Deworming in Children
Recommended Treatment Approach
For children at high risk of intestinal parasites due to exposure to contaminated soil or water in endemic areas, treat confirmed infections with albendazole 400 mg as a single oral dose or mebendazole 100 mg twice daily for 3 days, with specific adjustments based on the identified parasite. 1
Treatment by Specific Parasite Type
Soil-Transmitted Helminths (Roundworm, Hookworm, Whipworm)
Roundworm (Ascaris lumbricoides): Administer albendazole 400 mg single dose or mebendazole 100 mg twice daily for 3 days 1
Hookworm: Use albendazole 400 mg daily for 3 days, which is particularly critical in young children due to anemia risk 1
Whipworm (Trichuris trichiura): Prescribe mebendazole 100 mg twice daily combined with ivermectin 200 μg/kg once daily for 3 days, as combination therapy significantly improves cure rates in heavy infections 1
Pinworm (Enterobius vermicularis): Give albendazole 400 mg single dose or mebendazole 100 mg single dose 1
Tapeworms
Taenia saginata/solium: Administer praziquantel 10 mg/kg as a single dose 1
Hymenolepis nana (dwarf tapeworm): Use praziquantel 25 mg/kg as a single dose 1
Critical caveat: When Taenia solium is identified or species is uncertain, screen for neurocysticercosis before treatment 1
Protozoal Infections
Giardia lamblia: Prescribe nitazoxanide with age-based dosing: 100 mg twice daily for children 1-3 years, 200 mg twice daily for children 4-11 years, for 3 days (88% clinical response in HIV-uninfected children) 1
Cryptosporidium: Use nitazoxanide at age-appropriate dosing for 3 days, with essential supportive care and hydration 1, 2
When to Treat: Targeted vs. Mass Deworming
Treat all confirmed infections, even in asymptomatic children, to prevent transmission and complications. 1 However, the approach differs based on infection status:
Individual Treatment (Recommended)
Treat children with confirmed parasitic infections identified through stool examination 1
This targeted approach is supported by evidence showing that mass deworming programs in endemic areas have little or no effect on weight, height, hemoglobin, cognition, school performance, or mortality 3
Mass Deworming Considerations
While community-wide mass deworming may reduce prevalence more than school-based programs 4, recent evidence shows no meaningful impact on child health outcomes including growth, anemia, or cognitive development 3
The large-scale DEVTA trial involving over one million children found no effect on mortality with routine mass deworming 3
Diagnostic Approach
Submit at least 3 stool samples for examination when parasites shed intermittently, using concentration techniques (such as Baermann apparatus) to detect low parasite loads. 1
For Cryptosporidium specifically, request specific testing as it may not be included in routine stool studies, and use enzyme immunoassay or fluorescent antibody staining rather than acid-fast staining for enhanced sensitivity 2
Perform repeat stool examination 2-3 weeks after treatment for persistent symptoms 1
Administration Safety in Young Children
For children under 3 years old, crushing tablets creates significant choking risk and should be avoided when possible. 5
Choking risk with crushed tablets is 25.4% compared to 3.6% with whole tablets 5
When tablets must be crushed, avoid giving them to children who are fussy, fearful, combative, or struggling, as non-content demeanor increases choking risk 20-fold 5
Never use antimotility agents in young children with protozoal diarrhea due to safety concerns 1
Post-Treatment Monitoring
Conduct at least three stool examinations over three months following treatment to ensure eradication, as recrudescence can occur up to 106 days after ivermectin therapy. 6
For Ascaris lumbricoides specifically, single-dose albendazole may clear fewer than half of infections by 2-4 weeks, with reinfection rates returning to baseline by 12-16 weeks 7
This highlights the importance of addressing environmental contamination and hygiene practices alongside treatment 8
Prevention and Hygiene Education
Emphasize hand and fingernail hygiene with soap, adequate hydration with diarrheal symptoms, proper toilet use, wearing shoes in endemic areas, and thorough washing or cooking of fruits and vegetables. 1, 8
- For pinworm prevention specifically: wear tight underpants day and night (changed daily), vacuum bedroom floors for several days after treatment, wash bed linens and night clothes without shaking them, and keep toilet seats clean 8