Lousy Lice

 

Pediculosis capitis, otherwise known as head lice, is a common problem seen by pediatricians and feared by parents of preschoolers and school-age children. While they are a nuisance, head lice are harmless and don’t cause serious symptoms or carry any diseases. They do, however, cause a lot of anxiety among parents, as we discovered on The PediaBlog back in 2013 when we reviewed “The Facts Of Lice”:

Few things freak parents out more than head lice. Since head lice are very common in children, our offices get a lot of calls. About head lice. From freaked-out parents.

Sure, lice do bite, and these bites can cause scalp itching and irritation in some kids and disturb sleep in others. But with parents it causes panic. Part of that is due to the commonly held (and totally false) belief that lice infestations occur in poor, dirty, or unhygienic populations. In fact, head lice like clean hair and don’t discriminate based on socioeconomic status. Another reason is just the thought of little bugs crawling in our hair. Another is the fear of being fingered as the source of another child’s infestation.

 

A newly updated clinical report from the American Academy of Pediatrics addresses the social stigma associated with the diagnosis:

Head lice (Pediculus humanus capitis) have been companions of the human species since antiquity. Treatment costs in the United States have been estimated at $500 million annually. It is important for medical providers to educate and reassure affected individuals and caregivers that head lice are neither a health hazard nor a sign of poor hygiene and are not responsible for the spread of any disease. Despite this knowledge, there is significant stigma resulting from head lice infestations in high-income countries, resulting in children and adolescents being ostracized from their schools, friends, and other social events. Head lice can be psychologically stressful to the affected individual.

 

Transmission of head lice is not significantly influenced by an individual’s hair type, hair length, or by frequent brushing or shampooing:

Lice do not hop or jump; they can only crawl. In most cases, transmission occurs by direct contact with the hair of an infested individual, the most common situation being head-to-head contact. Indirect spread through contact with personal belongings of an infested individual (combs, brushes, hats, sport helmets) is much less likely to occur. Lice found on combs are likely to be injured or dead, and a louse is not likely to leave a healthy head unless there is a heavy infestation. In one study, live lice were found on only 4% of pillowcases used by infested persons. Thus, the major focus of control activities should be to reduce the number of lice on an individual’s head and to lessen the risks of head-to-head contact.

 

The American Academy of Pediatrics Red Book describes what these tiny critters and their eggs (“nits”) look like, and where to find them (you may need to use strong reading glasses or a magnifying glass to see them):

Adult lice (2–3 mm long, tan to grayish-white, with claws on all 6 legs) or eggs (match hair color) and nits (empty egg casings, white) are found on the hair and are most readily apparent behind the ears and near the nape of the neck.

 

Without a blood meal, lice can’t survive for more than a day, which is why they prefer living close to the scalp without venturing too far away. Lead author of the AAP’s updated clinical report, Dawn Nolt, M.D., follows the louse’s interesting lifecycle, from egg to pinhead-sized nymph to quick and stealthy adult. A female louse can lay up to 10 eggs a day. Once hatched, nymphs mature into adults in under two weeks. That’s when parents have the best chance of searching their child’s head and finding them:

Regular checks for head lice are a good way to spot head lice before they have time to multiply and infest (are present in large numbers) your child’s head.

• Seat your child in a brightly lit room.

• Part their hair.

• Look for crawling lice and for nits on your child’s scalp a section at a time.

• Live lice are hard to find. They avoid light and move quickly.

• Nits will look like small white or yellow-brown specks and be firmly attached to the hair near the scalp. The easiest place to find them is at the hairline at the back of the neck or behind the ears. Nits can be confused with many other things such as dandruff, dirt particles or hair spray droplets. The way to tell the difference is that nits are firmly attached to hair, while dandruff, dirt or other particles are not.

• Use a fine-tooth comb (such as a louse or nit comb) to help you search the scalp section by section.

 

Dr. Nolt lists a number of prescribed and over-the-counter medicated lotions that pediatricians recommend to defeat lice infestations in children. Because the treatments can have adverse side effects when used improperly, it’s important to follow these important guidelines:

• Follow the directions on the package exactly as written.

• Never let children apply the medicine. Medicine should be applied by an adult.

• Always rinse the medicine off over a sink and not during a shower or bath, so the medicine doesn’t run off the head onto other areas of skin. Place your child’s head over a sink and rinse the medicine off with warm water (not hot water).

• Never place a plastic bag on a child’s head.

• Do not leave a child alone with medicine in his or her hair.

• Store medicine in a locked cabinet, out of sight and reach of children.

• Check with your child’s doctor before beginning a second or third medicine. Your child may just need to repeat the same medication, or switch to a new one.

• Ask your child’s doctor if you have any questions or if treatments you have tried have not gotten rid of lice.

 

Forget about slathering on mayonnaise, tub margarine, vaseline, olive oil, or other home remedies tried by past generations to smother lice; none are proven to be effective. And don’t spray pesticides in your home, since exposure to those chemicals can cause harm and they won’t get to the area where lice are hiding: your child’s scalp.

Once treatment has started with one of the medicated lotions, children should be allowed back into the classroom unconditionally and without delay:

Some schools have “no-nit” policies stating that students who still have nits in their hair cannot return to school. The American Academy of Pediatrics and National Association of School Nurses discourage such policies and believe a child should not miss or be excluded from school because of head lice.

 

Click on the graph below to view the algorithm the AAP advises for treating lice:

Treatment Algorithm for Lice

 

 

(Google Images)

 

source http://www.thepediablog.com/2022/11/17/lousy-lice/