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Head Lice

HEALTH SERVICES: HEAD LICE
You just found out that your child has lice and feel frantic. Don't! Take a deep breath and realize that you are not alone. Some 6-12 million children get lice each year in the US, which makes it more common than all other childhood communicable diseases combined (excluding the common cold). Following is some information that may be helpful to parents faced with the challenge of dealing with a case of lice.

Some common questions:

What exactly are lice?
Lice are human parasitic insects that live on the scalp and lays eggs in the hair. They are wingless, active, fast-crawling insects (they do not jump or fly) with a lifespan of approximately 23-30 days. Female lice can lay about150 eggs (nits) a month (approximately 3-6 each day) and eggs hatch in about 12 days, reaching maturity in another two. They feed on human blood every 3-6 hours but can survive 6-20 hrs. (And there have been reports of up to 2-4 days) off of a host. They like warmth (about 82 degrees) and humidity (around 70%) which is why they tend to be more commonly a problem during the summer and beginning of the school year. Lice are species specific- you can't give them to pets or vice versa.

How does one acquire head lice?
One has to come in contact directly or indirectly with an infested person in order to catch them. Children between the ages of 3 and 11 are most often affected, because of their willingness to share and their close proximity in play situations and at school. Most often, the transfer of live lice occurs through contact with something that has come into contact with an infected person's scalp. Such items include combs, brushes, hair accessories, hats, coats, shared clothing, towels, bedding, and so forth. We can do much to prevent spread of lice by educating our children about the importance of not sharing these items. Additionally, think about potential situations that enable lice to move about. How about that pile of coats on the floor or bed at your child's sleepover party?

I never knew anyone that had lice when I was growing up. How come now?
Lice have been around since the beginning or recorded time. And because it is not a reportable disease, statistics are not kept by the CDC. It is predicted that school reports are underestimated at best. Lice are tenacious and continue to be a persistent problem. Much has been learned however through the experience of millions of parents and health care providers.

"No US area is immune to pediculosis outbreak: all levels of society and all ethnic groups are affected, although prevalence among African-Americans in North America is extremely low. The age most affected is three to 11, with more infestations among children with brown or red hair than among those with black or blond hair. Fine rather than coarse hair seems to be attractive to infestation. Clean heads actually appear to be more appealing to lice than dirty or 'dandruffy' ones. Girls are slightly more susceptible than boys. Some children, for reasons unknown, are more prone to repeated infestations, while others are unaffected. Large families are infested more often than small ones, a factor that is directly related to proximity rather than to socioeconomic status. Frequently, the family members of an infested child may also have lice."

How do I know if my child really has lice since I've never seen them before?
The thing usually most noticed is that the child will start scratching their head frequently and complain of itching. This is caused by the louse saliva injected into the scalp when the louse feeds. However, as many as50% of children may never itch at all. Additionally, you may notice redness or sores around the base of the neck and on the scalp from scratching. The lice lay eggs very close to the scalp (about 1/4 inch away from the scalp), primarily around the hair line. The eggs are about 0.8 mm in length and may appear whitish, tan or quite dark, depending on stage of development. Empty cases look white, those ready to hatch appear dark. They can look a lot like dandruff, but are more uniform in appearance and do not come off if you flick them with your fingernail. In fact they are laid with an extremely strong glue-like substance that attaches the eggs to the hair shaft extremely well. If you have any doubt, call the school nurse and she will be happy to double check for you. It is imperative to notify the school nurse (if school is in session) and any parents of children your child may have been with in the last few weeks. It is much easier to take care of in the early stages.

So now what do I do?
Get an approved shampoo designed to treat lice infestations at your neighborhood pharmacy. These are sold OTC and should contain one of the following active ingredients: Pyrethrum (Clear, Rid, Pronto) or Permethrin (Nix). It is extremely important to follow the directions on the bottle TO THE LETTER. Most require that you apply them to DRY hair. This is because lice have the uncanny ability to shut down their breathing apparatus for 1/2 hour or more when immersed in water, hence their survival when children swim all summer. While at the store, also pick up a large bag of hair pins, a nit comb, extra laundry detergent, snacks for your child, a toy for bribery, and perhaps a bottle of wine. Do NOT be tempted to buy any of the lice sprays. They are toxic and are a waste of money. Next, stop at the video store and pick up a bunch of kid videos. Finally, cancel ALL your appointments for the next couple of days as you will be VERY BUSY. Unfortunately, this is not one of those things you can hire someone to take care of for you.

