Deworming: It’s one of those rites of passage for an Indian parent, on par with vaccines and vitamins. Many of us follow the timeworn practice of our own parents or pediatricians, administering regular deworming medication to our kids even if we’re not sure they need it. Better safe than sorry, some think. But as sanitation improves in India’s metros, this health habit is falling behind the times.

Also known as helminths, worms include a variety of parasites that can reside in the intestines or blood stream, sometimes for many years, weakening you and depleting your stores of nutrition imperceptibly. Roundworms and hookworms are some of the most common types.

“Most children with worms remain without symptoms, and are diagnosed by coincidence by passing a worm in the stools or vomiting one,” says Dr Parang Mehta, a Surat-based pediatrician and head of Mehta Childcare. “The World Health Organization recommends routine deworming for children only in places where worm infestation is commonplace.”

India, unfortunately, is a place where infestation is commonplace. Our country ranks sixth, out of the 25 most populous nations, in the UNDP’s worm index. But not all parts or people of the country are equally susceptible to worms. Hygiene is a major factor in the spread of worms, meaning people living in areas – both rural and urban – with poor sanitation are most at risk.

Most types of worms are transmitted by ingestion. It could be as simple as touching an egg-infested surface, then touching your mouth. (Eggs are not visible to the naked eye.) Or, it could happen by consuming unwashed vegetables, especially leafy greens like lettuce, inadequately cooked meat, or unclean water. Some worms (roundworms, whip worms and hookworms), however, are found in the soil, due to outdoor defecation — not uncommon in both rural and urban areas. These worms emerge from the waste of an infested person, enter the soil, and thus, enter the bodies of others by piercing the soles of their feet. It’s not something people can feel.

Which is all to say it’s possible to be infected without ever knowing.

PREVENTION

First, know that any medication to treat worm infestation is not recommended for children under the age of 1 year, as side effects can be severe in a child so young.

While anyone at any age can contract worms, preschool-age and school-going children (ages 3-6) are some of the most likely to contract and spread worms through outdoor play and thumb sucking. In light of this, some doctors advise medication every six months to a year as a preventive measure. There is growing dispute to this practice, however, particularly for India’s urban elite.

“Routine administration of deworming drugs to apparently healthy children does not carry important benefits, especially for urban children who have safe food and water and do not venture out of the home without shoes,” Dr Mehta says. “The evidence for benefits — in terms of growth, development, school attendance, better nutritional status, and better hemoglobin level — is not significant.”

But if you’re still of the better-safe-than-sorry mindset, Dr Mehta says there’s likely no harm in preventative medication.

“All drugs have side effects, of course,” he says. “But deworming agents used today are relatively safe.”

Guarding against infestation to begin with is an equally good course. Dr Mehta advises taking these precautions:

• Avoid going barefoot in public places. Mud and gravel pose more of a threat than cement, so it’s possible to contract worms through the soil even in ‘clean’ spaces, like a housing society lawn or club park.
• Wash vegetables thoroughly before cooking. While most types of worms are visible to the naked eye, they are tiny (less than a centimeter long) and easy to miss or mistake for thread. Eggs, on the other hand, are not visible to the eye. Regardless, washing vegetables thoroughly will help prevent infestation.
• Cook meat thoroughly. For the same reasons it’s important to clean vegetables, make sure your meat is cooked thoroughly so that – on the chance it is infested – the eggs are killed by the heat.
• Keep your nails trimmed and clean. Worm eggs are usually transmitted by hand, living for long periods under the fingernails. Long nails make it easier to trap and spread worm eggs.
• Wash your hands thoroughly with soap. This includes scrubbing under your nails for the reasons above. (And no, sanitizer isn’t just as good.)

TREATMENT

When the infestation is severe, medication is definitely required, says Dr Mehta, as long-term effects can be dangerous. Symptoms of a severe worm infestation include:

• Body weakness, lack of apetite, inexplicable weight loss (all worms)
• Teeth grinding during sleep, disturbed sleep (all worms)
• Anemia (hookworm)
• Fever of 100 F or above (whipworm)
• Wheezing, shortness of breath, dry cough (whipworm)
• Abdominal pain (roundworm, tapeworm)
• Vomiting, indigestion (tapeworm)
• Itching in the rectal area, usually at night (pinworm)
• Diarrhea (tapeworm)
• Bloody stools, painful and frequent defecation (whipworm)

In fact, in such a situation, medication is required for the whole family. Because worms are so easily and unconsciously spread, reinfestation is a very common problem, and doctors recommend treating anyone living or working in the same home as an infested person, including family members and domestic help.

Ultimately, if you’re worried about a worm infestation in your family, the best thing to do is consult your doctor.