The mother of a 5 year old boy brings her son to your office because the child has been having difficulty sleeping at night because of severe itching in the perineal area. What advice would you give the mother?

Pinworms are caused by a nematode that most commonly affects children. They are found in all socio-economic classes and are world-wide. The life cycle of the pinworm begins after ingesting eggs that hatch in the stomach and duodenum. The larva migrate to the cecum where the male and females mate. The female then migrates to the perineal area and lays her eggs. The female dies after laying her eggs. The cycle is repeated by ingesting the eggs picked up after touching the perineal area. The entire cycle takes about 4-6 weeks. Infection may be spread by crowded conditions and close contact with infected individuals. Occasionally eggs may be spread by housedust.

1. The presence of eggs in the perineal area causes itching that may interfere with sleep.
   
2. May cause vaginal itching and vulvovaginitis when worms migrate into the vagina.
   
3. May see the female worm with the naked eye. They are yellow-white thread like worms.
   
4. There are no constitutional symptoms, diarrhea, bloody stools, nor eosinophilia.

1. During the night when the child is scratching, may see the adult worms with a flashlight
   
2. Apply scotch tape to the perineal area in the morning to pick up eggs and look at them under microscope.
   
3. Symptoms of extreme itching and no other findings.

1. Recommend Vermox 100 mg. for all family members. One dose is sufficient and may need to retreat in 2-3 weeks.
   
2. Washing all bedclothes and furniture in room not necessary
   
3. Reassurance very important and emphasis that this is not an invasive disease and only symptom is pruritis.