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Worms in children are intestinal parasites picked up from soil, dirty hands, unwashed vegetables or contaminated water. The commonest sign is itching around the bottom at night. Others are tummy pain around the navel, poor appetite and slow weight gain. A deworming medicine clears them, and the whole household usually needs treating at the same time.
This is one of the most common childhood problems in Pakistan, and one of the most under-treated. Worms rarely make a child dramatically ill. They quietly take nutrition, cause anaemia, and hold back growth and school performance for years.
Families here call them pait ke keeray. Most parents assume one tablet handles it. Often it does not, and this guide explains why.
Worms are parasites that live in the intestine. They feed on what your child eats, and some feed on blood from the gut wall.
That is where the real damage sits. A child with a heavy worm load can eat normally and still lose weight, stay pale and fall behind at school. Hookworms drink blood, and are a leading cause of iron deficiency anaemia in Pakistani children. The child looks fine to visitors. The growth chart says otherwise.
Most worm infections are mild. A few are dangerous, and those signs are listed below.
| Worm | How your child gets it | What you notice |
|---|---|---|
| Pinworm (threadworm) | Swallowing eggs from hands, nails, bedding, towels or toys. Spreads between children very easily. | Intense itching around the bottom at night. Restless sleep. Tiny white threads, about a centimetre long, around the anus or in the stool. Girls may itch around the vulva. |
| Roundworm | Eggs in soil, on unwashed salad and vegetables, or in contaminated water. | Tummy pain around the navel, a swollen belly, poor appetite. Sometimes a worm passed in stool or vomited, which frightens parents badly. |
| Hookworm | Larvae in soil entering through bare feet. Also swallowed from dirty hands or raw vegetables. | Pale skin, tiredness, breathlessness on playing, poor concentration. An itchy rash on the feet where they entered. |
| Whipworm | Swallowing eggs from contaminated food, water or soil. | Loose stools over a long period, sometimes with blood or mucus. Poor growth in heavy infections. |
Pinworm is by far the most common in school-age children, and it behaves differently from the rest. The female worm crawls out at night to lay eggs on the skin around the anus. That is what causes the itching. Your child scratches in their sleep, eggs lodge under the fingernails, and by morning they are on hands, bedsheets, door handles and school desks. One child brings it home and the family passes it around for months.
The route is almost always the same. Eggs or larvae from stool reach your child’s mouth, or burrow through their skin.
In Pakistani households the usual paths are these:
Crawling babies and toddlers who put everything in their mouths are at high risk. So are children at schools and madrassas where many share a washroom.
Many children with worms have no symptoms at all. When they do appear, look for these:
• Itching around the bottom at night. The single most useful sign. A child who wakes crying, scratches in their sleep, or has become suddenly restless at bedtime.
• Tummy pain around the navel that comes and goes over weeks, often with a bloated belly.
• Poor appetite and poor weight gain. A child stuck at the same weight over several months deserves a check.
• Visible worms. White threads in the stool or around the anus, or a longer worm passed or vomited.
• Pale skin and unusual tiredness, especially with breathlessness on running. This suggests anaemia from hookworm.
• Itching or redness around the vulva in girls, and sometimes bedwetting that has restarted after months of dry nights.
• Irritability and poor concentration at school, usually from broken sleep.
Often no test is needed. If you have seen worms, or your child has classic night-time itching, your doctor may simply treat.
Here is where most families go wrong. A stool test is the standard test for worms, and it usually misses pinworm. Pinworm lays its eggs on the skin around the anus, not in stool. So a normal stool report does not clear your child of the commonest worm of all.
For pinworm the right test is a tape test. Clear sticky tape is pressed against the skin around the anus, then examined under a microscope. It is done first thing in the morning, before your child bathes or passes stool. Ask for it by name if the stool test came back clean.
A stool test does work well for roundworm, hookworm and whipworm. Your doctor may send more than one sample, because eggs are not shed every day. A blood count is worth doing if your child looks pale, since it picks up the anaemia that matters most. Ultrasound is used only when a heavy roundworm load or a complication is suspected.
Deworming medicines work well and are safe when a doctor prescribes them for your child’s age and weight. Most worms clear with a short course.
Four things decide whether the treatment actually holds.
1. Treat the whole household at once. For pinworm this is not optional. Everyone sleeping in the house takes the medicine on the same day, whether or not they have symptoms. Treat one child alone and the others hand it straight back.
2. Expect a second dose. Deworming medicines kill the worms but not the eggs. Your doctor usually repeats the dose about two weeks later to catch anything that hatched after the first round. Families who skip the repeat see the itching return within a month.
3. Clean at the same time as you treat. On treatment day, wash all bedding, sheets, towels and nightclothes in hot water. Cut everyone’s nails short. Bathe your child first thing in the morning to wash off eggs laid overnight. Vacuum or damp-mop bedrooms rather than sweeping, which sends eggs into the air.
