Head lice have become an increasingly prevalent problem in our nation's schools and child-care centers, according to the American Head Lice Information Center. Some 12 million people are infected with lice each year, most of them children between the ages of 3 and 12. Although head lice never present a serious health threat, they are a major annoyance. Whether you're trying to help your child avoid these bugs altogether, or just trying to get rid of them, you'll want to read the answers to these frequently asked questions.
Head lice are tiny, translucent, brown- or gray-colored mites that have plagued humankind since ancient Egypt (lice larvae have been found on mummies). Because they're so small, lice are hard to detect without a magnifying glass. They live on the scalp and feed by drawing blood through the scalp, causing inflammation and itching. Adult female lice lay about six to ten eggs per day, which cling to the hair, causing your child's head to become a breeding ground for the pesky bugs.
Contrary to popular belief, lice don't fly or jump, but they can move very fast. According to Kate Shepherd, founder of Lice Solutions Inc., a group in Jupiter, Florida, that provides lice education, a louse can travel nine inches in one minute. To get from one head to another, it will grasp onto a strand of hair with its six hooked legs and ride over to the new host. Lice are spread most easily by direct person-to-person contact. This is often the case when children touch their heads together during play. Lice also can be spread indirectly, when kids share combs or brushes, pillows, or head gear such as hats or helmets.
According to James Herbert, MD, FAAP, a pediatrician in San Angelo, Texas, "It doesn't matter how clean you are; if your child is exposed to someone with head lice, she has a pretty good chance of getting it herself. There are cases of families with very good hygiene who are just devastated when they learn their child has lice," he says. "The child's whole classroom might be exposed, but they're still embarrassed when it happens to them."
When lice have invaded, the first signal will most likely be your child's incessant scratching. Take a closer look at your child's head and you may actually see the lice. The insects are found most often in the hair above the ears and at the back of the head, just above the neck. More visible though, are the tiny white nits that are found on the hair shaft, just above the scalp. They look like dandruff, but aren't flaky and are difficult to remove -- they won't just pull off easily. If you are uncertain of what you're looking for, ask your child's school nurse or your pediatrician to show you what a nit looks like.
If you determine that your child does indeed have head lice, ask your family's pediatrician to recommend a medicated shampoo or cream rinse -- preferably one that's nontoxic. Following the directions on the package, massage the shampoo into your child's hair and scalp for a full ten minutes.
This application will kill the live insects, but the nits -- which are now mostly dead -- will remain firmly attached to the hair. To remove them, comb your child's hair into sections that are one-inch wide, and examine each section thoroughly with a magnifying glass. If you do find a nit, use a fine-toothed comb to pull the nit down to the end of the hair shaft and remove it. (By dipping the comb in a solution of equal parts water and white vinegar, you'll help loosen the natural "glue" that helps the nits cling to the hair shaft.)
Once you've finished with one section, pin it out of the way, and move on to the next. Continue this process until you've inspected your child's entire head. After you've finished the treatment, soak all combs and brushes for an hour in a solution of the medicated shampoo or in very hot water.
Children may return to school after they've been treated and you find their scalps to be free of nits. However, many school districts around the country have a "no-nit" policy, which means that every single nit must be removed before a child will be readmitted. You can't be sure your child is lice-free, however, until the three-week life cycle of the lice has passed without a reoccurrence.
Because parents aren't likely to share hats, combs, clothing, and other items -- or to come into direct head-to-head contact -- with their children they're (thankfully!) unlikely to become infected with lice. "We don't see parents with lice very often, and only occasionally will we even see siblings with it," says Dr. Herbert. Still, if your child does become infected with lice, it's a good idea to have another adult inspect your head just to make sure they haven't taken up residence.
Head lice can't survive away from a human scalp for more than 48 hours or at temperatures above 120 degrees. You can use these weaknesses against them when cleaning your house and possessions. For instance, soak all hairbrushes, combs, and hair ornaments in hot (not boiling) water. Wash all stuffed animals, bed linens, towels, and recently worn clothing in hot water, and place them in the dryer on a high-heat setting. Items that can't be washed or dried in this manner can be dry-cleaned or stored in sealed plastic bags for several days. You should also thoroughly vacuum all furniture and carpeting. Although fumigating your entire home with an anti-lice pesticide spray may seem like a tempting, fast alternative to cleaning the entire house, the Centers for Disease Control and Prevention recommends avoiding the use of these sprays because they contain harsh chemicals. It's more time consuming, but a thorough house-cleaning is a much safer way to go.
If despite all your best efforts the lice show up again within 10 to 14 days of the first outbreak, ask your pediatrician if your child should be re-treated. In stubborn cases, doctors may prescribe a lindane-based prescription shampoo. Since lindane has been known to have side effects when used over a prolonged period of time, it's best to exhaust other methods first.
Reviewed 2/02 by Jane Forester, MD
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