Pinworms

Dear Lisa,

I just found out that a boy in my son’s daycare has pinworms. Just the thought of it makes me sick. What are pinworms and how do you catch them? Can my son get pinworms too? What signs should I look for?

“I hate worms in N.J.”

Dear “I hate worms”,

Pinworm infection is caused by the roundworm Enterobius vermicularis. They are 3 to10 mm in length and found in the colon and perianal area of infected children. Also known as seatworm or threadworm; pinworm infection is the most common helminthic infection worldwide. (1) School age children are particularly at risk because of their tendency to put their hands in their mouth and share toys. Mother’s of infected children and institutionalized patients are also at risk.

Pinworm infection is spread through the oral fecal route. Adult female worms travel from the colon to the perianal area where they deposit their eggs. This migration occurs at night, and leads to intense rectal itching. When children scratch their rectal area, eggs become hidden under their nails and then are transmitted back to the child or to other children via shared toys. The eggs can also contaminate clothes and bed linens and remain viable and infectious for 2 to 3 weeks.

Signs of Pinworm infection include intense rectal itching at night or the presence of worms in the child’s stool. If you are suspicious that your child has pinworms, it is best to check your child 2-3 hours after he falls asleep. First, wrap the tip of a clean pop sickle stick with scotch tape. The sticky part should be on the outside so that when you touch the end of the pop sickle stick your fingers stick to it.

Next, examine your child’s rectal area while he is sleeping, but do not turn the lights on in his bedroom because this may cause the adult worm to migrate back into the colon. If you can’t see any worms, gently touch the rectal area with the tip of the pop sickle stick covered with scotch tape. Tiny white eggs will stick to the pop sickle stick or white worms will be visualized if your child has a pinworm infection.

Some people prefer to put scotch tape over a child’s anus before he goes to sleep and check it in the morning. If you find pinworms or eggs you can bring them to your Pediatrician or Nurse Practitioner and she can prescribe Mebendazole. It is common for most practitioners to treat the whole family at the same time with this medication in order to prevent family members from infecting each other.

It is interesting to note that this helminthic infestation has been reported in 0.2% to 2.4% of children seen with apparent Appendicitis. (2) When the appendix was examined after Appendectomy, pinworms were found more frequently in girls; 4.6% than in boys; 1.9%. (3)

References:

(1)Liu L., Weller P. Intestinal nematodes. In: Fauci A., Braunwald E., Isselbacher K., Harrisons’s Principles of Internal Medicine. 14th ed. New York: McGraw Hill; 1994:1208-1227.
(2)Dalimi, A., Khoshzaban F, Comparative study of two methods for the diagnosis of Enterobius vermicularis in children. J. Helminthol. 1993;67:85-86.
(3)Dahlstrom, J. , Macarthur, E. Enterobuis vermicularis: a possible cause of symptoms resembling appendicitis. Aust N Z J Surg. 1994;64:692-694.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Sick Kids