Nitpicking: How to manage and treat head lice

That note in the backpack that brings fear and loathing to every parent: there is a case of lice in your child’s class! While getting rid of these pesky creatures is truly a nuisance, it is not a cause for concern. Lice are not dangerous. They do not spread viruses or bacteria and they pose no health problems, but they are extremely annoying.

Lice are tiny parasites that live in hair and feed on tiny bits of blood from the scalp. Lice themselves are small, but can be seen with the naked eye. The adult louse is about the size of a sesame seed and is white or tan in color. They lay eggs called nits at the base of the hair shaft. It is more common to see the presence of nits then the lice themselves. Nits are tiny white yellow dots that appear somewhat like dandruff. However, they are very sticky and cannot be removed simply by brushing or shaking them off.

Are they contagious?

Lice are extremely contagious and often spread quickly in places where children are in close contact, such as school, daycare or sports teams. Direct contact with the head of an infected person is the most common mode of transmission. Lice do not jump or fly, and are not transmitted by pets. They can be transmitted by sharing items such as hats, brushes and towels. It is important to remind your child not to share these types of items.

What are the symptoms to look for?

The saliva of the louse causes local irritation and the scalp becomes itchy. Small red bumps may form from scratching. Some children do not notice any reaction at all while others may note the sensation of something moving on their scalp. If a parent suspects lice, they should check their child’s hair by combing it into sections looking for lice and nits. It is common to find them at the nape of the neck and behind the ears.

They are there, what do I do now?

Fortunately, there are many safe treatments for lice. The most readily available over the counter treatment is one percent permethrin. This medication is toxic to lice, but safe and well tolerated in humans over two months of age. A second treatment is indicated seven to 10 days later. There are a growing number of prescription medications such as malathion, spinosad, ivermectin and benzyl alcohol five percent.

Lice may be resistant to certain medications in some geographic regions. Parents should consult their pediatrician if they are having problems eliminating the infestation. Petroleum jelly, mayonnaise and olive oil have been used in an effort to suffocate lice; however, these treatments are not as effective. Parents should avoid using cream rinse or conditioner prior to using lice medication and avoid washing their child’s hair for two days after using a medicated treatment. Nits can be removed with a finely toothed comb. There are some over the counter medications to loosen the nits and make them easier to remove.

How do I prevent spread at home?

Everyone at home should be examined for lice and treated if they are infested. Children who share a bed should be treated prophylactically. Lice do not survive off the scalp for more than two days. It is helpful to wash any clothing, towels or linen used 48 hours prior to the diagnosis in hot water and dry them on high heat. Items can be dry cleaned as well. Pillows and stuffed animals should be placed in a sealed plastic bag for two weeks.

When can my child return to school?

Many schools have very specific policies regarding when a child can return to school. Affected children should be treated promptly with an effective lice medication and then be allowed to return to school.

Lice affect children of all ages in all geographic areas and are not a sign of poor hygiene. While lice cause a great deal of annoyance and frustration, in the end, there is a cure.

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