They're a little gross, somewhat annoying and for most parents, inevitable. It also seems to me that for most of us they show up at the most inconvenient times. I'm talking about lice. With school coming to an end this month, you may think your child's chances of picking up the little bugs will diminish. Unfortunately, according to the American Academy of Pediatrics (AAP) most cases of lice occur outside school. Between summer camp, sports and play dates there are still plenty of opportunities for lice to take shelter on the head of at least one family member. They're certainly no picnic to deal with and they can also be unwittingly contagious during the school years. Clearly there's nothing to be ashamed of when discovering lice but it doesn't always feel that way. New guidelines from the AAP out last month offer some tips for getting your family lice-free as quickly as possible. Acting fast with a plan often diminishes all sorts of anxiety and discomfort for all.
Details In The AAP Clinical Report
- Respect: children should not be restricted from attending school because of lice. Lice aren't dangerous nor are they a medical problem; they're more of a nuisance than anything. Some children don't show symptoms/itching for 4 weeks after infesting, therefore it makes zero sense to urgently send a child home (sometimes they've been walking around school with lice for a month). Sending children home also creates undue stigma and hasn't shown to improve rates of recurrence or spread.
- OTC Treatment: Despite news about possible resistance patterns and lots of new lice treatments coming on the market, the first line of treatment recommended for lice officially remains the over-the-counter medications with 1% permethrin or pyrethins. They typically require treatment on day one when finding lice and again about 9 or 10 days later to eradicate new lice that may hatch from eggs/nits.
- When using these treatments you must follow with a comb-through -- I recommend every day -- as this is essential to capture and keep ridding the scalp and hair of lice and nits.
- Home: Excessive cleaning in your life/house isn't necessary. Because a louse can only survive for about a day away from the scalp, there's no need to strip every bed and put every stuffed animal in quarantine upon discovery. Wash all the pillow cases, give hairbrushes a deep scrub and check each family member for signs of lice or nits. It's also important to remember that pets do not get head lice and cannot spread them to humans. Spare Fido a hose-down.
New Recommendations For Treatment
- If lice are resistant to OTC medications or you suspect you're not getting rid of them despite great treatment routines, involve your pediatrician. They may recommend prescription medications such as spinosad or topical ivermectin. I will note that ivermectin is expensive but does have the benefit of requiring only a one-time treatment and no combing. The medication has few side effects and impairs lice (and future hatching lice) by paralyzing them thus making it impossible for them to feed on the scalp and survive.
- If the thought of chemicals of any kind on your family's skin is unappealing, manual removal by "wet-combing" through hair is acceptable and can be effective. It's important to note that wet-combing should be repeated once a week for at least three weeks to ensure all lice and nits are removed and requires you comb through entire scalp and hair fastidiously.
- The AAP states that "head lice screening programs have not been proven to have a significant effect over time on the incidence of head lice in the school setting and are not cost-effective." If school personnel are involved in the detection of infestations, they should be properly trained. It can be difficult to detect lice -- this is true for parents, pediatricians and school employees. When checking take you time and be sure to look behind ears and at nape of neck where lice tend to run and hide.
What Parents Need To Know
- Lice are very common in children between the ages of 3 -12. With the first case, itching may not happen for 4-6 weeks after exposure. You may find lots of lice (don't freak) as lice can lay up to 10 eggs a day and we often don't discover lice in the first few days. If your child gets lice know you can deal with it rapidly and it will go away...
- Lice don't jump from person to person! This is a common misconception. They can however crawl and cling very well to hair and are spread most commonly from head-to-head contact. When children discover lice it's best to restrict head-to-head contact while you get rid of them. Rarely do children share lice via combs/brushes or shared hats and helmets.
- Treatment with OTC shampoos and combing along with some prescription treatments will eradicate lice from your child. Cleaning clothing and bedding and restricting head-to-head contact until lice gone is your best bet. If you feel lice isn't going away after diligent treatment talk with your pediatrician about Rx options.
- If the thought of dealing with lice makes you light-headed, there are lice-removal services available. They're not cheap (starting around100 in the Seattle area), but some parents may find the expense well worth the piece of mind of getting rid of lice manually by professionals.
Follow Wendy Sue Swanson, MD, MBE, FAAP on Twitter: