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Treating the dreaded pinworms in children

Dr Deb Levy

Dr Deb Levy

Dr Deb is a dedicated holistic paediatrician. With 15 years experience as a children's doctor and a Fellow of the Royal Australasian College of Physicians in General Paediatrics and Paediatric Emergency Medicine. Dr Deb follows an evidence-based approach and combines the latest medical research with lifestyle and dietary advice to best care for your child. Beyond her...
Created on Oct 20, 2023 · 4 mins read

Pinworms (Enterobius vermicularis) are tricky little things that are very common in young children and can cause lots of problems. So it’s really important to know if your child has them and what to do about them.

Pinworms are the most common worm infection in preschool and school-aged children affecting up to around 60%. The reason they are so common is that they are highly contagious and spread by contact. They can even become airborne and inhaled.

Here are a few things it’s important to know about pinworms, symptoms and how to treat them.

What are pinworms?

Pinworms are a parasite that lives inside the human body and actually need us to survive. The research isn’t clear but worm infections (not just pinworms) seem to impact how our immune system develops and functions. There have been suggested links to the hygiene hypothesis, microbiome diversity, inflammatory bowel disease, obesity and diabetes. Some studies even show a benefit!

However, interesting as this may be, I’ve not been able to find enough evidence of overwhelming benefit so my recommendation is to treat worms.

How do you get pinworms?

The common way pinworms are spread is by direct contact. They are very easily spread by young children, by sharing food, toys, touching door handles or really by touching any object.

These eggs survive on surfaces for up to 2 weeks.

So it’s easy to see how they spread; along comes another child who touches that same surface and the eggs transfer onto his hands. The next time he eats or touches his mouth, in they go! The eggs are then swallowed and they travel to the gut where they hatch and grow into worms that then start causing trouble. Pretty disgusting, I know!

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What are the symptoms of pinworms?

Pinworms don’t typically cause direct damage to the gut, however, they are often responsible for a number of nasty symptoms.

The most common symptom caused by pinworms is an itchy bottom or perianal itching (also known as pruritus ani).

An itchy bottom occurs when a mature female worm travels out your child’s bottom and lays eggs in the skin around the anus. This usually occurs at night and can be very uncomfortable due to the irritation and itching. When your child then inevitably scratches their bottom, the eggs transfer onto their hands and the germs are then spread when they touch food or other surfaces. The cycle of infection then continues.

Other symptoms associated with pinworms include:

  • Disrupted sleep
  • Teeth grinding
  • Poor concentration
  • General irritability
  • Decreased appetite
  • Bedwetting
  • Vulvovaginitis (inflammation of the vulva & vagina)

Other rare symptoms include abdominal pain, nausea and vomiting.

Pinworm infestation can also become chronic with the pinworms migrating outside of the gut to other organs. This can make diagnosis difficult.

How do you know if your child has pinworms?

Unfortunately, there is no test to confirm pinworms, however, the best way of diagnosing them is to actually look for the worms or eggs.

What do they look like?

Pinworms are typically around 1cm in length and are white and thin – appearing somewhat like a piece of thread – but they will be moving.

Inspect your child’s bottom, underwear and linen first thing in the morning. It is unusual (but not impossible) to see the worms in the poo.

What is a sticky tape test?

Your doctor may request a sticky tape test to diagnose your child’s pinworms. This involves pressing clear, adhesive sticky tape onto the skin around the anus and saving it and sending it off for testing. The eggs will often be too small to see with the naked eye and require a microscope.

The test is 90% accurate if samples are taken for 3 days in a row and 99% over 5 days.

So as you can see, it can be difficult to diagnose, which means I often just treat when I clinically suspect it.

How to treat pinworms

Because of the contagious nature of pinworms, it is important to be vigilant about treating them. The following steps should be taken to maximise eradication and to minimise the risk of reinfection.

  • Everyone in the household should take the medicine recommended by your doctor (e.g. albendazole, mebendazole)Thoroughly wash all bed linen, clothing & soft toys, wipe down and clean all surfaces
  • Cut fingernails
  • Repeat all steps in 2 weeks

Your child’s symptoms should improve within a few days however it is important to repeat the treatment in two weeks. The medication only kills the worms and not the eggs, so you’ll need to tackle any of the worms that have hatched since the initial treatment.

Important things to remember about pinworms:

Pinworms are very common and highly contagious in small children, but it’s important to note they are not an indication of poor hygiene. Treatment, when adhered to correctly is highly effective in riding your family of these tiny but mighty nasties.

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