I'm not a Pediatrician, but I play one at Daycare...
April 23, 2019 12:32 PM   Subscribe

How should I handle a situation where our daycare teacher basically told us that our pediatrician is wrong, when it comes to treating our daughter's constipation issues?

Our 22 month old girl has been having recurring constipation over the past year, despite our--sometimes unsuccessful--efforts to feed her a lot of fiber and drink a lot of water throughout the day. She gets a lot of physical activity at daycare as well.

After many discussions and checkups with our pediatrician (whom we absolutely love), we have been giving her 1/4 capful of Miralax in her water bottle per day to help her get a little more regular. It has helped a lot, but over the past few weeks, it seems the constipation has come back, and after visiting with the pediatrician again, she felt that she might have "outgrown" the dosage we've been giving her, and suggested upping it to 1/2 capful to see if that improves it.

One idea she suggested was to send her to daycare with a water bottle already filled with the Miralax in it, rather than letting the daycare teachers fill it up with their own water. This would help ensure that she's drinking the full dosage over the day, which she definitely wasn't doing during the weekdays, previously. We’ve been doing this for the past week, and just doing seems to have drastically helped with her regularity.

But this morning, as I was dropping my daughter off at daycare (with her Miralax water bottle), I basically got a semi-passive aggressive lecture from the director of the toddler group that she thinks Miralax is "terrible" because she's seen it do awful things to kids, and "if it were my child, I'd just keep giving her as much high-fiber food as possible, etc etc."

While I don't disagree that it's always better to use "natural" methods of constipation relief, all my research leads me to conclude that Miralax is generally safe for children, and is widely prescribed by reputable pediatricians for situations just like this. The daycare teacher, on the other hand, seemed to imply that she felt that pediatricians "push" Miralax by default, out of some sort of industry obligation.

Am I wrong to feel that it's inappropriate for a daycare teacher/director to be directly contradicting the opinions of our own pediatrician?

We absolutely love this daycare, in general (its a Montessori school, and the owner/general director is totally awesome). But for many reasons, we’ve always had mixed feelings about this particular toddler director, who only started working there a year ago. I don’t doubt that she cares a lot for our little girl, but this is definitely not the first time she’s expressed judgmental opinions about how she thinks parents should raise their kids. She’s even passive-aggressively criticized the way the owner/director does things at the school, right to our faces!

I will continue to give our child Miralax until credible medical evidence surfaces that shows that we shouldn’t be giving it to her, so this question is less about “is Miralax safe?” and more about how to deal with a teacher who is sowing doubt in our own childcare choices?
posted by melorama to Human Relations (24 answers total)
Best answer: It's all about putting yourself in the shoes of the teacher you're having a problem with. She is the one that has to clean up after the kids who have accidents in her classroom on MiraLAX. She's wrong about the medicine, but she doesn't like having to deal with little kid poop in places it should not be (which is an operational hazard of MiraLAX for sure). Just let her have her opinion and keep doing what your pediatrician recommends for your kid.
posted by killdevil at 12:44 PM on April 23, 2019 [5 favorites]

The dose your doc recommends is standard: 1/2 cap-full of miralax mixed with 1/2 - 1 cup water. 1/2 a cup isn't much — could you possibly give her the dose before she goes to school? In that way you not only avoid the issue, but you get to make sure the dose gets taken, and the school can push all the high-fiber food they want. If this doesn't work out, I think you have to tell the director that you appreciate her opinion, but you also like your doctor, and this is what your doctor prescribed.

Miralax, by the way, is not like some of the more worrisome kinds of laxatives. It's basically an inert chemical that is designed to provide bulk and pass through the system. It's pretty safe.
posted by ubiquity at 12:46 PM on April 23, 2019

You have a two-fold issue. One is the teacher contradicting the advice of your doctor. For that, the simple answer is to ignore her. If you think she might do something harmful, such as not insure your daughter drinks from her Miralax bottle, then you could say something like, "I appreciate your concern, but we are confident in our doctor's advice. Please be sure daughter only drinks from this water bottle until it is empty." Also share that message with her co-teacher or aide if there is one. If you have any suspicion that she would go so far as to not give your daughter the medicated water, you will need to raise that with the owner/director and, if possible and one is available, transfer your daughter to another class at the school.

Your second issue is that this teacher is criticizing the owner/director to parents. You say you like the owner, so if you feels it rises to the level where it undermines the effectiveness of the school, you could give the owner a head's up. But then that opens a can of worms you may not want to open.
posted by agatha_magatha at 12:46 PM on April 23, 2019 [7 favorites]

This person at day care is moralizing; nothing less. When someone pushes upon you some version of "more pure" or "more natural," and then vaguely proposes a conspiracy theory about the medical industry, they are basically rationalizing some kind of personal moral revulsion for whatever it is you proposed -- Miralax in this case -- which like all moral revulsions is not based on reason, but gut instinct. Reasons are contrived to support the instinct, not the other way around; that's how it is with all moral 'reasoning.'

