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Parents Canada - - Contents - Ja­nine Flana­gan is a pe­di­a­tri­cian at St. Joseph’s Health Cen­tre and The Hospi­tal for Sick Chil­dren in Toronto.

What are pin­worms and why do we get them?

When it comes to itchy bot­toms, a bath might be the quick fix. Di­a­pers, sweat and dirt can all cause ir­ri­ta­tion (not to men­tion play­dates in the sand­box). Some­times creams and soaps can ag­gra­vate the skin and be the prob­lem. Oc­ca­sion­ally, the itch does not re­solve and it’s some­thing more. Two of the most com­mon causes of an itchy bum are pin­worm and pe­ri­anal strep. Don’t panic; these two en­ti­ties are very com­mon and are not caused by poor hy­giene.

PIN­WORM:

Some chil­dren with pin­worm don’t have symp­toms, but most do get itchy around the anus (and vagina in girls) es­pe­cially at night­time. In­fected chil­dren are rest­less dur­ing sleep and will scratch their bum dur­ing the night. This is be­cause the pin­worms live in the rec­tum and at night the adult worm crawls out of the anus and lays eggs on nearby skin. When a child scratches the bum, eggs get un­der the fin­ger­nails and then are in­gested when hands get put in the mouth. In­fected fin­ger­nails can also leave eggs on toys and other ar­eas where in­di­rect trans­mis­sion can oc­cur. The eggs can be very per­sis­tent, liv­ing for up to two weeks out­side the body on cloth­ing, toys, ob­jects and bed­ding be­fore be­ing in­gested by an­other child.

Pin­worms do not cause health prob­lems, tummy pain or weight loss. They are more of a nui­sance and ir­ri­ta­tion. Pin­worms are tiny (1 cm long), wig­gly, white and thread-like sized.

You may or may not see them. We used to ask par­ents to go look­ing for pin­worms at night or use tape to col­lect eggs over the anus, but this is not nec­es­sary and can cause un­due dis­tress to the par­ent/care­giver and child and is not al­ways suc­cess­ful. If you don’t see any­thing it doesn’t mean your child doesn’t have pin­worms (sim­i­lar to go­ing fish­ing – just be­cause you don’t catch any fish doesn’t mean there aren’t fish in the sea).

Pe­di­a­tri­cians rec­om­mend treat­ing your child if they have symp­toms. There is over the counter (OTC) med­i­ca­tion you can get with­out see­ing a doc­tor, which is very safe and ef­fec­tive. Be­cause 30 per­cent of chil­dren get pin­worm, med­i­ca­tion is read­ily avail­able to treat your child quickly. If you see a doc­tor, they will rec­om­mend the same OTC med­i­ca­tion or they may give you a pre­scrip­tion. Your child takes the medicine and then re­peats the same dose in two weeks due to the life cy­cle of the worms. It is rec­om­mended that other young chil­dren get treated, but adults don’t need to take the med­i­ca­tion un­less they are symp­to­matic.

You can re­duce trans­mis­sion by wash­ing your child’s hands thor­oughly af­ter us­ing the toi­let and keep­ing fin­ger­nails clean and short. Dis­cour­age thumb sucking and nail bit­ing.

PE­RI­ANAL STREP:

A sec­ond cause of an itchy bum is pe­ri­anal strep (strep­to­coc­cus). Yes, this is the same kind of bac­te­ria that causes a strep throat, but this time the bac­te­ria in­fects the other end of the gi (gas­troin­testi­nal sys­tem). Chil­dren may swal­low the bac­te­ria, which then de­scends to the anal area or they may dig­i­tally con­tam­i­nate them­selves from an in­fected throat or other sites of strep in­fec­tions (eg. im­petigo around the mouth). In ad­di­tion to itch­i­ness, chil­dren may com­plain of rec­tal pain and oc­ca­sional blood-streaked stools can be seen. When ex­am­ined, the anus is bright red in colour with a rash that can ex­tend up to

3 cm cir­cum­fer­en­tially around the pe­ri­anal area. If left un­treated the rash can spread to the vulva or onto the scro­tum and anal fis­sures can de­velop caus­ing the blood seen along­side the stools.

A rapid strep test around the anus us­ing a swab can be done in your doc­tor’s of­fice (sim­i­lar to check­ing strep in the throat). If pos­i­tive, then a 10day course of oral an­tibi­otic ther­apy will clear the in­fec­tion. Top­i­cal prepa­ra­tions are not ef­fec­tive.

Don’t freak out. Itchy bums are pretty

com­mon.

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