Infestations that itch - pinworms

Pediatrics for Parents, Feb, 1994 by Harry Pellman

What Parents Want To Know About...

Infestations with pinworms, head lice, and scabies are common problems in kids. Children harboring these vermin share common features. First of all, the three most common symptoms are itching, itching, and itching. Secondly, these are basically benign illnesses whose only significant complication comes from scratching. Scratching can damage and open the skin, allowing bacteria to penetrate this protective barrier and cause impetigo. Next, these highly contagious bugs cause people-only diseases (except for the occasional child developing animal scabies from a pet, usually a kitten or puppy). Finally, the mere suggestion that a child has any of these illnesses causes what sounds like soft, retching noises from the parents.

Pinworms

These little critters are 1/2 - 1 inch long, slender, white wigglers. They live in the intestine. After a female pinworm becomes pregnant, she migrates down the intestine to the anal area. She exits the anal area, usually at night, and deposits her microscopic sized eggs in this location. The wiggling produces itching. The child scratching this area winds up with fingers and fingernails full of sticky eggs. These dainty, dirty digits eventually find their way into the child's mouth. The swallowed pinworm eggs then hatch in the intestine and the cycle is complete.

Alternately, an infected child with fingers and finger-nails loaded with pinworm eggs plays with toys. Some eggs fall off during play and stick to toys and other objects touched by the child. These contagious eggs stick to the fingers of a number of other children that play with these toys. Once again, fingers, whose soft skin rarely feels the harshness of soap and warm water, deposit this new found bounty into the child's mouth and the pinworms have found another home. I am convinced this is the main reason none of the world's great chefs have been children!

Diagnosing pinworms sometimes takes diligence. The main symptom is anal area itching, usually in the evening. Rarely, a pinworm in a female child gets disoriented after exiting the anal area and ends up lost in the vagina. These bewildered critters go into a panic and try to find their way out. This wiggling frenzy can literally drive a child bananas. My wife and I have removed vaginal pinworms from one of our daughters on several occasions. They can be gently teased out with a moistened applicator or a clean, wet, dark-colored washcloth. The dark color makes it easier to visualize the white worms. Relief is instant. I suggest thorough hand washing after this ordeal.

A suspicious diagnosis can be confirmed by either seeing the live (occasionally dead) pinworm in the anal region or testing for pinworms. The best time to see these light-shy creatures is in the middle of the night, when they seem most active. If your child wakes up with an itchy anal area, turn him/her over on the tummy. Tuck the knees under the chest a little. Spread the buttocks so you can clearly visualize the anal area. Shine a bright flashlight on this region. If you see little, white, wiggly, thread-like worms, the diagnosis is confirmed.

Sometimes the worms go in and out and are just not there when you are looking. Also, in our society that is both crazed and concerned about sexual abuse, some parents are reticent to examine their own children, lest they be accused of wrongdoing. A laboratory pinworm test can be done in these situations. A physician can do this test. It is best done during an earlier morning appointment, or a parent can be taught to perform the testing technique at home. A scotch tape test paddle is pressed against the anal area, hoping deposited pinworm eggs will stick to the tape. This slide is then examined under the microscope for the distinctive, football-shaped pinworm eggs. This test should be performed before the anal area is wiped in the morning (before a bowel movement). No ointments should be applied to this area the previous evening because this interferes with eggs sticking to the scotch test slide.

The most common treatment is a one dose chewable tablet called Vermox. Since pinworms are so contagious, the whole family is often treated to prevent other involved family members from re-infecting the child. It is also wise to inform the infected child's contacts (schoolmates, playmates, etc.) to prevent re-infection and promote the diagnosis and treatment of other affected children. This also motivates adult supervisors to institute more thorough hand washing and hygiene techniques.

Although bedding, undergarments, clothing, etc. can contain some pinworm eggs, these do not appear to be major sources of re-infection. Still, laundering prevents problems from these sites and is recommended. Parents and care-takers, please wash hands after doing the laundry.

Eventually, all the pinworms die and enter pinworm heaven, and if the child has not re-infested himself or herself, the problem disappears.

Next month, Dr. Pellman will continue to explore the exciting world of infestations with a head-scratching discussion of head lice and scabies.