When the subject of worms and deworming comes up in my practice, I am immediately reminded of the rhyme my wife used to tell my children. It went like this…… “Ooey Gooey was a sweet little worm and a sweet little worm was he. One day on a railway track, a train he did not see….” And my children would squeal and shout back “Ooey Gooey”, their little faces scrunched up with a look of utter distaste.
While I know Ooey Gooey was of the family invertebrate phyla and the worms that infect human bodies are parasites, the look on people’s faces when you mention worms in relation to themselves or their children resembles that of my children’s faces when they realised that Ooey Gooey was now a sticky mess!
Worms in kids
Worms found in a person’s intestines are known as parasitic worms. This means that they live in and feed off the human body. The most common types of parasitic worms are Roundworms and Flatworms. South African studies have shown that school children have the highest infection rate and they are generally affected by soil-transmitted parasites. I will go into some detail about these in this article.
A common skin infection which we call Ringworm is, in fact, a fungal infection of the skin and is not a worm at all. I will touch on this fungal infection so that you as parents have an idea of how to recognise it and what treatment should be given.
Ok, I know you are all pulling a face right now but let’s be brave together and take a closer look at these infections. Please also keep in mind that if your child gets worms, it is not a reflection on you. It may be that your child lives and plays where there is limited infrastructure with regards to clean water or adequate sewage systems. Another factor is where your child is in close contact with other children in schools which have very high numbers with limited facilities. This is why the age group 5 to 10 years tends to form the major population group affected by worms, but children younger than this are also susceptible if they attend a play-school.
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Types of Roundworms in kids
Roundworms are parasites with their own digestive systems. They have long, round bodies but can be different sizes depending on which type of roundworm they are. These worms live in our digestive systems. In order to spread they are pooped out of the host (the human) and end up in the soil. Here they can infect another person who comes into contact with the contaminated soil. They include Threadworm/pinworm, Hookworm, Ascaris and Whipworm. I am going to limit this discussion to just 3 kinds for now.
Roundworm in kids: Threadworm/Pinworm
- Most common type of worm infection in kids
- Looks like white threads which may be 1 cm long
- It causes a very itchy bottom, which is usually worse at night because the worms come out of the anus to lay their eggs around the buttocks. Little girls may experience this itching around the vaginal area.
- It is spread when children scratch their bottoms. The eggs are carried back to the mouth under the fingernails. The child swallows the eggs and the cycle begins again.
- If the child touches a surface, food or plays in the dust then the eggs will remain there. They can last for up to two weeks so another person coming into contact with the eggs may unknowingly put the eggs into their own mouth.
- The symptoms to watch out for include itchy, red inflamed bottom, poor sleep, irritability and, in some cases, reduced appetite.
- It is not a parasite transmitted by animals.
How could my child get Threadworm/pinworm?
Catherine is 4 years old. She loves nursery school and playing in the sandpit. At the end of playtime Catherine and her friends hold hands to go back to the classroom. Of late, Catherine has been waking up crying at night complaining that something is biting her bottom. She scratches at her skin and is not a happy child. During the day this isn’t an issue. Mom is concerned that Catherine is having nightmares.
Eventually Mom calls the doctor for advice because no one in the house is sleeping. The history alerts the doctor to the possibility that this is threadworm. Her age, the night waking and scratching at her bottom are all significant symptoms of this type of worm. She is advised to take a stool to the laboratory to confirm the diagnosis. She is put onto treatment along with the other family members and symptoms clear within 3 days.
Roundworm in kids: Hookworm
- The adult worm lives in the intestine of the infected person. Here the worm lays thousands of eggs each day. The infected person would then pass these eggs out in their stool.
- Hookworm eggs are passed in the faeces of an infected person into the soil if there is no adequate sanitation.
- The eggs hatch and mature into larvae. When the larvae come into contact with unsuspecting humans, these larvae penetrate the skin. The hookworm then feed on the host’s tissue, including blood.
