Pediatric Basics

Mother with her toddler on the potty
Toddlers and preschoolers are at risk for pinworms because they often put their fingers in their mouth.. Ryan McVay/Photodisc/Getty Images

Although upsetting for parents, it is important to remember that pinworms only cause mild infections or infestations.

Symptoms of Pinworms

The classic symptoms of pinworms are rectal itching.

More rarely, pinworms can cause vaginal itching and you might think about pinworms in young girls who have persistent vulvovaginitis.

In either case, itching is usually worse at night and may interrupt your child's sleep.

Other things can cause rectal and vaginal itching though, including poor hygiene. Perianal cellulitis (caused by the strep bacteria) can also cause rectal itching and is often misdiagnosed as a pinworm infestation. If your child also has redness around his rectum and/or doesn't respond to pinworm treatments or has multiple negative pinworm preps, you might ask your doctor about perianal cellulitis, which requires treatment with antibiotics and can be diagnosed with a regular rapid strep test or culture (like for strep throat). So see your pediatrician if you think that your child has pinworms.

Diagnosing Pinworms

Diagnosis is often made by parents discovering live (small, 1/2 inch size, white, thread-like worms in a child's stool) in children with typical symptoms.

Your pediatrician can also look for pinworm eggs you collect on a pinworm prep or using a homemade scotch tape test.

Often though, your pediatrician will make the diagnosis based on your child's classic symptoms.

Treating Pinworms

In children over age two years, pinworms were classically treated with the prescription medication  mebendazole (Vermox). Unfortunately, it was discontinued by the manufacturer in 2011.

Reese's Pinworm Medicine (pyrantel pamoate), an over-the-counter alternative to Vermox that is available as a liquid, is now most commonly used to treat pinworms.


One of the keys to treatment of pinworms is to repeat the dose in 2 weeks to be sure and kill newly hatched eggs. Also, since some family members may have a pinworm infestation without symptoms, it is sometimes recommended that the whole family be treated, taking caution in treating children under age 2 years and pregnant women (ask your doctor first).

What To Know About Pinworms

Other things to know about pinworms include that:

  • Pinworm infestations are caused by the Enterobius vermicularis roundworm. After ingesting roundworm eggs, they will migrate to a persons intestines and hatch. Four to six weeks later, adult female worms will discharge their eggs on the perianal skin. These eggs are contagious for up to 2-3 weeks, and are picked up as children scratch their bottom. The eggs can then be spread to others through direct contact or sharing other objects, like toys, clothing and bedding.
  • Adult pinworms die shortly after laying their eggs, but children typically reinfect themselves and keep the infection going.
  • Other treatments and preventative measures might include cutting your child's nails short, encouraging frequent handwashing, encouraging kids to keep their fingers out of their mouth, and washing sheets, towels, etc. in hot water.
  • Pin-X, another OTC pinworm treatment has been discontinued.
  • Emverm (membendazole) is a new version of Vermox that can be prescribed to treat pinworms, as well as some other parasites. Unfortunately, while generic Vermox was very inexpensive, the retail price of Emverm is over $300 for a single pill. Because few people will pay that much to treat pinworms, the manufacturer offers a savings card that could mean you only pay between $20 and $60 for your prescription.

Most importantly, while certainly gross once you understand how they are spread, remember that pinworm infestations do not cause any serious complications and are considered a mild infection.


Long: Principles and Practice of Pediatric Infectious Diseases, 3rd ed.

Pinworm (enterobius vermicularis). Vermund SH - Semin Pediatr Infect Dis - 2000 Oct; 11(4); 252-256.

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