From the Guidelines
Common parasitic infestations in children, such as head lice, should be diagnosed and treated promptly to minimize morbidity and prevent spread, with treatment options including permethrin 1% cream rinse or malathion 0.5% for head lice, as recommended by the American Academy of Pediatrics 1.
Diagnosis and Treatment
Diagnosis of parasitic infestations in children typically involves identifying specific symptoms and confirming with appropriate tests. For head lice, diagnosis involves visual inspection of the hair and scalp for live lice and nits. Treatment usually consists of topical treatments such as:
- Permethrin 1% cream rinse applied for 10 minutes and repeated in 7-10 days
- Malathion 0.5% for children 2 years old or older, in areas where resistance to permethrin or pyrethrins has been demonstrated or for a patient with a documented infestation that has failed to respond to appropriately administered therapy with permethrin or pyrethrins 1
Prevention
Prevention strategies are crucial and include:
- Regular handwashing with soap
- Avoiding sharing personal items like combs or hats
- Regular cleaning of bedding and toys
- Proper food preparation
- Drinking clean water
- Teaching children good hygiene practices
- Environmental cleaning, particularly for lice and scabies, requiring washing of clothing and bedding in hot water Regular screening in high-risk settings like daycares can help detect infestations early before they spread widely 1.
Key Considerations
- No healthy child should be excluded from or allowed to miss school time because of head lice, and no-nit policies for return to school should be abandoned 1
- Pediatricians should be knowledgeable about head lice infestations and treatments, and take an active role as information resources for families, schools, and other community agencies 1
- New products should be evaluated for safety and effectiveness before being recommended for use 1
From the FDA Drug Label
The same dosage schedule applies to children and adults. The tablet may be chewed, swallowed, or crushed and mixed with food. Pinworm (enterobiasis)Whipworm (trichuriasis)Common Roundworm (ascariasis)Hookworm Dose1 tablet, once1 tablet morning and evening for 3 consecutive days1 tablet morning and evening for 3 consecutive days1 tablet morning and evening for 3 consecutive days If the patient is not cured three weeks after treatment, a second course of treatment is advised. No special procedures, such as fasting or purging, are required.
The diagnosis of common parasitic infestations in children is not directly addressed in the provided drug label. For treatment, mebendazole is used to treat:
- Pinworm (enterobiasis): 1 tablet, once
- Whipworm (trichuriasis): 1 tablet morning and evening for 3 consecutive days
- Common Roundworm (ascariasis): 1 tablet morning and evening for 3 consecutive days
- Hookworm: 1 tablet morning and evening for 3 consecutive days If the patient is not cured three weeks after treatment, a second course of treatment is advised. The prevention of common parasitic infestations in children is not directly addressed in the provided drug label 2.
From the Research
Diagnosis of Common Parasitic Infestations in Children
- Giardia infection can be diagnosed through stool microscopy with direct fluorescent antibody testing 3
- Cryptosporidium infection can be diagnosed through microscopy with immunofluorescence, which is sensitive and specific 3
- Cyclospora infections can be diagnosed through microscopy or polymerase chain reaction assays 3
- Trichinella infection can be diagnosed by serum antibody testing 3
- Pinworm infections can be diagnosed visually or by a tape test or paddle test, with the cellophane tape test being the most effective method 4
- Scabies can be diagnosed through standard superficial skin biopsy 5
- Head lice can be diagnosed through the vacuum method, which can increase diagnostic accuracy and efficiency 5
Treatment of Common Parasitic Infestations in Children
- Giardia infection can be treated with metronidazole, nitazoxanide, or tinidazole 3
- Cryptosporidium infection is often self-resolving, but treatment with nitazoxanide is effective for symptoms lasting more than two weeks 3
- Cyclospora infections can be treated with sulfamethoxazole/trimethoprim for patients with persistent diarrhea 3
- Trichinella infection can be treated with albendazole in patients older than one year 3
- Pinworm infections can be treated with mebendazole, pyrantel pamoate, or albendazole, all of which are given in a single dose and repeated in two weeks 4
- Scabies can be treated with permethrin or oral ivermectin, which are considered safe and effective for children and adolescents 5
- Head lice can be treated with permethrin, oral ivermectin, or an over-the-counter topical ivermectin formulation 5
Prevention of Common Parasitic Infestations in Children
- Good personal hygiene, such as frequent handwashing, especially after bowel movements and before meals, can help prevent pinworm infestations 4
- Clipping of fingernails, avoidance of finger-sucking, nail-biting, and scratching in the anogenital area can also help prevent pinworm infestations 4
- Treatment of all household members should be considered, especially if there are multiple or repeated symptomatic infections, to prevent reinfection 4
- Identification and eradication of bed bug infestations are crucial in preventing bedbug bites 5
- Community-based management, including mass drug administration, can help prevent worm infestations 6
- Preventive measures, such as improved sanitation and hygiene, can help reduce the risk of worm infestations 6