Saturday, October 27, 2012

Itchy Bottom? Is it Pinworms? What to do?

Pinworms have been around forever, but most people rarely give them a thought until they hear of a child at school or daycare with the infection or their child has symptoms. And yes, this idea came out of a recent phone call from an anxious parent, so they are in our daycares.

Pinworms are usually harmless but disturbing. Signs of infection are typically an itchy bottom at night. This is because the worms that are unnoticed while in our guts come out at night to lay eggs. Occasionally the worm will migrate to the vagina in girls, causing vaginal itching and discharge. Severe infections can lead to weight loss, but this is not typical. Rarely a small white thread-like worm is seen in the stool. (If you see this without other symptoms, bring it in to your doctor to be sure it isn't just a thread or other object.)

Pinworms can infect those who unknowingly touch the eggs on bedding, food, or other surfaces, then touch their mouth. Eggs can live on surfaces outside the body for up to two weeks. The eggs are swallowed and then hatch in the small intestine. The worms mature in the colon, and the female worms go to to the surface to lay eggs at night. This causes intense itching at the anal area, which can lead to a secondary infection from broken skin.  The scratching also allows the eggs to get under fingernails and then transfer to family members when they get onto household objects.  Pets don't carry pinworms, so don't blame your dog.

Testing for pinworms can be done at home. Before bed put a piece of clear tape on the anus of your child. Be sure it touches the skin of the anus so it can collect any eggs that are laid overnight.  In the morning remove the tape and look for small white eggs on it. (You can also touch the tape to the anal skin first thing in the morning, before toileting, but overnight might be more reliable if the child can sleep with the tape.)

Treatment of pinworms: 
Vermox is a prescription medication that stopped production this year and is not available any longer. Some pharmacies might still have some in stock, but a prescription is needed for these and without knowing the stock of any particular pharmacy, I don't recommend searching for it. 
An over the counter medicine can be purchased for each non-pregnant family member over 1 year of age and 25 pounds. Treating family members helps decrease the risk of infecting from each other, but is not universally recommended. If repeated infections occur, then all household members should be treated to treat a potential unknown carrier. Anyone who shares bedding should definitely be treated with the first round of treatments. 
If you are pregnant, talk to your OB about treatments.
There are no medicines approved for infants, but symptomatic infection is rare in this age group. Infants do not have the ability to scratch their bottoms, so they are not likely to spread an infection on the rare chance they are infected. If they do touch their bottoms during diaper changes, be sure to wash their hands!
Call your pharmacy before making the drive to ask if the medicine is in stock.
Two name brands are Reece's Pinworm Medicine and Pin-X. They might have to special order it.  It is okay to wait a few days before treating or you can call other pharmacies.
Be sure to get enough to treat all eligible family members twice. Follow package directions for dosing and repeat the dose in 2 weeks to decrease the risk of re-infection. Remember the eggs can live on surfaces up to 2 weeks, so reinfection is possible during that time!

To help with the itching, an oral antihistamine can be given per package directions.  You can also apply hydrocortisone to the anal area up to twice a day.

In addition to the medicine: clean toilet seats, bathtubs, bed linens, and other surfaces. Vacuum carpets and upholstered furniture. Wash clothing in hot water if the fabric allows (especially underwear!)  If pants will not tolerate hot water, avoid wearing them for 2 weeks and keep them separate from recently worn clothing. Keep fingernails short and clean so eggs aren't carried under nails.  Shower and rinse the anal area first thing in the morning for 3-5 days after the medication is given. Encourage everyone to wash hands frequently, especially before and after eating and touching the eyes, nose, or mouth!

What about school or daycare? If a child has (or might have) pinworms, they do not need to be kept out of school or daycare.

When to see your doctor: If the anal area is excessively red, bleeding, or the itching doesn't stop within a week after treatment, bring your child in for an exam to be sure pinworms are the problem. Antibiotics might be needed to treat a secondary infection.

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