The truth about head lice

07/29/2014 6:28 AM

08/08/2014 10:25 AM

With summer camps ending and school starting, the discussion on head lice with patients and parents will start again. There are a lot of myths surrounding head lice – treatment, causes and diagnosis to list a few.

So if your child gets head lice: stop, breathe and don’t overreact. This does not mean you are a bad parent or that your sweet child has been spreading disease everywhere he or she has gone.

The head louse (the plural is lice) is a parasitic insect that can be found on the human head, eyebrows and eyelashes. They live close to the scalp and feed on human blood several times a day.

Head lice are found worldwide. In the United States, infestations are most common among preschool children attending child care, elementary school children and household members of infested children. Another potential avenue of infection is summer camps. In theory, since the louse does not drown underwater, there is a potential risk at the swimming pool. However, the Centers for Disease Control and Prevention list this as an unlikely cause of infestation.

Personal hygiene or cleanliness in the home or school have little to do with getting head lice but are critical for getting rid of them.

Head lice move by crawling; they cannot hop or fly. They spread through direct head-to-head contact with the hair of an infected person. Sometimes head lice can be spread by sharing clothing or belongings, such as combs, brushes or towels. Children should be taught not to share these types of items. Another rare method of transmission is lying on a bed, couch, pillow or carpet that has recently been in contact with an infested person. If they fall off the scalp, eggs die within a week, and lice die within one or two days.

Don’t blame Fido or Fluffy and take them to the Humane Society. Dogs, cats and other pets do not play a role in the spread of head lice.

Symptoms of head lice include a tickling feeling in the hair, itching caused by an allergic reaction to the bite of the louse, irritability, difficulty sleeping and sores on the head caused by scratching. Sores can sometimes become infected with bacteria that live on the skin.

If your child has these symptoms, inspect the head for the three forms of lice: the eggs (also called nits), nymphs (young lice) and adults. The eggs look like knots in a thread and may range from white to yellow to brown in color. The adults have six legs and are about the size of a sesame seed. Generally, they range from beige to gray and may become darker when they feed.

They can be difficult to see. You can spot them most easily behind the ears and along the hairline on the back of the neck or by using a magnifying glass. All members of the household and other close contacts should be checked and, if lice or eggs are found, they should be treated.

Treatment involves several steps. If the child is age 3 or younger, consult a health care provider, as some of the medicines if used improperly may cause harm. If the child is older than 3, over-the-counter medicines are usually sufficient. Follow the instructions that come with the box or package. Some packages contain a fine-toothed comb for removing the lice and eggs. Usually the treatment needs to be repeated after seven to 10 days to kill any eggs that have hatched since the first treatment.

Do not use a hair conditioner or combination shampoo/conditioner before using lice treatment, as the conditioner coats the hair and prevents the medicine from being effective. Do not rewash the hair for two days after treatment. In general, these medications are well tolerated, causing only a mild itching or burning sensation.

Clothing, hats, scarves, pillow cases, bedding and towels worn or used by the infested person in the two-day period before treatment should be machine washed and dried using the hot water and hot air cycles. Items that cannot be laundered may be dry-cleaned or sealed in a plastic bag for two weeks, by which time all the lice and eggs will have died. Soak combs and brushes in hot water (at least 130 degrees) for 10 minutes. Vacuuming furniture and floors can remove any hairs that might have viable nits attached.

Please do not pay to have an exterminator come in to spray insecticides in the home or use fumigators. These are not effective and expose your family to unnecessary chemicals.

After eight to 12 hours of treatment, if no dead lice are found, and lice seem as active as before, the medicine may not be working. Some areas of resistance to medications have been found and at times treatments may only be 50 percent effective. A different medicine may be needed, so it is time to consult your health care provider.

Most health departments and schools do not require reporting of head lice infestation. However, a courteous friend and parent may want to share information with school nurses, friends and family who may have come into contact with your child.

For more information, log on to cdc.gov/parasites/lice.

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