Threadworms: Why We Need to Talk About Them

Ok, so this might not be a popular discussion, but one that I feel is much needed. For those that don’t know much about them, here is the NHS information and guidance.

My reason for this discussion is partly because I have an interest in the medical links to behaviour and well-being, particularly in autistic individuals. And threadworms (also known as pinworms) are surprisingly common.

It’s estimated that threadworm infections are among the most common parasitic infections in children .A 2019 review found that up to 61% of children in certain populations tested positive for threadworms, although in Europe it is estimated at around 20% in the aged 4-11 age group.

Here are some of the risk factors identified:

·       Age: Younger children, especially those under 10, are more likely to be infected due to immature hygiene habits.

·       Gender: Boys were found to have a slightly higher prevalence, though the reasons remain unclear.

·       Large family size: Living in households with multiple children increases the chance of transmission.

·       Poor hand hygiene: Infrequent or ineffective hand washing was a significant contributor.

·       Nail-biting and finger-sucking: These behaviours facilitate ingestion of eggs from contaminated surfaces.

·       Shared sleeping arrangements: Co-sleeping with infected individuals increases exposure risk (Wendt et al., 2019).

What’s less often discussed is how this affects autistic children, who may be at increased risk due to a combination of behavioural and sensory factors. For example, PICA (the compulsive eating of non-food items) is significantly more common in autistic children, with studies suggesting up to 60% may engage in PICA behaviours (NeuroLaunch, 2024), much higher than in the general population. This naturally increases the risk of ingesting threadworm eggs, which can survive on surfaces for up to two weeks (NHS, 2023).

Additionally, autistic children may struggle with hand washing routines. Support might need to be given such as using a picture routine to show the sequence of events.

Communication challenges also play a role. Many autistic children may not be able to express that they have an itchy bottom, which is one of the symptoms of threadworms. This may lead to increased irritability, sleep disturbances, and behavioural changes. Research is limited in this area, but it seems to me it makes sense for this to be more frequent than in the typical population. It is often a question that I ask families when working one to one, and some individuals were found to have them present. It might lead to difficulties with regulating, being able to sit still and sleep difficulties.

References

NeuroLaunch (2024)  https://neurolaunch.com/treatment-for-pica-in-autism/

NHS (2023)  https://www.nhs.uk/conditions/threadworms/

Wendt S, Trawinski H, Schubert S, Rodloff AC, Mössner J, Lübbert C. (2019) ‘The Diagnosis and Treatment of Pinworm Infection’, Dtsch Arztebl Int. 116(13) pp.213-219.