Pinworm Treatment for Kids
For children with pinworm infection, give either albendazole 400 mg or mebendazole 100 mg as a single oral dose, then repeat the same dose in 2 weeks. 1
First-Line Medication Options
Both medications are equally effective and safe across all pediatric age groups:
- Albendazole 400 mg: Single oral dose, repeated after 2 weeks 1, 2
- Mebendazole 100 mg: Single oral dose, repeated after 2 weeks 1, 3
The dosing is standardized—the same 400 mg albendazole or 100 mg mebendazole applies to all children regardless of age or weight 1. The FDA confirms mebendazole achieves approximately 95% cure rates for pinworm 3.
Why Two Doses Are Essential
The second dose at 2 weeks is critical to eradicate newly hatched worms from eggs that survived the initial treatment 1, 2. Pinworms have a short life cycle, and eggs deposited before treatment can hatch after the first dose, leading to reinfection 4.
Age-Specific Considerations
- Children ≥2 years: Standard dosing applies without restrictions 1
- Children 12-24 months: Expert consultation is recommended before treatment, though the same doses can be used 2
- Children <12 months: Medication use requires careful expert consultation 2
Alternative Medication
Pyrantel pamoate (11 mg/kg, maximum 1 g) is an alternative, also given as a single dose repeated in 2 weeks 4. However, pyrantel is only adulticidal (kills adult worms) while albendazole and mebendazole are both adulticidal and ovicidal (also kill eggs), making them superior choices 4.
Tablet Administration
Mebendazole tablets can be chewed, swallowed whole, or crushed and mixed with food—no fasting or purging is required 3. This flexibility is particularly helpful for young children who cannot swallow pills.
Household Treatment Strategy
Treat all household members simultaneously, especially when there are multiple or recurrent symptomatic infections 4, 5. Pinworm spreads easily within households through fecal-oral transmission, and treating only the symptomatic child often leads to rapid reinfection 4.
Clinical Presentation to Recognize
- Nocturnal perianal itching is the hallmark symptom, occurring in 60-70% of infected children 1, 2
- 30-40% of infected children are completely asymptomatic 1, 4
- Other symptoms include irritability, weight loss, diarrhea, and abdominal pain 1, 2
- Girls may develop vaginal discharge from worm migration into the genital tract 1, 2
Diagnostic Confirmation
The cellophane tape test (adhesive tape applied to perianal skin first thing in the morning before bathing) is the diagnostic method of choice 1, 2, 4. A single test has only 50% sensitivity, but performing the test on three consecutive mornings increases sensitivity to approximately 90% 4. Stool examination is not useful since pinworms and eggs are rarely passed in stool 1, 4.
Common Pitfall: Recurrent Infections
Recurrences are extremely common even with effective medication 4, 5. This is usually due to reinfection (particularly autoinfection from scratching) rather than treatment failure, given the short adult pinworm lifespan 4. For persistent recurrent infections despite standard treatment, consider a prolonged "pulse scheme" treatment for up to 16 weeks 5.
Essential Hygiene Measures
Medication alone is insufficient—implement these measures concurrently:
- Frequent handwashing, especially after bowel movements and before meals 4
- Clip fingernails short 4
- Discourage nail-biting, finger-sucking, and scratching the perianal area 4
- Daily morning bathing to remove eggs deposited overnight 4
- Change and wash underwear, pajamas, and bed linens frequently in hot water 4
When to Retreat
If the patient is not cured three weeks after treatment, administer a second full course of treatment 3. However, distinguish between treatment failure and reinfection—the latter is far more common 4.