Michelle came into the pharmacy with her 4-year-old son and asked to speak to the pharmacist. She started with, ‘I am a little horrified with what I just saw on my son’s bottom’. She had noticed him scratching his bottom often, and he’s also been irritable and tired lately. She thought she’d check his bottom and she noticed a tiny white worm wriggling around his anus. She also mentioned she is 20 weeks pregnant and wants to know what she could give her son and take safely herself.
The first thing I told Michelle was just how common worms are , and how easy they are to treat. Threadworm is the most common human worm found in Australia. Another name for threadworm is ‘pinworm’. Anyone can catch threadworm, but it is more common in young children as they are more likely to put their fingers in their mouths. Like their names suggests, threadworms look like white threads and are usually just under 1cm long. The most common symptom is an itchy bottom, restless nights sleep and irritability. Stomach aches, nausea and vomiting can also occur as well, and in girls itching of the vagina. If those symptoms occur, it’s important to see the doctor to ensure that threadworms are in fact the cause.
The way your child will get threadworm is by first ingesting an egg. The egg can be found on absolutely anything that can be touched by someone who has threadworm. It can be found on toys, towels, bed linen etc. Usually, it is simply from touching another child’s hand who has worms. That’s why it’s so common to see children who are at daycare, kinder or school being infected. Once the egg is ingested, the egg will hatch in the small intestine and the worm will travel down to the large intestine where they will live. When they are ready to lay their eggs they will travel down to the anus, and lay their eggs which will cause an uncontrollable itch around your child’s bottom. The eggs can get lodged under your child’s fingernails and can easily spread to other children or reinfect themselves by putting their fingers in their mouth and then the cycle starts again. The eggs are so microscopically small that they can be present in house dust, they can stick to clothes and carpet. The eggs can also live outside the body for two weeks. That is why we recommend when treating your child for worms you should also vacuum the carpet, change their bedding linen, clean the toilet seats thoroughly, wash their clothing and linen in hot water, and always keep the blinds and curtains open during the day as the eggs are sensitive to sunlight.
The good thing about Threadworm is, it is not dangerous and is easy to treat. Once a child is diagnosed with worms, the whole family should be treated for worms. What is very important to know is that worming treatments will only kill the adult worms, but they won’t kill the eggs, making it important to check for worms again 2-4 weeks after treatment. The worms can still hatch from the eggs already laid as well as those eggs may get trapped under the fingernails due to scratching and can re-infect the child, so often a second dose of worming medication is required approximately 3 weeks after the first treatment.
The best time to check for worms is first thing in the morning before your child goes to the toilet, you can shine a light on the area to help see around the anus. Another way to check is by placing a small piece of sticky tape to the skin around your child’s anus and checking for worms and eggs stuck to the tape. If no worms are stuck to the tape and you think your child has worms your doctor can always check for the eggs under a microscope.
How to treat?
There are two drugs that are available over the counter in Australia to treat threadworm and they are:
Pyrantal- Brands include Combantrin, which come in a pineapple or blackcurrant flavoured liquid and chocolate squares. Pyrantal can be given to children from 1 year of age. Pyrantal is the drug of choice during pregnancy and breastfeeding. In Michelle’s case, this was the medication recommended but she was also advised to speak to her obstetrician before taking any new medication. The obstetrician may suggest not to take it as it is only precautionary, and perhaps only if Michelle does contract the worms. That is a discussion Michelle will need to have with her obstetrician.
Mebendazole-Brands include Combantrin-1 which comes in chocolate squares or orange flavoured chewable tablets and Vermox which comes in a banana flavoured liquid, choc-chews, and orange flavoured chewable tablets. Mebendazole can be given to children from six months of age.
After the initial treatment, children may continue to scratch their bottom, as the skin will remain irritated for a few days following the treatment. You can apply a zinc based cream to relieve the discomfort and help the skin underneath heal eg Sudocrem, Zinc and castor oil, Desitin etc. Care of the skin around the anus is important because sometimes when the skin is so itchy, your child can scratch so intensely that they may tear the skin causing it to bleed and lead to an infection.
Other tips:
- Keep your child’s nail short and ensure to clean their nails with a nail brush
- Discourage nail biting and thumb sucking
- Ensure your child is vigilant with washing their hands before eating and after the toilet
- Get them to stand in the shower first thing in the morning to wash away any eggs that were produced overnight
Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also, if you tried a remedy that worked well for your children that was, or wasn’t mentioned above, let me know. I hope this information does help.
Disclaimer – The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein. The names of people mentioned in this blog have been changed to protect the real patient’s confidentiality.
