Summary Background and aim To investigate the nature, origin and extent of reported neuropsychiatric side effects of polyethylene glycol 3350 (PEG, MiraLax©) leading to avoidance of this laxative by parents and caregivers. Methods We analysed (a) Federal Drug Administration (FDA) Adverse Effect Reporting System (AERS) data. (b) Google Search© and Google Trend© analysis of internet search trends of PEG side effects and (c) Surveys of US paediatric gastroenterologists. The data was analysed by descriptive statistics, chi squared tests with Benjamini‐Hochberg procedure. Results Between 2007 and 2017, 1564 adverse symptoms (AS) were reported on 645 children between the ages of 0‐21. Of these, 919 (58.75%) were neurological, 770 of these were neuropsychiatric (83.8%), such as anxiety, anger, abnormal behaviour, etc. As media reports for AS were released, we found (a) a spike in internet traffic related to PEG AS and (b) a marked increase in AERS reporting; chronologically coinciding with release of media reports on AS. The internet activity has remained above the baseline since then. Of 149 paediatric gastroenterologists surveyed, 25 (16.8%) recalled neuropsychiatric symptoms reported by parents, PEG refusal was reported by 63.3% (76/120), significantly more by those reporting neuropsychiatric symptoms (P = 0.03). Conclusions The PEG refusal reported by paediatric gastroenterologists was temporally related to an unprecedented and sustained spike of internet activity that immediately followed multiple media reports on PEG AS. It appears that negative public perception triggered by media reporting and amplified by internet activity has resulted in increased AERS reporting and parenteral refusal of PEG.

Epidermolysis bullosa (EB) is characterized by blistering of the skin and mucosal erosions caused by hemidesmosomal abnormalities. EB is divided into 3 major subgroups depending on the particular location of tissue separation: EB simplex, dystrophic EB, and junctional EB. Junctional EB (JEB) can further be broken down into Herlitz, non-Herlitz, and JEB with pyloric atresia (Carmi syndrome) depending on genetic and histologic testing. When extensive, management of a patient with EB can be challenging due to not only cutaneous but also extracutaneous manifestations as well. Families and health care teams are often faced with difficult decisions in their infant's best interest. We report a case of a preterm neonate with Carmi syndrome and unique findings on immunofluorescence studies. The patient's course was complicated by multisystem involvement and ultimately death. A multidisciplinary approach was crucial in the light of diagnostic, therapeutic, and ethical challenges.

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Linked ContentThis article is linked to Hussain et al and Chittenden papers. To view these articles, visit https://doi.org/10.1002/ygh2.336 and https://doi.org/10.1002/ygh2.360.