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Quick reference medical handouts used by Pediatric offices

Get the Upper Hand with: Parasites, Pinworms, and thrush

Worldwide, one in three children has pinworns. Just because they are so common, however, doesn't make them any less disgusting. The adult looks like a wriggling piece of white thread about half an inch long. She normally lives in the lower intestinal tract and crawls out of the rectum at night to lay her eggs on the nearby skin. These eggs get to a child’s mouth on unwashed fingers that touch the skin. Once swallowed, the eggs develop into adult worms in two to four weeks. A child with pinworms will itch day and night. That can make them irritable but the parasite does not cause stomach pain (sorry grandma!). Occasionally, pinworms migrate into the female genital tract causing redness and irritation.

If you suspect pinworms, inspect your sleeping child's anal opening with a flashlight at night. The parasite looks like a piece of very thin white thread, about 1/4 inch long. Some pediatricians will have parents check for the pinworm eggs on their child’s skin with cellophane tape or special test kits. By the way, finding pinworms is not a medical emergency and you can safely wait until morning to call your child’s doctor.

One dose of medication is all that's necessary and, except for pregnant females, most physicians treat the entire family. However, therapy does not prevent reinfection. Since it is not possible to eliminate pinworms from your child’s world, encourage them to wash their hands before eating and after using the bathroom.


Children in day care are bound to share more than toys, even under the best of circumstances. One of the most common diseases preschoolers pass around these days is the intestinal parasite Giardia lamblia , a one-cell microscopic organism related to the amoeba we all studied in school. A recent study showed that between "10% and 26% of children attending day care centers were infected with this protozoan," according to All Children’s infectious disease specialist Dr. Jack Hutto. "Since these children have no symptoms, during an outbreak of diarrhea the Giardia is most likely to be a ‘fellow traveler’ rather than the cause of the child’s diarrhea," Dr. Hutto added.

When the Giardia is the cause of the illness, loose fatty stools, bloating, and abdominal pain are the common symptoms. Occasionally the child will experience nausea and vomiting along with fatigue. Flatulence with an especially foul order is frequently noticed.

Children usually become infected by hand to mouth transfer of the parasite’s eggs. For example, an infected child who does not wash their hands after having a bowel movement leaves the Giardia’s eggs on anything they touch, including food, toys, and clothes. In addition, a day care provider who does not clean their hands after changing an infected child’s diaper could unknowingly pass the parasite on to another child. Less commonly, children can become infected with Giardia by drinking contaminated water from lakes or streams.

It usually takes about 1 to 4 weeks after ingestion of the cysts before the child has symptoms. Once the parasite is identified in stool samples, treatment can be started with a medication called Furoxone for 7-10 days. The child remains contagious as long as they excrete the cysts, which can be as long as 12 to 14 months, but can return to day care once the diarrhea clears. Some physicians will screen the stools of sibling’s infected with the parasite and treat these children even if they do not have symptoms. Most experts, however, would only look for the parasite if the child developed symptoms suggestive of Giardiasis.

If you child becomes infected with Giardia , don’t necessarily blame their daycare. While the spread of the parasite can be minimized by parents and daycare personnel who practice good handwashing using liquid soap and paper towels, most studies show that even the most meticulous sanitary practices do not result in better control of the Giardia parasite.


Thrush is an overgrowth of the yeast germ, Candida , producing white patches inside the mouth. It is most commonly seen in babies but may occur in anyone who has been on antibiotics for a long time.

Thrush can be distinguished from the white coating of milk left behind after feedings by gentle washing of the white patches. Thrush is firmly stuck against the mouth, and if you manage to get some off, the surface left behind is swollen and red. If the white patches are easily removed, then it probably is not thrush.

Each of us has yeast in our mouth, as these little germs live there in harmony with normal mouth bacteria. Babies usually obtain both yeast and bacteria from their mother’s birth canal. In some cases the yeast growth overtakes bacterial growth before the body develops a balance between the two, and thrush develops.

Thrush is treated either by the antifungal prescription nystatin oral suspension or gentian violet, available over the counter. A 1% solution of gentian violet is applied with a cotton swab to the white patches 1-3 times a day. The major problem with gentian violet is that it is messy and stains everything purple including clothing, nipples, the carpet, and the skin. In fact, articles of clothing can be permanently stained. The nystatin is more convenient but more expensive. It is given four times a day and placed on each side of the mouth. If the thrush isn’t responding, rub the nystatin after meals directly on the affected areas with a gauze wrapped around your finger. Breast feeding moms should apply nystatin to their breasts as well. Some physicians will not even treat thrush since it will eventually go away and most babies do not seem to have any discomfort from it.

If thrush is present, carefully wash the nipples and pacifiers and anything else that goes into baby’s mouth. It is a good idea to store bottles, nipples, and pacifiers in the refrigerator -- the yeast do not like a cold environment. By the way, normal children and adults do not get thrush since they develop an immunity to the overgrowth of the yeast germ.


As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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