DEAR DR. DONOHUE: My little boy started kindergarten this year. I tell you that so you can understand why this happened. I saw him scratching his rectal area, and I examined him and found he had scratched himself raw. I took him to the doctor, who said he had pinworms. I am distraught. I keep an immaculate house. Did my son pick this up at school? – W.R.

ANSWER: If pinworms have made you distraught, you can join the ranks of millions of similarly distraught mothers whose children have pinworms. Pinworms are no reflection on a mother’s housekeeping or on the family’s cleanliness.

You are probably correct. Your son likely picked up the infestation at his school. After scratching, pinworm eggs become lodged under the fingernails, and an infected child can then transfer the eggs to an uninfected child. It is also possible for pinworm eggs to be spread by clothing, bed linen or particles of egg-contaminated airborne dust.

After a child swallows the eggs, it takes about a month or two for the pinworms to mature.

At night, the female worm migrates to the anus and adjacent skin, where she deposits as many as 10,000 eggs. It’s the nocturnal meanderings of the female pinworm that cause the intense itch, which is usually worse at night.

To put your mind at ease, a single dose of medicine, repeated in two weeks, almost always gets rid of the pinworm problem. Family members are encouraged to take the medicine, too.

For a few days after he has taken the medicine, wash the boy’s underwear and bed linens in the hot wash cycle. Vacuum and dust his bedroom during the same time period.

On the bright side, pinworm treatment is quite effective.

DEAR DR. DONOHUE: I recently watched a TV documentary about two brothers, one of whom had Klinefelter’s syndrome. That boy was tall and lanky and had trouble with schoolwork.

I have two boys, and one of them is tall, thin and does poorly at school. I think he might have this, too. Where can I get it diagnosed, and can it be treated? – N.J.

ANSWER: Klinefelter’s syndrome is something that happens only to boys. An affected boy has an extra chromosome. Humans have one pair of sex chromosomes. Boys have the XY configuration, and girls, the XX configuration.

A boy with Klinefelter’s syndrome has an XXY complement of sex chromosomes. This is not an unusual condition. It happens to about one in 500 male babies. That makes it anything but rare. Sad to say, it is not always diagnosed.

Up to puberty, a Klinefelter boy is hard to spot, so subtle might be its signs. From puberty on, distinctive features begin to emerge. A Klinefelter boy tends to be slim, tall and long-legged. His genitals are often smaller than normal. Quite frequently these boys (and men) have larger-than-normal male breasts and sparse facial hair. Many have learning disabilities.

Blood testosterone level is low, so muscular development lags.

You can get Klinefelter’s syndrome diagnosed right in your own town. A pediatrician knows what to look for, and he or she can order blood tests that reveal the testosterone deficiency. The doctor can also arrange to have the boy’s chromosomes studied and the results will confirm or deny your suspicions.

Treatment of Klinefelter’s consists in supplying the missing testosterone hormone. It does not cure all Klinefelter signs and symptoms, but it does give the boy a normal body appearance.

Don’t let this stop here. For information on diagnosis, treatment and outlook, write to Klinefelter’s Syndrome and Associates at Box 119, Roseville, CA 95678 or visit its Web site at www.genetic.org/ks/.

DEAR DR. DONOHUE: I have had asthma for years, but only now has my doctor gotten an attachment, a long tube, to put on my inhaler. Why? – K.W.

ANSWER: That attachment is a spacer, and it helps the medicine in a spray get to the airways where it is needed. Without it, some medicine sticks in the mouth and throat.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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