So, do you think it's wrong for a daycare teacher to push a morality-based purity-obsession on you and your parenting style and acts, to say nothing of pediatrician's instructions?
posted by Sunburnt at 12:46 PM on April 23, 2019 [7 favorites]

Is she refusing to give your child the Miralax? If she is, then you are absolutely entitled to be upset at her and to escalate it to her supervisor. If not, then well, she has a different opinion from yours, and it doesn't affect you or your child, so let it go.
posted by Etrigan at 12:46 PM on April 23, 2019 [6 favorites]

Best answer: I agree that it’s inappropriate for the toddler director to second guess your pediatrician (especially in a situation where the pediatrician is making a very standard recommendation, as opposed to a situation where a teacher might have a unique insight on a behavioral issue).

Since the preschool director is awesome, I’d talk to her about it and get her take on it. If possible I’d probably talk in person when you pick up or drop off, but over email would be okay if not. I’d open the conversation in a somewhat neutral way - “Our pediatrician told us to do this, X told us it was a terrible idea. I was surprised that she contradicted our ped, what are your thoughts?” Ideally the director will immediately understand that the teachers should not be doing that and will talk to the toddler director. If the preschool director doesn’t have a problem with it - well, I would probably just let it go at that point if you are otherwise happy with the school. But hopefully the director will want to cut off that kind of comment!
posted by insectosaurus at 12:47 PM on April 23, 2019 [5 favorites]

I would have thanked her blandly for her opinion and forgotten about it.
Look, you want daycare workers to feel invested in the kids they care for, right? She is not a lowly servant who is prohibited from even having an opinion about something you've been discussing with her and that she's been involved in managing. It would be totally different if, say, she tried to change the dosage, or kept pushing her agenda on you day after day. But from this, it seems like all she did was tell you what her belief system is and what she'd do if it were her own kid. The "how dare she speak" attitude here is not warranted. Take what she says with a grain of salt, if you don't believe it, and be glad that she cared enough to say something. Believe me, there are times when you'll want some input from a daycare worker, a teacher, or someone else who is tasked with the burden of caring for children without the benefit of fair financial compensation or social status, even if it contradicts an authority.
posted by nantucket at 12:48 PM on April 23, 2019 [42 favorites]

I am not in your state. In my state, doctors notes are required for administering anything to kids at day cares, and the regular inspections by the state confirm that a) there are notes for all medications, even over-the-counter, and b) there are records of compliance with the specified dosage protocol.

If your state is similar, your child must receive appropriate care or the center will face fines and closure. If that is the case, I'd just let this go and move on -- she has to do what you want even if she doesn't like it.
posted by bfranklin at 12:54 PM on April 23, 2019 [1 favorite]

Parents, especially women/mothers, face constant judgment about their choices and the drip, drip, drip of it is just tiresome and particularly unwarranted in your case. What's more, it's completely unprofessional and outside the responsibilities of this person's job to question your choices.

Since this is a pattern of behavior that you've witnessed or experienced I don't think it's out of line for you to bring it up. If your preschool does a regular survey/evaluation of parents, then I would use that as a venue for providing feedback on this person's professionalism.

I wouldn't hestitate to set a respectful boundary and tell them directly that you appreciate their concern, but are not interested in hearing their opinions about anything outside of learning and behavior issues.

If the person continues, write a note to the director of the school.
posted by brookeb at 1:07 PM on April 23, 2019 [6 favorites]

Best answer: she's sharing her experience with you. In her experience, Miralax has bad results. She isn't ranting about antivax or chem trails. She says she's seen it have bad results. You have no reason to disbelieve this: already in this thread we've had a parent comment that their kid also got bad results.

Her experience is a data point you might find useful, for example if you find that you also get bad results.

It's ok and desirable for her to share her knowledge with you, as long as she doesn't act against the instructions you give her. Thank her for letting you know, and tell her you're going to go with the pediatrician's advice and to let you know if your kid does have problems.
posted by fingersandtoes at 1:28 PM on April 23, 2019 [23 favorites]

“Thank you so much for letting me know. We’ve discussed it in depth with our pediatrician and we’re going to stick with her method for now.”

I don’t doubt the teacher will be quick to let you know if she sees any adverse effects. If so, you can discuss with the pediatrician and revisit it.
posted by sallybrown at 1:45 PM on April 23, 2019 [7 favorites]

You need to start feeling more confident in your childcare choices. I bet there are tons of opinions, both from laypeople and pediatricians on this topic that all contradict each other. The person is a human and expressed an opinion. Just letting it go will probably be the best for everyone. It’s just wasting your energy, really.
posted by MountainDaisy at 1:58 PM on April 23, 2019 [2 favorites]

Into each parent’s life drop some of these unwanted life coaches. I would overall counsel cheerful boundaries — “thanks for sharing your thoughts, it’s amazing how many people seem to have strong feelings about constipation remedies!”* But if she’s sharing like this every few days, I’d have a word with the school director.

