HEAD LICE

The first thing to remember is that head lice are nothing to panic or be embarrassed about. If your child has head lice, it just means that they were in the wrong place at the wrong time. Lice is in no way indicative of a lack of cleanliness and once observed can be eliminated. The key to eliminating head lice is diligence. You should treat everyone in the home along with appropriate bedding and clothing at the same exact time, take measures to prevent reinfestation, and then continue to screen for returning signs of lice. 

SCREENING FOR SIGNS OF HEAD LICE

Constant itching is a symptom of head lice infestation, but may not always occur. Examine the hair and scalp closely. A rash on the scalp is sometimes an early sign. Lice and nits (lice eggs) are very tiny and sometimes difficult to see. The use of a bright light, comb to separate the hair, and/or magnifying glass can make identifying them easier.

Nits are lice eggs and are shaped like tiny teardrops or pussy willow buds on the hair shaft. As seen in Figure 1 below, nits are initially dark in color. Even after the nit hatches, it remains strongly attached to the hair. Mature and empty nits become pearly white. Nits are typically found within a few inches from the scalp around the ears or at the back by the nape of the neck. Screen for nits by lifting and parting the hair above each ear, and then above the neck while the person looks towards the floor. Part the hair in these areas every half an inch or so, and look very closely. If dandruff is present, it should brush away easily. Nits can be differentiated by their characteristic shape and because they hold tightly to the hair. Figure 2 shows an example of numerous nits. These dark nits are not too difficult to spot in light colored hair. Figure 3 shows dark hair with a few nits identified. This is where spotting dark new nits becomes tricky, and rescreening becomes important.

Lice are dark colored and also very tiny. Figure 4 shows some various sizes as they mature. Screen for lice in the same places as nits, but also on the top of the head. Lice are best spotted when they move through the hair. So as you part the hair, hold it in place and stare at the scalp area for 5-10 seconds. Watch for movement. If any lice or nits are found, or if you simply have more questions, please contact the school nurse’s office.

TREATING HEADS

There are a number of over the counter, prescription, and home remedies that can be used to treat head lice. Each family should make their own choice on what product is best for them. If you have questions, you may call your pediatrician, or the school nurse's office.

Most pediatricians will recommend medication to kill the lice and their eggs. A pediculicide such as RID or NIX is available over the counter. Read and follow all instructions carefully. With this method, you must comb out the lice and nits after treatment. The metal combs like in Figures 5 and 6 seem to work best, and are available at any drug store. The combing process can take up to an hour and may need to be repeated for several days. Thorough removal of lice and nits is necessary to ensure complete effectiveness. If retreatment is necessary, it should be done 7-9 days later (after all nits have hatched and before new nits are laid).

TREATING THE HOME

Lice and nits require the comforts of a warm head to survive. Lice can only live for a few days off the head. Nits on stray hairs are less likely to survive. Therefore treatment of items in the home should focus on high contact areas; combs, hats, coats, bedding, couches, etc. Isolate clothing and linen; wash in hot water (at least 130 degrees) then place in a hot dryer (high heat for a minimum of 20 minutes). For non-washables, dry clean or place them in a tightly sealed plastic bag for 2-3 weeks. Furniture and carpeting may be vacuumed and/or sprayed with a lice control spray. Allow all sprayed articles to dry before touching. Be sure to follow all label instructions and cautions, and note that lice control sprays should not be used on humans or animals. Head lice do not infest pets.

PREVENT REINFESTATION

Head lice cannot jump or fly. They are spread by direct or indirect close contact. You can reduce the chances of spreading them by discouraging the sharing of combs, barrettes, hats, jackets, shirts, bedding, and other personal items commonly in contact with the head. Also helpful is washing your hands and your child’s hands thoroughly, especially under the nails.

 If you find that the head lice continues to return, either the treatment itself has not been sufficient, or reinfestation is occurring from another source. Consider very carefully that you have been diligent and thorough with treatments. Did you treat everyone in the house on the same day? Did you wash or isolate bedding and clothing that same day? Are belongings kept separate? Even jackets hanging next to each other or hats in the same bin can spread head lice.

FIGURES

Figure 1 – Close up of various stages of nits.

Link Expired - http://www.hsph.harvard.edu/headlice/photos.html

  

 

Figure 2 – Numerous nits on light hair.

Photograph by: Clay Scherer, University of Florida

Link Expired - http://entnemdept.ufl.edu/creatures/urban/nits_scalp.htm

 

 

Figure 3 – Few nits on dark hair.

http://www.mayoclinic.com/health/medical/IM02435

  

   

Figure 4 – Lice at various size and maturity.

Link expired - http://www.afpmb.org/pubs/Field_Guide/Images/originals/Fig.%2074.jpg

      

 

Figures 5 and 6 – Metal Lice Combs