Pinworms

What is it?

Pinworms are a common complaint in preschool and school aged children. Children with pinworms often have intense itching of the anus, especially at night. The itching is actually part of the worm’s normal life-cycle. Children become infested with pinworms when they swallow the tiny, invisible eggs. In toddlers children often spread the eggs from one child’s hands to another’s mouth. Once a child has swallowed the pinworm eggs, the eggs travel through the child’s stomach and intestines. During the trip, the eggs hatch into larvae (growing baby worms). When the larvae reach adult size (about one millimeter long), they mate. At night, female adult pinworms emerge from the child’s anus and lay their eggs on the skin. The eggs and the presence of the adult worms cause the powerful itching. The infested child scratches him or herself, picking up eggs on fingers and under fingernails. This is a very tiny amount of material, and it happens in all children all the time – even when there aren’t pinworms.

At some later time, the child puts his or her fingers in the mouth or on the face. Eventually, the child swallows some of the material containing the eggs, and the cycle begins again. If another child sleeps in the same bed or has close contact with an infested child’s hands before washing, the other child may swallow some of the eggs and develop pinworms.

Pinworms are unpleasant and very annoying, but they are not actually dangerous. The biggest concern for the child is usually the itching. Itching can be so bad that the child doesn’t sleep normally. This can disrupt all kinds of things from bedtime to daytime behavior. Sometimes pinworms can migrate into a girl’s vagina and cause itching and intense irritation (vaginitis). It can even cause signs of a urinary tract infection. You can read our Aftercare Instructions on Vaginitis and Urinary Tract Infections. In very unusual cases pinworms can cause appendicitis.

Parents’ biggest concern, after making sure that their child is comfortable, is to get rid of the worms and prevent them from spreading or returning. The first step is to be sure that the child actually has pinworms, to make sure we aren’t using a medication unnecessarily. In many cases the symptoms are so typical that the doctor doesn’t feel the need for a test. If your child has had pinworms before, you may have seen the adult worm yourself. If your doctor wants a specimen before starting treatment, s/he will have given you instructions on how to collect a sample to look for pinworms. S/he may have given you a device called a "pinworm paddle" to help. You can use the pinworm paddle, or just a piece of cellophane tape (Scotch® Tape and others). In either case, the collection method is simple. Pinworms are usually on the skin near the child’s anus early in the morning, just before the child wakes up. The idea is to put the sticky side of the tape, or the sticky part of the paddle, gently but firmly against the skin were the worms will be. You will need to gently separate your child’s buttocks, and then press the sticky material several times on and around the anal opening. Adult worms and eggs will stick to the tape or paddle, and your doctor’s office will send them for microscopic examination. Fold the tape over on itself sticky side in, so the material you collect will be trapped between the layers. Then put the sample in an envelope with the date and your child’s name on it. Follow the package directions for the paddles. Please bring the sample to your doctor’s office as your doctor directs (some doctors may want several days of samples at once). Please don’t forget to wash your hands as soon as you’ve collected the sample!

If your child is old enough to understand, please talk with him or her about the collection the day before you do it, so that s/he is not frightened when you begin collecting the material. Of course, just as with anything that involves the child’s private parts, please let your child know that no one but you should ever touch him or her in this way.

Once your doctor is sure of the diagnosis, s/he will recommend a medication to give by mouth. Pyrantel (Pi-ran-tell; Pin-X®, Reese’s Pinworm Medicine®, others) is a non-prescription medication that comes as a liquid suspension or as a pill. The dose depends on your child’s weight, so please check the label or ask your doctor. As with all liquid suspensions, you should shake the bottle immediately before giving a dose to mix the medicine and liquid together. You can read our Aftercare Instructions on Administering Oral Medication. You’ll give on dose one time only, and then you should repeat the dose in 2 -3 weeks to be sure you have killed all the worms.

Many doctors prescribe Mebendazole (Vermox®) chewable tablets. The dose for children over 2 years old is one tablet (100mg) one time. Again, most doctors recommend repeating the dose in several weeks.

The itching around the anus may take up to a week to clear up. This does not mean the medicine has failed. Please do not give a repeated dose of medication before the scheduled time.

It will be important to treat everyone in your household who might have the worms. If you don’t treat everyone at the same time, the worms are likely to spread from untreated people right back to the ones you treated. Please check with your doctor about which members of your household need treatment, based on their ages and symptoms.

It is also very important to clean house the day you treat your child or children. Please be sure to gather up all the bedding, pajamas, and clothing that any of the children in the house have used or worn. You’ll want to wash all the clothes, not just those of the children who you know have the worms. Please wash everything thoroughly with laundry detergent in the warmest water the label says you can use. Simply shaking out the bedclothes will not get rid of live eggs. To be on the safe side, please repeat the washing process again the day you give the repeat dose of medicine.

It can also help to reduce the spread of the worms if you cut your child’s fingernails fairly short. Please cut them just to the tips of the fingers, though, because shorter can cause ingrown nails. Also, please try to get your child in the habit of washing his or her hands frequently, and first thing in the morning as well. Please be sure to wash your own hands after putting your child to bed and waking him or her up in the morning.

Pinworms are never dangerous. Complications can include vaginitis and urinary tract (bladder) infections in girls, and very rarely appendicitis. Children with other bowel diseases, like Crohn’s Disease or Ulcerative Colitis can have abdominal pain as a result of the worm medication. Here are some things to watch for while your child has worms or takes worm medication:

• Itching around the anus that continues for more than 7 days (itching does not clear up right away)
• Redness, swelling, or pain of the anal area or buttocks
• Fever
• Rash
• Vomiting
• Abdominal pain (mild cramps may be the result of medication)
• Diarrhea
• Blood or mucous in stool
• Vaginal itching or painful urination

Pinworms normally live only in humans. Children don’t get them from household pets (though they can get worm infections from those pets). Recently, researchers have found pinworm eggs and adults in household cockroaches. If you have a roach problem in your home, please let your doctor know about it. Please also try to eliminate the roaches with safe insecticides and traps. You may have to work with your landlord to do this. Now that we know that roaches can carry pinworms, this information might help get landlords to take action.

Children can get infestations with other worms that aren’t pinworms. Visible worms that might be confused with pinworms can include another human parasite called Ascaris (ask-air-iss). Ascaris worms are unusual in children who have not been outside of the United States. They are very common in the rest of the world, especially in crowded or poor areas. Ascaris worms are very large, and parents sometimes find them in the diaper or toilet.

Children can also get worms from pets like dogs and cats. These are "accidental" infestations. That means that the worms don’t normally live in humans, so they don’t have their normal lifecycles. Animal roundworms may produce a condition called "larva migrans" of the skin, internal organs, or eyes. These are unusual but potentially dangerous conditions. Animal tapeworms can cause cysts in human brain or internal organs. Dog and cat worms often show up on the animal’s fur near the anus. They can look like tiny rice grains. Their eggs can be on or around the animal’s mouth. If you think your pet has worms, please have it treated right away, and meanwhile warn your child not to let the pet lick his or her face or hands.

Having child with pinworms can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Babies and children with pinworms are often fussy and irritable, and parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your child’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.