To begin, treat your infested child with the shampoo, and check everyone else's head in the family. Only shampoo other family members if they have nits or lice. Don't do this on a preventative basis because there is no way to prevent them and all these shampoos have some toxicity associated with them. The shampoo will hopefully kill all the lice on your child's head and will kill MOST of the nits. Be advised, however, that there is NO product on the market which will kill 100% of nits, which is why it is imperative that they be removed manually before you can consider yourself home free. This is also why most brands recommend a 2nd shampooing in 10-14days, in case a resistant nit or 2 or 3 survived the first go around. There have been many reports of lice that have become resistant to pyrethrin and permethrin, but even so, if nit removal is complete, this should not be reason to cause undue concern. Once the shampooing is accomplished, set your child in a comfortable chair in a room with a very good light source (fluorescent is great), put a video in, and begin removing the nits. Regardless of how many there are to start with, you need to proceed systematically so that you don't miss any of them. Part the hair, clip excess aside and work with approximately one square inch of hair at a time, pulling nits off with the nit comb initially ( wipe the nits removed onto a piece of tissue with each combing) and removing the remainder by pulling them all the way off the hair shaft between your fingernails. (And you wondered where the expression "nit-picking" came from?) Once a section of hair is completed, twirl that strand around your finger and pin it, then proceed to the next section. Do the entire scalp in this fashion and then take a break. Throw away all those tissues, soak all the combs and brushes in the house in HOT water (130 degrees min.) for 10 min., and get ready for some major house cleaning.

Your child's bedding and towels need to be stripped and washed in HOT water or dried in a HOT dryer for at least 20 min. Also wash the pillows and mattress liners if there are any. Wash all the clothes your child has worn in the last several weeks in HOT water or dry them in a HOT dryer as well. So as to not drive yourself crazy with laundry, select enough clothing for your child to wear for the next two weeks, and bag up everything else in their dresser and closet in plastic bags and keep them in these plastic bags for a full two weeks. This should suffocate any lice and nits that may hatch. Also do the same with all their stuffed animals or soft toys(perhaps wash a few if they are mandatory for bedtime). Bag them for 2weeks. Also wash all jackets, coats and hats or scarves. Any of these can be dry cleaned if preferred. Once this is all accomplished, vacuum the ENTIRE house thoroughly, including ALL upholstered furniture, all carpeting, and mattresses. Don't forget to vacuum out the cars as well. At this point, you should be fairly well exhausted. But do yourself a favor and go over your child's head again and keep removing nits as you find them because you almost NEVER get them all out on the first go around. If you have someone to share the burden, take turns.

Removing nits from a scalp is tedious, frustrating work. Take your time, take breaks (for your sanity as well as your child's) and reinforce to the child that he or she is not at fault. Reports of resistance have frustrated many parents to the point that they have experimented with all kinds of alternative treatments. Many of these have been tried and documented on various web sites, and there are lots of anecdotal stories supporting much of their use. Most are based on the idea of smothering or suffocating lice for a long period of time. One well-touted method is to use Hellman's mayonnaise, and to cover the entire scalp with a full jar of this stuff, cover with a shower cap and then let it sit for 4-6 hours before then shampooing it out. While this probably does kill the lice and will soften the hair, it is messy, and will still require the removal of all the nits. But if you are averse to using the chemical shampoos, this is a reasonable option. If you have difficulty shampooing out the mayonnaise afterwards, consider trying Dawn liquid detergent. It is supposed to help. Another product on the market, called "Not Nice To Lice" is made by a local company, Ginesis of Ohio. This is an enzyme-based product which is supposedly safe and non-toxic. I have no personal experience with this product and am not promoting it, but if interested, their phone number is 216-524-8415. Or toll free: 1-800-266-6394.

If school is in session, it is required that you have the school nurse check your child's head before returning to school. So call the nurse and schedule a time to bring your child in for checking. Beachwood has a live lice free policy, so if your child is found to still have live lice, he or she will be sent back home.

Head Lice Resources: