By: Sean Reynolds MB, BCh, BAO & Matthew Mahoney, DO
Have you noticed your little one scratching their bottom? Anal itching (pruritus ani) is common among children. This uncomfortable condition can have a variety of causes. Thankfully, most of these causes are easily treatable.
Here are a few of the most common reasons for anal itching in kids and how they're treated.
Pinworms
The most common cause of anal itching is
pinworms. Around 20% of all children in the United States will be affected by pinworms at some time in their lives.
What are pinworms?
Pinworms are very small parasites that can live in the intestines of humans. They are the most common worm infection in the United States.
Fortunately, pinworms do not cause intestinal problems or transmit any other germs or infections. But pinworms can cause intense itching when they crawl out of the intestine to lay their eggs. This mostly happens at night.
What symptoms do pinworms cause?
Most children with pinworms have intense itching of the perianal (around the anus) area. This is worse at night or in the early morning. That's because pinworms tend to emerge from the anus and lay their eggs on the outside skin when the child is asleep. Some children with pinworms have no symptoms.
How does someone get pinworms?
Pinworms are very contagious and often spread from child to child.
Pinworm infections spread when a child ingests microscopic pinworm eggs. This usually happens when a child who is infected gets pinworm eggs on their hands while using the toilet. Then, they touch surfaces shared by others. Examples of shared surfaces where pinworm eggs can spread include toys, bedding, clothing, food, toilet seats, doorknobs and faucet handles.
How are pinworms diagnosed in children?
The information you share about how your child is feeling and behaving can help the doctor diagnose pinworms. Sometimes, pinworms can be seen on the perianal skin around 2-3 hours after the child falls asleep. The pinworms look like a moving white thread that is around ¼ inch long. Stool tests are not useful as worms and eggs are not typically passed in stool.
What is the treatment for pinworms?
Thankfully, the treatment for pinworms is relatively simple. Your doctor will recommend a medicine for your child to swallow one time, and then to take again 2 weeks later.
All the children in your home should be treated at the same time, even if the others are not itching. The sheets, blankets, towels and clothing should be washed in hot water and dried in the dryer on a hot setting. Try not to shake items—this will scatter the eggs. It usually takes around one week before the itching stops.
Other common causes of anal itching in children
Perianal strep
Just as children can get a
strep throat infection, they can also get a strep infection of the skin around the anus.
Perianal step (A Streptococcus) infection is common in children between
6 months and 10 years old. It leads to a rash, itching and sometimes pain.
The perianal rash usually looks like a bright red ring around the anus. Perianal strep is diagnosed with a skin swab that is sent to the lab, similar to how strep throat is diagnosed. This test can be done by any medical provider.
Perianal strep infection is treated with antibiotic medicine taken by mouth.
Skin irritation
Skin irritation is another common cause of anal itch. The cause for the irritation can be many things, Examples include tight clothing, poor toilet hygiene or products like packaged wipes, bubble bath, soaps or cleaning products.
When the skin gets irritated, it gets itchy. Then, scratching irritates the skin more. This leads to more itching. It's called the itch/scratch cycle.
The best way to help skin irritation around the anus is to prevent it from happening in the first place. Avoid children's products that contain fragrance, like bubble bath and scented soaps. Small children should also get help to wipe the area clean after toileting.
For children who already have skin irritation, it helps to wipe after toileting with a wet washcloth instead of dry toilet paper. This will be less irritating and help healing. Packaged, pre-moistened wipes can be convenient, but some children will develop a rash to the ingredients in these products, too.
Protecting the affected skin with petrolatum ointment or zinc oxide paste (the ingredient in many
diaper rash creams) is a good first treatment. If the problem doesn't improve, talk with your child's doctor for guidance about additional treatments.
More information
About Dr. Reynolds Sean Reynolds MD, BCh, BAO is a pediatric dermatologist at Children’s Mercy Hospital, Kansas City. He is an Assistant Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine.
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About Dr. Mahoney
 Matthew
Mahoney, DO is a pediatric resident physician at the University of Minnesota
and M Health Fairview Masonic Children’s Hospital. He has a special interest in
pediatric dermatology and is a member of the American Academy of Pediatrics
Section on Dermatology Education Committee.
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