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Healthy
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Head Lice, That Pesky Problem
The first time a child comes home from play group, childcare, or school with head lice, many parents feel mortified. While some adults believe head lice results from poor hygiene and should not occur in a regularly bathed child, the experienced child caregiver or parent knows that this is not true. Head lice can be acquired whenever people come together. Pediculus capitis humanus, the technical term for head lice, is a common nuisance to preschool and elementary school children (sometimes middle and high school students too!), with outbreaks occurring in most camps and schools one or more times per year.
Head lice are parasites that are about the size of a sesame seed. The lice thrive on blood taken mostly from the nape of the neck, the scalp, and behind the ears. Although the lice themselves generally do not cause severe problems, the itching and scratching can cause skin irritation such as eczema and impetigo.
Even though lice cannot fly, hop, or jump, they can easily crawl from head to head when children are in close contact. They also can crawl from one coat or hat to another if clothing touches on a rack. In addition, head lice can be transmitted by sharing combs, brushes, head sets, hats, and scarfs.
How to Spot and Treat Lice
Head lice can be spotted in the hair by a close inspection or with the use of a magnifying glass. It may be difficult to see the lice, but you can usually spot the "nits" or lice eggs. The nits will appear to be dandruff-like whitish spots, but will not flake off when touched. The nits will remain "glued" to the hair strand close to the scalp, even if the hair is brushed. Members of the child's family, the caregiver, and all children in the childcare facility should be examined for lice infestation. All infected persons should be treated.
The treatment for head lice is to apply a shampoo or cream rinse specially made to kill lice and the nits. Most lice treatment shampoos and cream rinses are sold over-the-counter at drug and grocery stores. Over-the-counter anti-lice shampoos and cream rinses contain two pesticides: pyrethrum and permethrin, a synthetic version of pyrethrum. Parents should pay careful attention to the application and duration directions given on the specific product label. Children who are allergic to ragweed should not use anti-lice products containing pyrethrum, because it is made from chrysanthemums.
Prescription anti-lice products (which may be available over-the-counter in some areas) may contain lindane. A physician's advice should be sought in the use of these products. Products containing lindane are usually strongly discouraged because improper use of these products has been associated with reactions ranging from seizures to death.
After towel drying the hair, remove nits with the special comb provided in the anti-lice product package. The special comb in the product package is an essential key to a successful removal of nits. The parent should part the hair in one to two square inch patches and comb each patch thoroughly. Try to remove every nit from the patch of hair. If careful combing is not done, the remaining nits may have survived the treatment and another infestation can begin. This is another reason to use an approved OTC lice treatment that kills both the lice and the nits.
To complete treatment, all lice and nits must be removed from the home and childcare environment. Disinfect all brushes and combs in the anti-lice shampoos or very hot, soapy water. All bed and bath linens, clothing, dress-up clothes, and stuffed toys should be washed in hot water (at least 130 degrees) and placed in a hot dryer for at least 20 minutes. Articles which cannot be washed (such as stuffed toys, or wool blankets) should be placed in an airtight bag for at least two weeks, then thoroughly shaken outdoors. The two-week isolation period allows the nits to hatch and the new lice to die. All furniture, car seats, rugs, and pillows should be vacuumed and the vacuum bag thrown away in a sealed plastic bag. Over-the-counter lice sprays are available, but are not recommended since children can breathe in the toxic fumes. Pesticide sprays and home fumigations are usually unnecessary and are not worth the health risk.
Caregivers should complete daily head checks on all children and staff for at least two weeks following an infestation. Childcare programs and schools will usually have a policy on the dismissal of a child with head lice from the play group or classroom. The child may return to school only after the lice have been treated with a medication that also kills the nits. It is not necessary that all nits be removed from the child's hair.
By Sari Edelstein, PhD,author of The Healthy Young Child, West/International Thompson Pub. Co.Resources
The Child Care Providers Guide to Controlling Head Lice is available on line at www.headlice.org. This multi-part document, created with the Pennsylvania Chapter of the American Academy of Pediatrics' Early Childhood Education Linkage System, covers exclusion policies, prevention, treatment, communication with parents and more.
Contact the National Pediculosis Association, P.O. Box 610189, Newton, MA 02461; 781-449-NITS; www.headlice.org.
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