It’s annoying but part of the village it takes to raise a child, it includes all the village archetypes I’m afraid. I have many similar stories, and one where a daycare teacher helped save my son’s vision.

* it actually really is.
posted by warriorqueen at 2:03 PM on April 23, 2019 [5 favorites]

So, my daughter has been dealing with chronic constipation on and off for years, and if there is one thing I've learned it's that this is something people have feelings about.

First of all, not that you asked, I think you're doing great! Constipation is hard to deal with and most people think it's a lesser health issue than it can be...my own experience has been that a daily dose of MiraLax has been life-changing for my daughter, in terms of her health and comfort but also her ability to be in the world and not have constant poop-related anxiety. So. It sounds like you're advocating for your child and having close talks with her doctor and that all seems perfect, keep doing the things!

Second of all, yeah, we're at a Montessori too and it can be like that, I think. I think the first line of defense, as others have suggested, is a very pointed "We're working with her doctor on this, we've got the treatment plan covered, thanks for your concern" Delivered with a smile, or not, as needed. But honestly if it's more than one comment from her and there hasn't been any poop-related incidents that would impact her/the classroom at large, I'd speak with the director. It's truly none of her business.
posted by cheese at 2:45 PM on April 23, 2019

Those who clean up the poop are allowed to have opinions.
There are state health and education issues involved here, which as posted above may include a paper trail showing that medications are being given to a child, including over-the-counter meds. This opens the daycare up to liability issues, both in making sure that your child has the correct dosage, and that other children do not ingest the treated water by mistake.
I'm surprised that the water is not mixed on site to ensure that the correct and timely dosage is administered, as would be the case with other medications. My experience at schools is that this is done at the nurse's office, not by the classroom teacher, and medications are in their original packaging with a note from the doctor or parent.

As for the teacher's statement, you are paying for her expertise. Advise from the medical community changes with time (put your baby on his stomach... no, on his back... no....) As the on-site caregiver, she is using her judgement to give your child the best care under the circumstances. If you feel that is not the case, then by all means contact the daycare director to get it sorted out.
posted by TrishaU at 4:28 PM on April 23, 2019

To answer your question, yes it's wrong and inappropriate. Experienced childcare professionals should know better and I can tell you when I was one I STFU about kids' medical stuff unless directly asked by the parents, and then only spoke about their kid and never in generalities.

That being said, it's a "type" unfortunately, when it comes to childcarers. As a parent myself now, I basically just ignore this kind of stuff, if I feel it's not interfering with the care my kids are receiving.

However, if I feel it is interfering with their care, than yeah I have a chat to the director (interestingly, I find these types are never directors).

As long as she's giving your kid the water, I wouldn't sweat it. It can feel like a lifetime, but your kid will be out of that room/class etc before you know it, and you won't have to deal with that lady again.

Best of luck,
posted by smoke at 4:51 PM on April 23, 2019 [2 favorites]

Best answer: Believe me, there are times when you'll want some input from a daycare worker, a teacher, or someone else who is tasked with the burden of caring for children without the benefit of fair financial compensation or social status, even if it contradicts an authority.

Quoted for muthafuckin' truth. And I don't think you may realize how seriously I consider that statement due to the fact that DrMsEld, a child clinical psychologist, takes research supported treatments and methods very seriously. That is to say that she isn't keen on woo > data much but we very much understand that the daycare workers we trust with our two young ones have seen a lot and have a lot to add to our knowledge base when it comes to raising our kiddos as we attempt to role-play parents that know wtf we are doing but don't really.

I mean, A) this person isn't indicating that they aren't following parental or doctor orders nor are they B) advocating some completely bullshit view like "You should apply some lavendar oil behind the child's ear 18 or 20 times a day. It works!". They're simply saying what they've seen born out in their experience or in their, obviously limited compared to the Mirialax clinical trials, data set. That doesn't mean they're not worth listening to because, trust me, the other side of the coin is that docs aren't infallible either nor are they spending nearly as much time with a kiddo as you or your daycare worker on a daily basis.

It's a balance. I hope you have good luck and the kiddo's bowel situation improves.
posted by RolandOfEld at 6:52 PM on April 23, 2019 [7 favorites]

Daycare providers work with so many different children and families and have a wealth of experience and knowledge, so there definitely can be a lot of value in getting opinions or advice from them. A friend of mine's son was experiencing constipation, so his daycare providers suggested that perhaps he has a dairy intolerance. My friend has stopped giving him dairy, and it has helped a lot.

