By Dr. Cristina Mitchell
Hillside Family and Community Medicine
It’s that time of year again. In the last month or so, head lice infestations have been reported at several area schools. These infestations are fairly common, as are parental overreactions. Yes, lice are icky and the mere thought of them make us itch; however, they are relatively easy to treat and do not carry or spread disease. Lice infestations are common among school-age children, and are NOT an indication of poor hygiene. They are spread by head-to-head contact and possibly the sharing of hats, combs, brushes, and other hair accessories. Head lice are only interested in humans. They are not spread by pets and cannot fly or jump, and can survive off the human host for less than three days.
Looking for Lice
If lice have been reported in your child’s classroom or school, it is a good idea to do a head check, especially if you notice your child scratching. The itching is caused by a local allergic reaction to lice saliva. Lice can be hard to see, so using a bright light and magnifying glass, and separating the hair can help. During an infestation, a child or adult will usually have fewer than twenty live lice. Look for live lice or their eggs (nits) which are glued onto the hair shaft at an angle. And, if you find lice on one kid, you probably want to check the others . . . and yourself.
If you find lice, the next step is to kill them. The most effective treatment is permethrin, available over the counter as Nix. This is the least toxic of the available treatments and fairly easy to use. It is most effective when applied to dry hair. You must also remove the nits and any live lice that remain once the treatment application is complete. This can be done with a nit comb, which is typically included in the package or can be purchased separately (brand name: Lice Meister). A recent study showed that plastic combs were as effective as metal and easier to use. Using conditioner to make it easier, thoroughly comb through small sections of the hair. Finding nits or lice when you comb does not mean the treatment didn’t work. You should comb out the hair every three days until you stop finding nits or lice. The permethrin treatment can be repeated after seven days.
Other prescription treatments are available through your doctor but these tend to be more toxic and are generally reserved for lice that are resistant to permethrin.
All bed linens and recently worn clothing and hats should be laundered in hot water and dried in the dryer. Combs and brushes should be soaked in hot water for ten minutes. Things that cannot be washed should be vacuumed. Bleach is unnecessary, as are lice sprays.
There are many alternative treatments for lice. Most are not as effective as permethrin, and few have been formally studied. Lice are fairly difficult to kill by suffocation, but this can be done by coating the hair with olive oil, mayonnaise, or petrolatum (Vaseline) and covering the head with a shower cap. This can take up to six hours to kill all the lice, and the oil or petrolatum can be difficult to get out of the hair. Using a nit comb alone can be effective but takes multiple treatments and can be very time consuming. Shaving the head is only temporarily effective and therefore not recommended. Heat (hair dryers, etc), which seems to work only about 50 percent of the time, is also not recommended.
Bottom Line: Don’t freak out!
Yes, lice are gross and make our skin crawl, but they won’t harm your child and are easily managed. Keeping the hysteria to a minimum helps everyone through this situation. If you have more questions, contact your family doctor or pediatrician.
Dr. Cristina Mitchell is a family doctor at Hillside Family and Community Medicine and a contributing writer for Kidoinfo. She shares her knowledge and expertise related to health issues for kids.