- Since they feed on blood the host may experience a loss of iron and protein leading to anaemia.
- People usually become infected when they walk barefoot on contaminated soil. In South Africa this infection would be of concern for people living in places with limited or no sanitation.
How could my child get Hookworm?
Sipho is 8 years old. On weekends he loves to go fishing with Dad at the river. He has been told to keep his shoes on when fishing because further up the river there are some homeless people who unfortunately do not have access to good sanitation. Sipho did get his takkies wet and decided to fish barefoot.
A couple of days later Sipho is complaining of itchy feet and has a rash on his feet. Perhaps it is a grass allergy? Sometime later Sipho begins complaining of a sore tummy, and is tired a lot of the time. When Sipho goes to see the doctor, the doctor suggests a stool test and some blood tests. The stool test shows the presence of worms because there are eggs present and the bloods indicate that his iron levels are low. He is treated for Hookworm and recovers well.
Roundworm in kids: Ascaris
- More common in children than adults
- Most people infected will have no signs or symptoms.
- Moderate to heavy infections cause various symptoms.
- Mild symptoms would usually include tummy pain, weight loss and diarrhoea. In severe cases the parasite may find its way to the lungs and this would then result in a fever, coughing and wheezing.
- Often develops when a child puts his or her hands into the mouth after playing in contaminated soil. They swallow the eggs and these hatch in the small intestine. The larvae migrate through the bloodstream or lymphatic system into the lungs. This may result in symptoms like a persistent cough, shortness of breath or wheezing. After being in the lungs for 10 to 14 days they travel to the throat where they are coughed up and swallowed again and so the cycle continues.
- This infection is most common in developing countries with poor access to sanitation. It is almost unheard of in America except if people have travelled to tropical places. In South Africa I would be most concerned about this infection for children living in hot, humid provinces, in a rural setting or squatter camps where people live without access to adequate toilets or clean water.
- Fruit and vegetables may be fertilised with human faeces or pig faeces so eating unwashed fruit or vegetables is a risk.
How could my child get Ascaris?
The Smith family are on a road trip in the countryside. They come across a farm store with wonderful fresh fruit and vegetables. They buy some fresh farm produce including strawberries, carrots, potatoes etc. Little Caroline can’t wait. She helps herself to a couple of unwashed strawberries. Months later Caroline is suffering from a persistent cough and often complains of a sore tummy and intermittent diarrhoea. A stool test is performed at the laboratory and it is established that she has an Ascaris infection. Since this is very unusual in Caroline’s setting the only explanation for the infection appears to be the unwashed strawberries. Caroline was treated for the Ascaris and responded very well.
Flatworms in kids
Flukes and Tapeworm form the two major types of flatworms of concern to humans. These parasites don’t have their own circulatory system or respiratory system which means they have to rely on their host to survive.
Flatworms in kids: Tapeworm
- These worms are flat and segmented. They live in the intestines of some animals. The animals themselves get infected when they graze on contaminated grass or drink contaminated water.
- The animals are known as the intermediate host. They eat or drink the eggs, the eggs hatch and mature into larvae which burrows into the muscle of the animal and forms a cyst. When we eat uncooked beef, fish or pork then we ingest the cyst and the worm hatches. It has suckers and hooks which attach to the intestinal wall of the person.
The worm constantly breaks into pieces and these pieces burst with eggs that are then passed out in the stool.
- Tapeworms don’t always cause symptoms and the only way you may know that you have it is if a segment is passed out with a stool and you see it in the toilet.
- Other more serious symptoms may include nausea, diarrhoea, tummy pain, hunger or loss of appetite, fatigue and weakness and vitamin deficiencies.
How could my child get Tapeworm?
