By Dr Megan Yap - PaediatricianGeneral12 Feb 2018

So today I am going to blog about something easy and fast!  I was planning on posts on “Fostering resilience in kids” and “Anxiety” but undoubtedly they will end up epically long, so THREADWORMS it is ( ha ha ha ha ha!! So gross… yet so common!).  Also known as PINWORMS.

So the first time I learnt about threadworms was probably about 20 years ago when I was studying my pharmacy degree.  As an elective, I did “Biology of Invertebrates”  BL105, with my one of my best mates, Rosie (who is now an awesome GP).  Threadworms are gross and unbelievably common (which makes them even grosser).

They are tiny – and look like little pieces of cotton thread.    I Googled “images of threadworm” and was totally overwhelmed by photos that people had taken of their own poo with worms in/on it (I SO wish I could insert a vomit emoji here, but have no idea how to).  ***Blechhhhh…***  So they are about 8mm long, they live in the lower intestine.  Infections by this parasite are not normally serious and thankfully easily cured with medication.  They usually infect more than one family member (ie treat the whole family).

Signs and Symptoms:

  • Itchy bottom (especially at night time)
  • Red/inflamed bottom (usually from scratching)
  • Irritability
  • Poor sleep
  • Vaginal itching

So the REASON why these symptoms occur is that the worms crawl out of the bottom (ie the anus) at night in in the early morning hours to lay their eggs in the area between the buttocks.  The “glue” that the female worm uses to stick the eggs to the skin is irritant to the skin and causes itching.  Threadworms are SPREAD by the child scratching their bottom, then carrying the worm eggs back to their mouth with their hands.

The worms appear white when full of eggs, and become transparent when they have laid their eggs.  The eggs can survive for up to 2 weeks outside the body.  They are spread REALLY easily, for example via food (eg a child with eggs on unwashed hands touching and then sharing food), or if there are eggs in undies/pajamas or bed sheets – one flip of the sheets and the eggs become airborne, you inhale them and BINGO – you’re infected.


You can usually see threadworms if you examine your child a short time after they have gone to bed.

Using a torch, look carefully around the anus (separating the buttocks) and opening to the vagina in girls.  They appear like little pieces of white cotton thread, but they MOVE.  There is also the “sticky tape test” where you use a piece of clear Cellotape and apply it to the area around the anus in the morning before a bath or going to the toilet.  This can be stuck to a glass slide (that you can get from your GP) and eggs/worms might be visible on this under a microscope (your doctor will examine the slide).


Fortunately, threadworm infection is pretty easily treated (PHEW!!!!), even though it is inconvenient and uncomfortable.  There are a couple of medication treatments out there, and various brands.

Pyrantel (eg Combantrim) –  paralyses the worm and then relies on your body to pass the bowel motion containing the worm to rid your body of infection; if a bowel motion is not passed in time, then the worm becomes unparalysed and the host remains infected.

Mebendazole (eg Vermox, and Combantrim also put out a version of this) – kills the worm

I like the mebendazole treatment for obvious reasons (ie it kills the worm).  BUT repeat infection is really common.  SO, here are some tips for treating:

  1. Treat at night before bed
  2. Treat everyone in the family (with mebendazole, the drug is not actually absorbed so the same dose is used regardless of age or weight)
  3. In the morning, everyone showers and ALL the undies, pajamas, sheets, pillow cases, doona covers, soft toys etc etc are washed in HOT water and hang in the sun to dry (some also advise to go over with a hot iron, but who has time for that?)
  4. Vacuum floor frequently to remove eggs
  5. Re-treat in 2 weeks
  6. Don’t worry about family pets – they get different types of worms and do not spread threadworm
  7. Keep your child’s nails short and clean; encourage them not to scratch (and if you catch them scratching, wash their hands thoroughly and use a brush to scrub under their nails); discourage nail biting and thumb sucking.
  8. Throw away food that has fallen on the floor


So although I KNOW this post is icky, I hope it has helped you to be more aware of threadworm infection and what it looks like, and also taught you how to treat it.

xxDr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at



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