4. Fix the anaemia, not just the worms. If your child is pale from hookworm, killing the worms does not restore the iron they have already lost. Your doctor will check and treat that separately.
Do not buy a deworming syrup off the shelf and give it repeatedly on a hunch. Dose depends on age and weight. Some medicines are unsuitable under one year. And worms are not the cause of every tummy ache.
Routine deworming is recommended for children in areas where worms are common, and Pakistan qualifies comfortably.
Deworming starts from 12 months of age, not 2 years. Some health articles still say 2 years, which is out of date. WHO includes children from 12 months, using a reduced dose under 24 months. It is given once or twice a year, depending on how common worms are locally. Your pediatrician decides the timing and the dose.
Many schools run deworming days. If your child received a tablet at school, tell your doctor the date so doses are not stacked unnecessarily.
• Shoes outdoors, every time. This is the one habit that blocks hookworm, and the one most often ignored in summer.
• Handwashing with soap after the toilet, after playing outside, and before eating. Count 20 seconds out loud with young children.
• Cut fingernails short and keep them clean. Discourage nail-biting and thumb-sucking.
• Wash salad, coriander and mint in safe water, and peel fruit where you can. Boil or filter drinking water.
• Cook meat right through. Tapeworm comes from undercooked beef and mutton.
• Do not let babies crawl on bare soil or unwashed floors.
• Deworm pets, and keep children from playing where animals pass stool.
| What people believe | What is actually true |
|---|---|
| Teeth grinding at night means pait ke keeray. | This is the most widespread belief about worms, and the evidence does not support it. Some studies found a mild link, others found none, and none showed worms cause grinding. Teeth grinding runs in families and is linked to sleep and stress. Do not deworm on this sign alone. Night-time itching is the sign that counts. |
| Eating too many sweets gives children worms. | Sugar does not create worms. Worms come from swallowing eggs or from larvae entering the skin. This belief is common and harmless in itself, but it distracts from the habits that actually matter. |
| One tablet is enough. | The medicine kills worms, not eggs. Without the repeat dose about two weeks later, and without treating the household, pinworm usually returns. |
| A normal stool report means no worms. | A stool test misses pinworm, the commonest worm in school-age children. Ask about a tape test if the symptoms fit. |
Book an appointment if your child itches at the bottom at night, or has tummy pain that keeps returning. Also if they are not gaining weight, look pale and tire easily, or if you have seen a worm.
Come to the emergency room today for severe tummy pain with vomiting, or a hard swollen tummy. Also for a worm from the nose or mouth, or a child too weak and pale to stand.
Our Pediatric Medicine department at Kids Care International Hospital in Rawalpindi assesses worms properly rather than handing over a tablet. That means the right test for the worm suspected, and a blood count where a child looks pale. It also means treating the whole family where needed, and a growth check to see what the worms have cost. You can view clinic timings for our child specialist and consultant pediatrician and book online.
Worms are one cause of a child not gaining weight. Poor diet, coeliac disease and long-running digestive problems are others, and a pediatrician can tell them apart.
The clearest sign is itching around the bottom at night, often with restless sleep. Others are tummy pain around the navel, a bloated belly, poor appetite, slow weight gain, pale skin and tiredness. Some children pass white thread-like worms in stool. Many children have no symptoms at all.
Check with a torch two to three hours after your child falls asleep. Gently part the buttocks and look for short white threads that move around the anus. Seeing them confirms pinworm. Not seeing them does not rule it out, because the worms do not come out every night.
From 12 months of age. WHO includes children aged 12 to 23 months, using a reduced dose. Preschool and school-age children are dewormed once or twice a year, depending on how common worms are locally. Your pediatrician decides the medicine, dose and timing.
No, and this catches many families out. Stool tests work for roundworm, hookworm and whipworm. They usually miss pinworm, because pinworm lays its eggs on the skin around the anus rather than in stool. If symptoms fit and the stool report is normal, ask about a tape test.
Usually two to three days. The lab needs time to grow the bacteria from your child’s blood sample. That wait is hard when your child is burning with fever, and it is worth it, because the culture shows which antibiotics still work against that particular strain. Your doctor may start treatment before the report arrives and adjust it once the result is in.
For pinworm, yes. Everyone living in the house takes the medicine on the same day, whether or not they have symptoms. Pinworm spreads easily between people sharing bedding and bathrooms. Treating only the child who complains is the usual reason it keeps coming back.
Not a reliable one. Studies looking at this have given mixed results, and none has shown that worms cause teeth grinding. Grinding tends to run in families and is linked to sleep patterns and stress. Night-time itching around the bottom is a far better indicator. Do not deworm your child on grinding alone.
