Worm infestation, medically referred to as helminthic infestation, remains one of the most common yet under-recognised health problems affecting children in India. Helminths are parasitic worms that can infect humans, and they broadly fall into three main groups: roundworms, tapeworms, and flukeworms. While most intestinal worms primarily affect the gut, certain species can also involve vital organs such as the liver, lungs, and even the brain.
They are more commonly seen in regions with inadequate sanitation and unsafe water sources. Studies and field observations show that prevalence remains significantly higher in rural areas at about 91%, while urban areas report lower rates around 33%, largely due to better hygiene practices, improved sanitation, and access to clean drinking water. Despite progress, worm infections continue to affect a large number of schoolchildren across both rural and peri-urban locations.
Worms commonly enter the body through two major routes: by ingestion of worm eggs through contaminated food, water, soil, or unwashed hands and the other is due to direct skin penetration by larvae, particularly when children walk or play barefoot on contaminated soil.
In some worm species, the larvae travel through the bloodstream to reach the lungs or brain, which explains why symptoms are not always limited to the digestive system.
Symptoms: Often silent, sometimes severe
The clinical presentation varies depending on the type of worm and the number of worms present in the body. Many children remain asymptomatic, especially when the worm load is low. While others may experience abdominal pain, crampy abdomen, diarrhoea, bloating, excessive gas, nausea, vomiting, and loss of appetite. This may lead to reduced food intake, which can lead to fatigue, weight loss, and poor growth. Some children present with perianal itching, particularly at night during sleep. This symptom is commonly seen in pinworm infections, but can also be reported with other intestinal parasites.
One of the most serious consequences of chronic worm infestation is anaemia. Iron-deficiency anaemia is commonly caused by hookworm and whipworm infestations, as these worms lead to chronic blood loss from the intestine. The affected children may appear pale, irritable, with reduced attention span, increased hair fall, poor academic performance, and be easily tired. Some children have PICA, a condition where they crave non-nutritive substances such as chalk, paper, paint chips, or raw rice, further worsening nutritional deficiencies.
Another form of anaemia, vitamin B12 deficiency, can be associated with Diphyllobothrium latum (fish tapeworm) infection. These children may present with weakness, tiredness, breathlessness, swelling of hands and feet, and poor concentration. In severe cases, untreated anaemia may progress to the extent that some may need a blood transfusion.
Ascaris lumbricoides (roundworm) can migrate to the lungs, causing Loeffler’s pneumonitis, which may present as fever, nocturnal cough, breathing difficulty, and wheezing. in children characterised by transient lung symptoms due to larval migration.
Taenia solium (pork tapeworm) can cause infection of the central nervous system (brain and spinal cord), presenting with Seizures, Headache, vomiting, and diplopia/blurring of vision/squint.
Worm infestation can lead to growth failure, stunting, and developmental delays. The reasons are reduced appetite and poor calorie intake, anemia, and poor sleep due to itching, especially at night.
Over time, these factors result in poor physical growth, reduced cognitive ability, low attention span, and decreased productivity, effects that can extend into adulthood if not addressed early.
While worm infections can occur at any age, schoolchildren are at the highest risk due to increased exposure to contaminated soil, outdoor play, and developing hygiene habits. This is why school-based public health interventions play a critical role.
When it comes to treatment after infestation, some may not respond adequately to initial treatment. In such cases, further evaluation, including stool examination or perianal swab tests, is done to identify the specific parasite, followed by targeted therapy. Importantly, deworming is recommended for the entire family, as household members may unknowingly act as carriers, leading to repeated reinfection.
Prevention: Simple steps, big impact
Preventing worm infections is possible through basic hygiene and sanitation measures:
Avoid open defecation; always use toilets
Wash hands thoroughly after using the toilet and before eating
Keep nails trimmed and clean
Wash fruits and vegetables thoroughly
Consume only properly cooked and covered food
Drink boiled and cooled water or use RO-filtered water
Wear slippers or footwear while walking outdoors
Follow bi-annual deworming as per age guidelines
Worm infections may be silent, but their impact on a child’s growth and development is profound. Regular deworming, good hygiene practices, proper nutrition, and community awareness are essential to break the cycle of infection. Parents, schools, and caregivers are urged to ensure that no child is left behind in the fight against worm-related anemia and poor growth.
- by Dr Aparna G, consultant paediatrician, Rainbow Children’s Hospital, Chennai.