Worms in Stool

Dear Lisa,

I have a five month old who has had colic since birth,(we are talking- always crying)we have been giving him Mylanta 1/4 teaspoon with each feeding. We also have begun to introduce some solid food. Yesterday he had some bananas in the morning with his milk and squash with his dinner. Then he had a bowel movement with black threadlike substance among the feces. Is that something to worry about, could it be a worm of some sort? I looked and didn't see anything moving.

“Very concerned”

Dear “Very Concerned”,

Parasitic or worm infestations are less common in the United States as compared to the tropical and subtropical parts of the world. (1) Although uncommon, they can occur in the United States depending on the climate, sanitation and living conditions. Infants in particular are not typical hosts for Parasitic infections because they don't engage in activities that promote transmission of the disease.

Parasitic infections and worms are transmitted through infected human and animal feces. The transmission of the disease occurs when a child ingests soil that is contaminated with stool. Other modes of transmission include eating undercooked pork or beef, eating raw fish, drinking or swimming in contaminated water, ingesting pet feces, accidentally ingesting an infected flea or through transmission from an infested family member. (1,2)

The type of behaviors that can promote this transmission of Parasites include playing in outdoor sandboxes contaminated with animal feces, eating dirt, playing around farm animals, swimming in contaminated water, exposure to rodents (which are potential hosts for certain parasites) and playing with and eating a pet’s stool.

Infants do not engage in these types of behavior that tend to put older children at risk. An infant’s diet is typically limited to breast milk, formula and pureed fruits and vegetables; therefore there shouldn’t be any risk for parasitic infection from contaminated food. Before a child crawls and learns to put items in their mouth, it is unlikely that they have the opportunity to come into contact with infected soil or feces. A toddler on the other hand is a better candidate for contracting a parasite because they tend to play in the dirt and put things in their mouth.

Because of your child’s young age it is unlikely that the strand that you saw in the stool was a parasite. If your child was exposed to contaminated water or to a family member with a Parasitic Infection then that would be a different story. It is more likely that the changes that you saw in your child's stool are normal changes due to his diet. (1) The consistency and color of infant stools vary according to their diet. The way to be sure that strings or strands seen in a child’s stool are not parasites is to save the specimen and have it evaluated by your baby’s Physician. A stool test called an Ova and Parasite test can be performed in order to identify parasites.

The symptoms of a Parasite infection include diarrhea, weight loss, rectal itching or rash, Anemia and epigastric distress. Preventive measures include eating only cooked meat and fish, good hand washing after handling soil, sanitary disposal of pet feces, avoidance of potentially contaminated water supplies, control of rat and flea infestations, good hand washing when cooking and preparing food and close observation of toddlers and young children who put items in their mouths. (2)

If your son continues to have stands in his stool it would be a good idea to show them to your Pediatrician because these strands may represent fat or mucus in the stool. An isolated incident of mucus in the stool has little significance, but the regular occurence of mucus or fat in the stool may be a sign of another problem, such as malabsorption. (1)

References:
(1)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984:1101-1104,291,794.
(2)Morello J, Mizer H, Wilson M. Microbiology in Patient Care. New York, New York:Macmillian Publishing Company. 1984:516-547.

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

Pediatric Advice About Keeping Infants Healthy