Deworming in Children
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Direct answer
A single 400 mg chewable albendazole tablet given on National Deworming Day — 10 February, with a second round on 10 August in high-prevalence states — to every child from one to nineteen years is India's mass answer to soil-transmitted helminths; the dose is halved to 200 mg for ages one to two. The programme targets roundworm, hookworm and whipworm, the drivers of iron deficiency anaemia and impaired growth that make deworming a nutrition intervention, not merely an anthelmintic one. Pinworm, the itchy-perianus parasite of preschool years, is treated differently: albendazole repeated after two weeks, with the whole family treated together.
What you must remember
- National Deworming Day: school- and Anganwadi-based mass albendazole — 400 mg single dose for ages 2–19 years, 200 mg for 1–2 years — no fasting, no purgation, with a mop-up round days later for absentees.
- WHO strategy: annual mass deworming where soil-transmitted helminth prevalence is 20–50 per cent, semiannual above 50 per cent — India's high-burden states run the twice-yearly schedule.
- Roundworm (Ascaris) is the commonest soil-transmitted helminth in India; heavy loads occasionally cause intestinal obstruction or bile duct migration.
- Hookworm causes chronic occult blood loss and is a leading infectious cause of iron deficiency anaemia in school-age children; larvae enter through the skin of bare feet — footwear is prevention.
- Whipworm (Trichuris) causes dysentery-like diarrhoea with tenesmus and, when heavy, rectal prolapse; its lemon-shaped ova appear in stool.
- Pinworm (Enterobius) causes nocturnal perianal itching; diagnosis is the morning cellophane-tape test, because eggs are deposited on perianal skin, not in the bowel lumen.
- Pinworm regimen: albendazole 400 mg once, repeated after two weeks, with every household member treated simultaneously plus nail trimming and morning washing — autoinfection defeats single-person treatment.
- Side effects in mass use are mild — abdominal discomfort, nausea, diarrhoea; the dose is deferred in known first-trimester pregnancy and in children acutely unwell that day.
- The tablet rides with sanitation: footwear, toilets, safe water, handwashing and washed vegetables, since reinfection follows within months where soil stays contaminated.
A clinic day and a programme day
Two children illustrate the two faces of deworming. The first, a four-year-old brought for "worms in the stool" after a dose last week, expelled a roundworm, is thriving, and needs only the advice: repeat dose at the next National Deworming Day, shoes outdoors, washed vegetables, handwashing — a programme-style encounter. The second is a six-year-old with three weeks of night-time perianal itching and disturbed sleep; the morning tape test shows the colourless spindle-shaped eggs. She gets albendazole 400 mg now and a repeat in two weeks, her parents and brother are dosed the same day, bedding is laundered, nails cut, and morning perianal washing explained — because eggs laid overnight re-enter via fingernails and restart the cycle within days. The examinable contrast is exactly this: mass single-dose albendazole for the soil-transmitted trio, versus tape-test diagnosis, a two-week repeat and family-wide treatment for pinworm. Mixing the two protocols is the standard trap.
Where students slip
The dose-by-age error leads — 400 mg is not for the one-year-old, and 200 mg is not "half a tablet for anyone small". Second, forgetting the pinworm repeat at two weeks plus family treatment; a single dose to the index child fails within a month. Third, ordering stool microscopy for pinworm — the eggs are on the perianal skin, so the tape test is the answer. Fourth, treating mass deworming as an anaemia cure: it removes one driver, but the response needs the iron-folic acid schedule and diet alongside. A gentler point: a child with a mild cold on deworming day still gets the tablet — only vomiting within minutes or acute illness defers it.
Frequently asked questions
What is the dose of albendazole on National Deworming Day?
400 mg chewable single dose for children aged 2–19 years and 200 mg for ages 1–2 years, given at schools and Anganwadi centres on 10 February, with an August round in high-burden states.
Which worms does the mass programme target?
The soil-transmitted helminths — roundworm, hookworm and whipworm — which impair growth, nutrition and school performance and drive anaemia.
How is pinworm infection diagnosed?
By the morning cellophane (Scotch) tape test pressed on the perianal skin, showing typical eggs; stool microscopy is usually negative because eggs are deposited outside the gut.
How is enterobiasis treated properly?
Albendazole 400 mg once, repeated after two weeks, with simultaneous treatment of all household members plus nail trimming, morning washing and laundering of bedding.
What are the side effects of mass albendazole?
Mild, transient abdominal pain, nausea, diarrhoea or headache in a small fraction; it is avoided in known first-trimester pregnancy.
Why does deworming need sanitation alongside?
Reinfection from contaminated soil, unwashed vegetables and bare feet follows within months — footwear, toilets and handwashing close the loop the tablet alone cannot.