or dairy products. 
• No red or purple colored liquids.  These can stain the colon and make it look bloody.

This bowel prep is done 4 days before the colonoscopy test.

Supplies that are needed.
• MiraLax (Polyethylene Glycol) 255/238 gram bottle.
• Several different flavors of Gatorade or Powerade to mix the MiraLax in.  Pedialyte or juice is best for younger children. Do not give red or purple colored liquids.

What to do for four days before the test.
• Give ____ capfuls of MiraLax in ____ ounces of fluid____ times a day. 
• Your child will need to drink this amount every day for 4 days before the test.
• This will help your child have more regular bowel movements to start the clean-out before the test. 

What to do the day before the test. This is the 4th day of the prep.
• Give the MiraLax throughout the day as listed above. 
• Your child may have a light breakfast before 10 a.m. the day before the test. 
• Give your child only clear liquids after breakfast the day before the test.
• When the stools are clear and watery for 2 times, the clean out is done. Your child can continue to drink only clear fluids.
• Your child should drink some clear liquid every 30 to 45 minutes until bedtime.  This will lessen the hunger and keep your child hydrated.

Helping your child prepare for the cleanout. 
• Talk with your child ahead of time. Make a plan that will help your child be successful. 
• Avoid high fiber vegetables, corn and seeds 3 days prior to the test.
• Offer a low fiber diet (eg. melons, grapes, cucumber, rice, zuchinni, cereal, mashed potatoes and pasta) 3 days prior to the test.

What if the clean out is not working?
• If your child has not started to have loose stools by 5:00 PM call (414) 266-2000 and ask to have the GI Fellow paged.
• If you child isn’t able to do the clean out at home, your child may need to come into the hospital for the clean out. This may include an IV and enemas and a tube put down the nose to give the liquids.

On the day of the test.
• You will be given specific instructions from the Day Surgery nurse about when to stop eating and drinking before the procedure.

Before you go home.
• Your child will need to be awake and able to take some fluids before going home after the procedure. 
• You will need to plan to have an adult watch for any problems for 24 hours after the procedure.