I don't think it's completely inappropriate for your provider to express her opinion, but it becomes inappropriate if she pushes it or expresses it in an insulting way.
posted by kinddieserzeit at 7:42 PM on April 23, 2019 [3 favorites]

Response by poster: I don't think it's completely inappropriate for your provider to express her opinion, but it becomes inappropriate if she pushes it or expresses it in an insulting way.

I think this is what pushed it over the edge for me. Not only did she give an unsolicited dismissal of our pediatrician’s advice, but she also implied that we were “doing it wrong”, with her “if it were my kid, blah blah blah...” comment. I guess it annoys me that she would say such a thing, when as far as I know, she does not have children of her own.

Maybe I’m being overly sensitive, though?
posted by melorama at 10:14 PM on April 23, 2019

Maybe I’m being overly sensitive, though?

F**k it. Be over-sensitive.

As a parent of three children I have had all sorts of people offer unsolicited opinions about what I was doing wrong. I call it "momsplaining".

Curiously enough, though, this unwanted advice almost never comes from people who are also parents, but from self-appointed experts who are themselves childless.

Ignore them.
posted by Pechorin at 6:53 AM on April 24, 2019 [2 favorites]

I would probably say something like "Wow, I didn't realize some kids suffered so much with Miralax. So far we've been lucky enough not to have any side effects, but please let me know if she seems to be having trouble with it." She's being kind of a jerk about it, but on the other hand, she may have valuable information or observations down the road that you'd like to know about. Some people are just better at dealing with kids than with grownups.

On a practical note, my son took Miralax (well, Restoralax, which is the identical Canadian version) from about 18 months old to around 4 years. I did have concerns about him taking it for so long, but the advice from his pediatrician was that long term constipation was worse than long term use of Miralax, and it did eventually clear up as he grew. We started out at an eighth of a dose, and by the end he was taking half the adult dose.

We would mix it up with a small cup (around 4 oz) of juice in the morning and have him drink it before he went to daycare. (We didn't usually have juice, so it was a treat for him.) With so little liquid you have to stir it like hell but it will eventually dissolve. Taking it all at once worked fine and we always knew he had gotten the correct dose. That way we didn't have to ask daycare to administer it at all.
posted by pocams at 7:12 AM on April 24, 2019

I don't doubt her attitude was annoying. As someone said above, there is definitely a "type" that likes to criticize other people's choices; and this "type" also often displays the behavior you mentioned, of criticizing others' choices, particularly those of more highly credentialled professionals, behind their backs.

But I still think you'll have better results by treating her comments as professional input rather than gossip, one-upmanship or snottiness that you need to fight.
posted by fingersandtoes at 8:13 AM on April 24, 2019

oh, one more thing, in case you want to add to the constipation fight arsenal. I give you my invention: PRUNOCO. It's how I get prune juice (which I've found very effective) into my kid who is fussy about flavors and doesn't want to drink it. It's basically cocoa mixed with prune juice and doctored to mask the flavor.

Take a tsp of cocoa (dutched is best) and heat in a mug with an optional tsp or so of sugar (you're going to be adding a lot of sugar with the juice, so you don't need much extra) and a little bit of hot milk; stir to dissolve into a smooth syrup. Add a pinch of salt (crucial.) Now fill mug half with prune juice and half with milk. Stick it back in the microwave to whatever temperature your little fussbudget prefers; mine freaks out if it's hotter than lukewarm. Now, crucially, add about half a tsp of vanilla. The vanilla and the salt and the dark cocoa do wonders to mask the taste of the prune juice. If your kid is like mine she will drink it and like it, and enjoy a much improved bowel situation.

You can make the whole thing in a pyrex measuring cup and then pour into a plastic sippy cup if she's still in sippy cups.
posted by fingersandtoes at 8:25 AM on April 24, 2019 [1 favorite]

Best answer: I'm coming back in to the thread to say that what informed my opinion that this was not acceptable and my advice to talk to the preschool director is more how the teacher talked to you than that they did.

A semi-passive aggressive lecture from the director of the toddler group that she thinks Miralax is "terrible" because she's seen it do awful things to kids is really not appropriate and I don't think you're being oversensitive at all to be annoyed/upset by it. If the teacher had come to you and said, "hey I know your pediatrician recommended miralax, but I've seen it do some bad things to kids, and I think it's upsetting your specific kid's stomach. I'd keep an eye on her whatever and consider other options like XYZ or a second opinion" then that would be fine and in fact I'd thank the teacher for looking out for her. There's a big difference from an "in my experience, it's worth looking at this carefully" and a "you're doing it wrong" and based on your description, this incident was much more of the latter.
posted by insectosaurus at 10:59 AM on April 24, 2019 [1 favorite]

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