Ask Dr. Doug: Suspecting Pinworms

Q:  My toddler is often trying to scratch her bum in her diaper. I’m terrified she has pinworms. How do I tell?    

A:  Toddlers love to explore, and usually that includes the diaper area. Understanding the body parts that are usually hidden under a diaper is a normal developmental process, so don’t be worried when she wants to be naked or explore in the bathtub. If it seems like she is uncomfortable, or frequently grabbing the front or back of her diaper, then check for any rashes or discharge. Most itching is due to general irritation and can be cleared up with plain baths, gentle cleansers, and some ointment or diaper cream. 

Pinworms can certainly be a cause of itching around the anus. As unsavory as it is to think your child has tiny worms living in her lower intestine, please remember these are very common, not related to “being dirty,” don’t cause any disease, and are easily treatable. 

Pinworms are tiny parasites about the size of a staple and the width of a piece of thread. They get into a child’s system when a child eats the eggs by accident, usually after getting them on her hands from clothing, bedding or common play areas. After about one month, the female worms exit the anus and lay eggs around the anal skin, which causes itching. This is usually two to three hours after kids go to sleep. Younger girls will often complain of vaginal discomfort, so if your daughter is waking and saying “owie” at night, consider a UTI, but keep pinworms on your list. 

You can sometimes see the pinworms around the anus if you look at night, and sometimes you can see them in the stool. That being said, identifying tiny worms in the stool can be tricky — strands of mucus will sort of look like worms. Sometimes foods like strings from bananas confuse the picture. And everything looks like it kind of moves while you’re staring at it in the toilet water (if potty trained). Your pediatrician can order a test to look for them, but sometimes we just treat if a parent (who maybe has prior experience) is quite sure her child has pinworms. 

Treatment is quick and easy and works well — one dose of a medication and another two weeks later. Often it makes sense to treat everyone in the house. Itching usually gets better within a week. Eggs can live on surfaces for two to three weeks, so it makes sense to carefully wash PJs and bedding in hot water after treatment. Prevention is tough, but keeping nails trimmed short and frequent, good hand washing goes a long way.

Tiny parasites and checking poop — the glamorous side of parenthood no one told you about! 

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Dr. Doug Lincoln practices general pediatrics at Metropolitan Pediatrics in Happy Valley. He is board certified in both pediatrics and preventive medicine, with special interests in helping parents meet their breastfeeding goals, caring for neurodiverse children with behavioral health needs, and advocating for children via teaching and policy. As a dad of two boys, he understands the joy and hard work that comes with parenting.