“They’re back for the third time — I need tablets for all of us this time, me included”

Recurrent threadworm is usually reinfection, not treatment failure. Mebendazole kills the worms but not the eggs, which survive on hands, nails, bedding and surfaces for up to two weeks, so the whole household should be treated at the same time and everyone should follow hygiene measures for 6 weeks. CKS: offer mebendazole to household members aged 2 and over as a single dose, repeated after 2 weeks if infection persists (check the SPC/local formulary); children aged 6 months to 2 years can be treated off-label; pregnant women (especially in the first trimester), breastfeeding women and children under 6 months should use hygiene measures alone for 6 weeks. Always ask about pregnancy and breastfeeding before advising treatment for adults. Threadworm commonly causes vulval itching and soreness in girls, but a parent’s worry about sexual abuse must be explored calmly and taken seriously: ask about disclosure, behaviour change, bleeding, discharge and who has access, and know when to discuss with the safeguarding lead or refer. Families in temporary accommodation with shared facilities face real barriers to hygiene advice, so adapt it to what is possible. In England, B&B-type accommodation with shared facilities should not be used for families with children for more than 6 weeks (Homelessness (Suitability of Accommodation) Order 2003), so a supporting letter and involvement of the health visitor and midwife are part of good care. UKHSA guidance sets no exclusion from school for threadworm.