As the kids head back to school we begin to receive calls about head lice. Lice are not a major health problem, since they do not transmit diseases or cause permanent problems. They can cause the scalp to itch and prompts a call home from the school nurse.
What Do They Look Like?
Head lice are crawling insects that are grey to tan colored and about the size of a sesame seed. They particularly like the hair around the back of the neck and around the ears. The tiny white eggs, or nits (empty eggs), are firmly attached to the hair shaft near where the hair starts from the scalp. You can tell it is an egg when you rub your fingers over it and it cannot be removed from the hair shaft.
How Did My Child Get Head Lice?
Lice do not fly or jump from person to person. The travel from one person to another when heads of hair are touching or sometimes when we share infected hats, combs, etc. Lice live only on human hair. Animals do not have lice. Lice can only live for a day when not on our scalp. It is uncommon to find live lice on bedding and pillowcases or floors.
How Do I Prevent Head Lice?
It is important to avoid head-to-head contact with other people. Avoid sharing brushes, combs and hats.
How Do I Get Rid Of The Lice?
The first question to ask is do I really have head lice? It is common for people to have white or tan flakes in the hair and scalp. You would only want to treat a child for head lice if you see the live (moving) lice or eggs close to the base of the hair (about ½ inch from the scalp). Many people misdiagnose head lice and treat with chemicals unnecessarily.
If you can blow or flick off the white speck or it crumbles in your fingers it is not a nit or egg. If the white or tan speck does not move on its own it is not a live louse.
A Classmate Had Head Lice. Should I Treat My Child?
Treatment of kids who have been exposed to head lice but are not infected is not generally recommended. You might consider treating other children who sleep together in the same bed where one had head lice. Look for lice in other family members and treat only if needed.
Getting rid of head lice is a three step process: kill the live lice, check for and remove the nits and eggs by combing and manual nit picking, and do a reasonable job of cleaning the infected person’s belongings and home environment.
There are various over the counter treatments for head lice including Nix, RID, A200 and Pronto. There are also some prescription medicines when the over the counter medicines appear not to help. It will be important to consult with our staff, your child’s health care provider or the pharmacist when you are considering lice medication especially in a child under 2 years of age.
Treating head lice has become more difficult over the years. It appears that some lice are resistant to some medications. One of the most important treatments is using a fine toothed “Nit Comb” or metal flea comb to comb through the hair once or twice each day after treatment has begun. The combing is best done on damp hair. The eggs can be loosened from the hair by applying a dilute vinegar solution (1 part vinegar to 9 parts water). This will make the combing much easier. It is generally recommended that you wait to apply the vinegar solution for 2 days after applying a head lice medication as it may inactivate some medicines.
Vigorous cleaning of the house is not a requirement for successful treatment of head lice as the lice will only live for 1- 2 days when not on our hair or scalp. Clothing and the environment can be cleaned to avoid reinfection. Soak combs or brushes in rubbing alcohol for 1 hour or wash in soap and hot water. Animals have not been shown to carry human lice.
There have been other less conventional approaches to treatment. One is to slather the hair with Vaseline, olive oil or mayonnaise, apply a shower cap, leave over night and shampoo off in the morning. Though this is a somewhat messy approach it is believed that these treatments effectively suffocate the louse.
You would not want to use these alternative treatments and a medication as sometimes your child will absorb too much medicine through the skin and they may become ill.
Other Sources of Information
There are a variety of web sites that have information on pediculosis or head lice. The information value may vary depending upon the particular views of the authors or their source of funding. There is a definite lack of science involved in the area of head lice. As such much of the advice and warnings are anecdotal opinions based upon personal experience or sporadic reports from other patients or parents. As always each parent will need to weigh the benefits and the risks involved in specific treatments for their child. If you have questions please speak with our staff or your child’s physician.
Centers for Disease Control
This federal agency has a fact sheet with helpful advice on head lice management and takes a balanced approach to the medications available for treatment. However, they do allude to the potential for side effects for the various medications.