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Heads Up on Head Lice — Itching for answers?

Courtesy of the American Academy of Pediatrics

Here's how to prevent and treat this pesky condition. Each September children head back to the classroom, find their old buddies, and cluster together, playing in close-knit groups. Unfortunately, head lice - commonly known as "ukus" in Hawai‘i - also make their return, spreading more quickly than wind-tossed autumn leaves.

According to the Centers for Disease Control and Prevention (CDC), in Atlanta, six to 12 million people a year are infected with head lice, most of them children between the ages of three and twelve. Sue Partridge, a spokesperson for the CDC, says, "We've gotten a number of phone calls from frustrated parents, school nurses, and even physicians who are trying to remove all the nits [louse eggs] from a child's hair."

Although head lice never present a serious health threat, they are a major annoyance. Whether you're trying to prevent your child from getting these bugs, or trying to get rid of them, you'll find this advice from the experts helpful.

What exactly are head lice?

Head lice are tiny, translucent, brown-or gray-colored mites. Because they are so small, about the size of a sesame seed, lice are hard to detect without a magnifying glass. They live in the hair close to the scalp, causing inflammation and itching. Adult females lay about six to 10 eggs a day, which cling to the hair and hatch in eight days, causing a child's head to become a breeding ground for the pesky bugs.

How are lice spread?

Contrary to popular belief, lice don't fly or jump, but they can move very quickly. According to Kate Shepherd, founder of Lice Solutions, Inc., a resource group in Jupiter, Florida, a louse can travel nine inches in one minute. To get from one head to the next, the louse 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, brushes, pillows, or head gear of any kind, such as hats or bike helmets.

Does personal hygiene play a role in whether a child gets head lice?

Having head lice does not mean you, your child, or your house is dirty. "It really 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," says James Herbert, MD, FAAP, a pediatrician in San Angelo, Texas. "There are many cases of families with very good hygiene who are just devastated when they learn their child has head lice," he says. "The child's whole classroom might be exposed, but the family is still embarrassed when it happens to them."

How can I tell if my child has head lice?

If your child has been exposed to lice, you may notice that he scratches his head repeatedly. Upon closer inspection, you may actually see the lice, though this is usually not the case. The insects are generally found in the hair above the ears or at the back of the head, just above the neck. More visible are the tiny white nits or egg sacs that are found on the hair shaft, about one-quarter to one-half inch from the scalp. The nits look like dandruff but aren't flaky and are difficult to remove.

If you are uncertain about what you are looking for, ask your child's school nurse or pediatrician to show you what a nit looks like. She can slip a suspected nit under a microscope and show you what to look for. If you discover that your child has head lice, be sure to inspect the rest of your family.

What is the most effective way to get rid of head lice?

If you determine that your child has head lice, ask your pediatrician to recommend a medicated shampoo or cream rinse. These products contain either pyrethrin, a natural chemical extracted from the chrysanthemum flower, or permethrin, a synthetic chemical with similar properties. Following the directions on the package, massage the product into your child's hair and scalp for a full 10 minutes. This application will kill the live insects, but the nits - which are mostly dead - will remain firmly attached to the hair.

If your child's school has a no-nit policy, you will need to remove the nits before your child is allowed to go back to school. Have her sit in a well-lit, comfortable place, as this process may take a couple of hours. To begin, comb your child's hair into sections that are one-inch wide, and examine each section thoroughly with a magnifying glass. If you find a nit, use a fine-toothed comb to pull it down to the end of the hair shaft, then remove it. If you dip the comb into a solution of equal parts water and white vinegar first, you'll loosen the natural "glue" that helps the nits cling to the hair shaft. Be sure to wipe the nits onto a paper towel dampened with rubbing alcohol so that you don't inadvertently comb them back into your child's hair.

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 very hot water (130 degrees F).

Over the next three weeks, inspect your child's hair carefully for any additional lice or nits. Pay special attention to the areas at the nape of the neck and above the ears, as these are the places where lice frequently gather to lay their eggs. Immediately remove any lice or nits that you find. Many pediatricians recommend re-treating your child's hair seven to 10 days after the initial treatment to make sure you kill any lice that may have hatched from the surviving nits.

If my child had head lice, when can he go back to school?

Children may return to school after they've been treated with a medicated shampoo or cream rinse. However, many school districts around the country have a no-nit policy, which means that the school nurse must verify that every single nit has been removed before readmitting a child. The American Academy of Pediatrics and the National Association of School Nurses do not support a no-nit policy in schools, because most nit cases (the remnants of louse eggs) are empty after treatment and will not spread new lice.

Can I get head lice from my child?

It's possible to get head lice from your child, but it's unlikely. Because parents usually don't share hats, combs, clothing, or other personal items with their children, they are unlikely to become infected, "We don't see parents with lice very often," says Dr. Herbert. But if your child has had a case of head lice, it's a good idea to have another adult inspect your head just to make sure you haven't been infected.

How can I delouse my house?

Head lice cannot survive away from a human scalp for more than 48 hours or at temperatures higher than 130 degrees F. So you can use these "weaknesses" against them when cleaning your house and possessions.

For instance, after an episode of head lice, soak all brushes, 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 in the dryer on a high setting. Items that cannot be washed or dried in this manner can be dry-cleaned, stored in plastic bags for 10 days, or frozen for 48 hours. Thoroughly vacuum all furniture and carpeting, too. Keep in mind that pets cannot transmit head lice, so there's no need to wash (or treat) your pet when cleaning up.

Although spraying your entire home with an antilice pesticide spray may seem like a tempting and speedy alternative, the CDC recommends avoiding the use of these sprays. They contain harsh chemicals that could be harmful to your family.

What happens if the lice return?

If, despite your best efforts, the lice show up again within 10 to 14 days, ask your pediatrician if your child should be re-treated. "Most of the time when a parent calls and says that the treatment didn't work, we usually go over the steps again," says Barbara L. Frankowski, MD, FAAP, a pediatrician in Burlington, Vermont. Sometimes a parent has missed a crucial step or has misread the directions, she adds.

According to Ronald Hansen, MD, FAAP, a professor of pediatrics at the University of Arizona College of Medicine, in Tucson, "Some lice have become resistant to standard treatment and may require stronger options. "If, for instance, you've treated your child twice with an over-the-counter product and you're still having trouble, your pediatrician may recommend a prescription shampoo to treat the resistant lice.

The most important thing to remember is that head lice can't harm your child's health in any way. They simply are a nuisance - an undeniable part of childhood. But with patience and persistence, you can claim victory over the dreaded louse.

No Bugs About It

Prevention is critical in keeping kids free of head lice. Here are some simple rules to follow.

  • Teach your children never to share their hairbrushes, combs, hats, bicycle helmets, coats, or other personal
  • items with other children.
  • Make sure that coats and hats are stored in individual cubbies at school, if possible.
  • At home and at school, avoid piling children's coats and hats on top of each other.
  • Have your child take her own pillow to a sleepover party, and wash the pillowcase afterward.
  • If your child has long hair, keep it tied back or braided during lice outbreaks at school or child care. You may even want to cut your child's hair to a shorter length to make lice removal easier.

When washing or brushing your child's hair, make sure no lice or nits are present. Make this a part of your child's normal hair-grooming routine.

To make an appointment with a Straub Pediatrician, call (808) 522-4777 anytime, 24-hours a day.