History and Physical:
A History and Physical Exam (also known as a H&P) must be completed within 30 days of your child's procedure. You will need to see your child's primary physician or pediatrician for this exam. The most important piece to this step is that you HAND CARRY a complete History and Physical examination from your primary physician/pediatrician's office to check in at the above medical facility.

Purchase the following supplies at your local pharmacy:
 

  • 2 - Bisacodyl Tablets OR 2 – 15mg Ex-Lax Chocolate Squares

(Dulcolax® laxative NOT Dulcolax® stool softener) each tablet contains 5 mg of bisacodyl

  • 1 - 8.3 ounce bottle of Polyethylene Glycol (PEG) 3350 Powder 

(MiraLAX, SmoothLAX, ClearLAX or generic equivalent)

  • 64 oz. Gatorade® (No red colored flavors)

Regular Gatorade®, Gatorade G2®, Powerade®, Powerade Zero®, Propel® or Pedialyte are acceptable. Red flavors are not allowed; all other colors (yellow, green, orange, purple, blue) are okay. It is also okay to buy two 2.12 oz packets of powdered Gatorade that can be mixed with water to a total volume of 64 oz of liquid.

To-do Checklist

  • Review pre-procedure forms and follow preparation directions carefully.
  • Ensure a legal parent or guardian will be in attendance the day of the procedure. If this is not possible, complete the consent form allowing a non-custodial parent to give consent.
  • Make plans to be with your child or have another adult present for 12 hours after the procedure.

PREPARATION FOR COLONOSCOPY
Cancel or reschedule your appointment:
If the procedure must be cancelled or rescheduled, please call 612-871-1145 as soon as possible.

Transportation:

The patient must be driven home from the procedure by a responsible person that stays for the duration of the procedure. A taxi ride is not an option unless the patient is accompanied by a responsible person. If a responsible person is not present, the procedure will be cancelled and rescheduled.

7 days before:

  • Discontinue fiber supplements and medications containing iron. This includes multivitamins with iron, Metamucil® and Fibercon®.
  • Confirm a driver for your procedure.

3 days before:

  • Begin a Low-Fiber Diet. A low fiber diet helps make the cleanout more effective.
    • Examples of a low fiber diet include (but are not limited to): white bread, white rice, pasta, crackers, fish, chicken, eggs, ground beef, creamy peanut butter, cooked/boiled vegetables, canned fruit, bananas, melons, milk, plain yogurt, cheese, salad dressing and other condiments.
    • The following are not allowed on a low fiber diet: seeds, nuts, popcorn, bran, whole wheat, corn, quinoa, raw fruits and vegetables, berries and dried fruit, beans and lentils.

For additional details on following a low fiber diet, please see www.mngi.com/lowfiber

1 day before:

  • Begin Clear Liquid Diet (clear liquids include things you can see through).
    • Examples of a clear liquid diet include: water, black tea (no milk or cream), clear broth or bouillon, Gatorade, Pedialyte or Powerade, carbonated and non-carbonated soft drinks (Sprite, 7-Up, Gingerale), strained fruit juices without pulp (apple, white grape, white cranberry), Jell-O and popsicles.
    • The following are not allowed on a clear liquid diet: red liquids, alcoholic beverages, dairy products, protein shakes, cream broths, juice with pulp and chewing tobacco.
  • At noon: Take 2 Bisacodyl (Dulcolax®) tablets OR 2 15mg Ex-Lax chocolate squares
  • Between 4-6pm: Drink Miralax – Gatorade preparation

Mix 1 bottle of Miralax® with 64 oz. of Gatorade® in a large pitcher.
Drink 1 - 8 oz. glass of the Miralax®/Gatorade® solution.
Continue drinking 1 - 8 oz. glass every 15 minutes thereafter until the mixture is gone.

Colon Cleansing Tips: Your child should drink adequate amounts of fluid before and after colon cleansing to prevent dehydration. Stay near a toilet because your child will have diarrhea. If your child feels nauseous or vomits, take a 15 to 30-minute break and then continue drinking the solution.

Day of procedure:

Morning Medications: Your child may take all morning medications including blood pressure medications, blood thinners (if you have not been instructed to stop these by our office), methadone, and anti-seizure medications with sips of water 3 hours prior to the procedure or earlier. If your child has diabetes, contact your monitoring provider for further direction on insulin and/or blood sugar management.

Continue the Clear Liquid Diet up to 3 hours prior to your procedure, then stop drinking. Avoid red liquids, alcoholic beverages, dairy products, protein shakes, and chewing tobacco.

  • 3 hours prior:
    • STOP consuming all solids and liquids.
    • Do not take anything by mouth during this time.
    • Allow extra time to travel to the procedure as your child may need to stop and use a restroom along the way.

Your child is ready for the exam, if they followed all instructions and their stool is no longer formed, but clear or yellow liquid. If you are unsure whether your child’s colon is clean, please call our office at 612-871-1145 before you leave for your appointment.

Bring the following to your procedure:

  • History and Physical Form: Bring the completed History and Physical form with you the day of your appointment.
  • Insurance Card / Photo ID
  • List of Current Medications