A: Jennifer, hookworm is an intestinal infection that is spread by poor sanitation and contamination of the soil with human and animal feces. It is mainly found in tropical and subtropical countries, where it is estimated that one in five people are infected. Hookworm is uncommon in the United States because of improved sanitation, but it is occasionally found in the Southeastern states.

You are correct that hookworm can be caught by walking barefoot. The tiny, immature form of the worms, which are barely visible, burrow through the skin. They travel through the bloodstream to the lungs and then into the intestine, where they develop into adult worms approximately ½ inch long. The worms’ microscopic eggs come out in the stool.

Many people with hookworm have no symptoms. But it can cause an itchy rash, loss of appetite, nausea, diarrhea, abdominal pain, anemia, pale skin, fatigue and growth problems. If you think your child might have hookworm, talk with your doctor about the need for a stool test for parasites. There are antiparasitic or “deworming” medications that successfully treat hookworm infection.

If you live in an area where hookworms are common, it is important to take measures to prevent infection:

• Go to the bathroom only in toilets or latrines.
• Always wear shoes when walking outdoors.
• Don’t allow your children to play in areas with feces and sewerage, such as drainage ditches and garbage dumps.
• Avoid working in soil that is contaminated with feces.
• Wash your hands after working or playing outdoors and before handling food.
• Work in your community for better sanitation.

If you live in an area where hookworms are uncommon, you don’t have to worry much about it. You could let your children run barefoot on the grass in your yard, as long as it is not contaminated with feces. But remember, in general it’s good for children to wear shoes outdoors to also protect them from cuts, splinters and bee stings.