Dear Doctor,

My child is now eight months old and crawls around putting almost everything in his mouth. I think he is teething. My questions is, with all this dirt that he picks, is it wise to de-worm him? My sister says it is okay and says there is de-worming medicine available for babies in pharmacies but I’m not sure about it. What are the effects? Is it too soon?

Eunice

Dear Eunice,

An eight-month-old child tends to crawl around inside and outside the house. He may crawl over damp wet surfaces even mud. In this process, mud and grime can stick to his body, which may be carried to his mouth and ingested by his fingers. He may unknowingly ingest dirty water, mud clay, whatever is at hand.  As gums become swollen for preparation of eruption of teeth, one or two teeth may already have erupted, causing pain over gums. He likes to put objects in his mouth as chewing over it soothes the painful gums. Besides, he sees no harm in putting any object lying around in his mouth. In this process as well, he is exposed to various kinds of germs entering the body. Even teethers specifically made for babies are not safe. A baby can put it in his mouth, throw it out on the ground and then put it back again, causing microbes to enter in his body in big numbers.

A baby’s immune system is not developed enough to fight these infections. Hence he/she is more prone to develop sickness due to worm infestation. These worm infestations make a baby repeatedly sick. There can be a range of diarrhoeal diseases with or without vomiting, fever, loss of appetite, bloating of abdomen, abdominal colic, one or more of these symptoms. Some worms like tape worms can affect brain, schistosomes can affect liver, kidneys. The child becomes irritable and cries frequently instead of playing cheerfully. His belly also becomes swollen and painful to touch, making him cry whenever it is touched.  Besides, his nutrition is also affected due to repeated worm infestations. A baby grows constantly at this age. Growth of a baby is also affected due to repeated worm infestation.

Since many of the situations causing worm infestations in a toddler are unavoidable, it is better to de-worm the child every six months. Since these drugs eradicate the adult worms but not the larval forms, hence, it is advisable to repeat it every six months.   Even World Health Organisation (WHO) has included regular de-worming of toddlers and small children as a campaign for prevention and eradication of worm infestation in children. The drugs commonly used for this purpose are albendazole and mebendazole. They are generally very well tolerated. Common side effects are diarrhoea, abdominal pain, dizziness, body ache, and etcetera. But the benefits of these drugs outweigh the side effects; hence one should not hesitate to use them.

Preventive measures are equally important to minimise risk of these infestations in toddlers. These include good hygiene of baby and his surroundings, washing teethers regularly, and putting other objects out of reach.

Dr Rachna is a specialist in internal medicine at Ruhengeri Hospital.

rachna212002@yahoo.co.uk