Health notebook

Infections vulnerable to worm Children are more worms your child has than adults. Discovering childhood but this common might be distressing, treated and prevented. ailment is easily

Feeling freaked out by the very idea that your child might have worms? Don’t worry, you’re normal. Even Dr Chantelle van der Bijl from Bloemfontein, who blogs as Bloemmomdoc and is a mother of two, says she feels that way, and as a doctor – she’s seen it all! Fortunately the problem is easily solved, but to protect your child from potential long-term effects, you have to deal with the issue promptly or – ideally – preventatively.

HOW WORMS WORK

Intestinal parasitic worms invade and thrive in the intestines of the human body, growing in number through recurring infections. Your child’s health can really be damaged by an infestation, as malnutrition can occur. The appetite is repressed, so the child eats less, and the food that’s eaten is poorly absorbed by the body. Malnutrition in turn leads to poor physical and mental growth and weakens the body, increasing the risk of other infections.

Hook-, round-, whip-, pin- and tapeworms are types found in children. Dr van der Bijl explains that these parasites enter your body and mature in the intestines, where they lay eggs. They feed on the nutrients of the food that passes through the intestine. They can also cause small internal bleeds and loss of iron through this.

Dr Paul Sinclair, a Cape Town paediatrician, says that infections, particularly from thread- or pinworm, are very common in children, especially among the age groups where children put their hands in their mouths often. “They’re often contracted from children playing, swimming, bathing and sleeping together,” he says.

SO HOW DO YOU KNOW?

The severity of a worm infection will depend on just how many worms are present in the intestine. The greater the number of worms, the more ill the child becomes. A heavy roundworm infection, for example, can cause blockages in the intestine, hindering the digestion of food. Hookworm in large numbers causes bleeding in the intestines and blood loss. Fewer worms, and you may hardly notice any apparent illness. The most common symptoms of heavier infections include: loss of appetite, swollen and painful stomach, coughing, fever, vomiting, diarrhoea, paleness, tiredness, disturbed sleep, itchy anus, mucus or blood in the stool, skin rash, swelling around the eyes and generally feeling unwell.

Your child might also suffer from chronic diarrhoea, iron deficiency and poor sleeping habits.

Some of these worms can cause an infestation in the brain and lead to seizures, Dr van der Bijl says. Children are not that much at risk from dying from worm infestations, but the serious health effects that worms create can lead to eventual death if not managed properly. Symptoms of heavy infections can manifest within a few weeks or several months after infestation.

Early signs to be on the lookout for are loss of appetite, and picky eating, stomach ache, an itchy bum, or scratching and rashes around the anus or genitals in girls. Some children might also want to eat strange things like soil or ice. A bloated belly and bad breath, and itchy, red eyes are also signs that worms might have moved in. Sometimes you might even see the worms in your child’s poo or climbing out of the anus.

HOW DID THEY GET THERE?

Contact with soil that has been contaminated with the faeces of an infected person is a sure way of spreading infection. In the case of roundworm and whipworm, it’s possible for the worm eggs to be ingested by eating contaminated foods such as fruits and veggies watered with water containing contaminated soil. Hookworm larvae enter the body by burrowing into the skin of bare feet. Pinworm or threadworm infections are spread when a child comes into contact with an already infected child. Infection spreads easily, especially as children share toys that they somehow manage to put into their mouths more often than not, unknowingly swallowing worm eggs, which then hatch in the intestine. They may also be spread because of poor hygiene, like not washing hands after going to the toilet. Pinworms cause intense itching of your child’s bottom and in particular the anus. You may be able to see the worms in your child’s stool or on close examination of his bottom. Pinworms look like tiny cotton threads. Roundworm eggs, once in the duodenum of the intestine, hatch into larvae that break through the walls of the intestine to enter blood and lymph vessels, eventually ending up in the lungs. Here, they grow and develop, before travelling to the throat to be swallowed once again and back into the intestine where they eventually mature and start laying eggs. Roundworms are larger and resemble garden worms. Hookworm eggs passed out through the faeces of an infected person hatch out into larvae and begin to live on the surface of the soil. If given the chance, the larvae penetrate the skin of bare feet to enter the body. The larvae are carried in the blood stream to the lungs. As they develop, they move up the throat to be swallowed down to the intestine. The now mature hookworms attach to the lining of the intestine with sharp teeth to begin producing eggs.

Whipworm eggs hatch into larvae, growing and developing in the small intestine before moving onto other parts of the intestine. They end up in the cecum part of the intestine where now, as matured adults, they start producing eggs that are then passed out with faeces. They are a type of roundworm that looks like a “whip”. Tapeworms are ribbon-like worms that live in humans and animals. They can be

picked up swimming in contaminated waters like a river or lake when water is accidentally swallowed. There is a definite risk of tapeworm infection when eating undercooked meat of an infected animal like a cow or pig. Sometimes, ingested tapeworm eggs embed themselves in muscle tissue and organs like the eye or brain, causing cysts to form.

DEWORMING IS FOR EVERYONE

Deworming simply means taking medication to treat and get rid of intestinal worms. It kills off the worms, and they come out in the poo. This can be done to treat an intestinal worm infestation or to prevent it. You might think your home is clean and your child will not get exposed to worms. However, children are very susceptible to pick them up in other places like school, playgrounds, shops or restaurants.

Dr van der Bijl says that in developing countries, regular deworming can start from 1 year of age. Then deworm every six months after that. And adults? Adults should also preferably be dewormed every six months. The easiest way to remember it is to deworm the whole family at the same time, then you know it is time for it again in six months.

Just a note though: anti-parasitic medications have not been proven safe in pregnancy and breastfeeding, so it is best to avoid them then. Talk to your healthcare provider if you are unsure.

Offer deworming to your childminder or anyone else, such as grandparents, who are also in regular contact with your child. The medications have very mild side effects such as abdominal pain and nausea and are most likely due to the worms being passed out of the intestines. After taking the medication, you may see some of the dead worms in your child’s poo. Do not panic, this is just the way of the body getting rid of the worm. Deworm the family again in six months. ●