The Van der Walt family love eating sushi and sashimi. They often try out new little places with interesting menus and special offers. One morning Johan screams for mom to come quickly. Inside the toilet is a worm. He is so distressed. Mom rushes him off to the doctor. A stool test is performed and it is found that Johan has a tapeworm. The doctor explains about raw fish having the potential to spread tapeworm, if it is not treated correctly before serving or is obtained from an unknown source. Johan is treated with medication for tapeworm. The doctor explains that the medicine paralyzes the tapeworm so it lets go of the intestine and dissolves. Johan is told to expect to see some of the tapeworm in his stool over the next couple of weeks. Johan must come back after a month and then again in three months to make sure the infection has cleared.
Flatworms in kids: Flukes
Flukes are not common in South Africa but may be of concern if you have travelled to countries where this parasite is widespread. These countries may include China, Korea, Thailand and the Philippines. For this reason I will only give a brief summary about Flukes.
- They are more likely to cause an infection in animals than people.
- One may get Flukes from raw watercress, other freshwater plants and drinking of contaminated water.
- Freshwater fish including salmon and trout may spread Fluke eggs if one eats the fish raw.
- They may infect the liver and lungs.
Worms in kids: let’s put this all into perspective
The question of routinely deworming a child often comes up. I guess parents feel the need to deworm their children in much the same way as we deworm our pets. In my practice, in Johannesburg, I have only had two children in the last year with a worm infection. It is not common for children to get a worm infection if they are living in areas where they have access to good sanitation. The examples I used were simply to demonstrate how this kind of infection may occur.
In discussions with Associate Professor John Frean of Wits University, he advised that a program for mass treatment was on the table for high prevalence areas only. This would include children in informal settlements or rural areas with poor sanitation facilities. He emphasised that it would not be appropriate to recommend routine 6 to 12 month deworming in low prevalence areas.
If you suspect that your child has worms or if you have travelled to destinations where worms are a concern, then I would recommend a stool test. If you see the physical evidence of worms in your child’s stool then your healthcare provider will advise you accordingly.
Children under the age of two years cannot simply be given deworming medicine without the guidance of a healthcare practitioner. There are specific protocols and dosages for children in this age-group. This applies to women who are pregnant or breastfeeding as well.
What about ringworm?
As mentioned in my introduction ringworm is a common skin infection, caused by a fungus. It is not a worm at all. Unlike real parasitic worms I do see ringworm fairly often in my practice. Children may have it on their bodies (tinea corposis) or on their scalps (tinea captis).
On the body, ringworm appears as a patch with the characteristic ring shape. The lesion is usually dry and scaly and is often itchy. If the ringworm is on the scalp then you may notice a scaly, bald patch. The hair around the affected area may break off or fall out.
Generally ringworm is treated with an antifungal cream or ointment.
Ringworm spreads easily in 4 different ways:
- Human to human: this may happen if your child shares a brush with another child who has ringworm on the scalp.
- Animal to human: your child may be very excited to pick up a puppy in the pet shop. The little dog may have ringworm and the fungus then spreads to your child.
- Object to human: a child going on a school camp often shares the showers with other children. It may be that the fungus is on the floor of the shower and your child may pick it up from this source.
- Soil to human: this is an unlikely way to get ringworm but it is possible that someone with ringworm drops the fungus spores into the soil and your child then puts his or her hands into that soil.
Parents do worry about worms and it may lead them into thinking that they have to deworm their child every six months along with the pets. If you have been deworming your children, there is no harm done, but it is not necessary in areas with a low prevalence of worms. Good sanitation, strict regulations on food and modern hygiene standards protect individuals from these parasites. If you do see evidence of worms in the nappy or toilet please contact your healthcare provider for guidance on treatment.
You can take precautions yourself by ensuring that all meat is well cooked before consumption and that you wash fruit and vegetables well. Do not allow your child to swim in unclean water and if possible make sure your children are wearing shoes or flipflops in sandy areas where faecal matter is possible. All in all, worms are not a comfortable subject to discuss but they are treatable and do not pose a major problem to the average child growing up where good sanitation is provided.