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The Signs and Symptoms of Pinworms

by Sue Hubbard, M.D.

I had an email from a patient who was wondering what could possibly be wrong with her four-year-old who had been waking up at night with complaints off rectal pain and itching. Upon further inspection, during one of these middle of the nights, she found a worm coming from her child’s bottom (rectum)!!!  Her first words were GROSS!  In medical terms this is actually a case of pinworms (enterobius vermicularis).

Pinworms occur in about 5 to 15 percent of pre-school children. These worms are small, thin and white and live in the colon and rectum of humans. Children get pinworms after ingesting the eggs either from their hands, or from contaminated bedding or other surfaces. Because pinworm eggs are of such small size, they may also become airborne and may be ingested while breathing. In other words, they are easily passed from child to child and are less prevalent in older children.

Once the pinworm egg is ingested it hatches in the small intestine and matures and then migrates to the large intestine. The female pinworm then emerges through anus to lay her eggs on the surrounding skin. The pinworm typically migrates and emerges during the night while a child is sleeping, thus causing the symptoms of nighttime rectal itching and restlessness. Of course, if a child has an itchy bottom, they scratch it and then the eggs are deposited beneath their nails, only to be passed to the next unknowing child. Pinworm eggs are also very hearty and can survive for 2 to 3 weeks on bedding, clothing and other objects. In other words, it is easily acquired, despite good hygiene.

The best way to diagnose pinworms is to look for the eggs around the rectal area, but they are not seen by the naked eye. The best method to identify eggs is by using scotch tape or a “pinworm test paddle” and using the sticky side to press up against the child’s anus. This is done either in the night while they are sleeping or first thing upon awakening. The eggs are easily washed off with bathing or wiping, which is why the “test” is performed during sleep or early morning. The eggs, which are microscopic, will stick to the tape and can then be seen under a microscope. In the case of the patient, the tape she brought in had both eggs and a few live pinworms, a great microscopic visual!!

The treatment of pinworms is with a prescription medication that is given to the infected child as well as to all household contacts. A second dose of medication is given after two weeks. Re-infection may occur and is best prevented by good hand washing and avoiding nail biting, and scratching. The child’s bedding, pajamas, underwear and towels should all also be laundered. Even though pinworms are a very common childhood ailment they always cause great parental angst and disgust!

That’s your daily dose, we’ll chat again tomorrow.

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