Dr. Claire McCarthy is a primary care physician and the Medical Communications Editor at Boston Children’s Hospital. Along with her blogs here on Thriving, you can find her at the Huffington Post and Boston.com. Follow her on Twitter @drClaire.
Head lice. Two words that make anyone’s head start itching almost immediately.
Head lice are incredibly common, especially among school-aged children. There aren’t any good numbers on infestations, but it’s somewhere in the millions every year (just in the U.S.)—and these tiny bugs end up costing the country millions of dollars, if you include not just treatments but lost wages. The American Academy of Pediatrics just issued a clinical report on head lice to educate parents about what should—and should not—be done while battling lice in the home.
In some parts of the world, it’s normal to always have a few lice on your head (now that makes me itch!) It’s not a hygiene thing—washing more just gives you cleaner lice. They are hardy little buggers, and in some places people just get used to them. Here in the U.S. we get freaked out. We’ll try anything to get rid of them—and we don’t want to be near anyone who has them.
The diagnosis and treatment of head lice has moved away from doctors over the years. It’s mostly school or daycare staff, parents, friends, neighbors and other assorted people who are deciding if children are infested—and what to do about it. This worries the American Academy of Pediatrics (AAP), who just issued a clinical report on head lice. They have three main concerns:
Children are being diagnosed with lice when they don’t have them. This happens in two ways:
- People think that stuff in the hair is nits (lice eggs) when it’s actually dandruff or debris or something else. Nits are grayish-white and look like a tiny leaf coming off the hair shaft. They are stuck on tight; if you can brush it off easily, it’s not a nit.
- Having nits doesn’t mean someone has lice. Lice feed on the scalp, and lay their eggs on hairs very close to the scalp (within a quarter inch). The eggs hatch a week or two later. This means that any nit found more than a half-inch or so away from the scalp is likely hatched and dead. The only way to know that a person has lice is to see the actual live lice (are you itching yet?). No creepy-crawlies, no infestation. Which leads to the second main concern of the AAP…
Children are being kept out of school unnecessarily.
- Many schools have “No-Nit” policies. This means that if the school staff finds a single nit on a child’s head, they are sent home. Doesn’t matter if it’s six inches out and there isn’t a creepy-crawlie anywhere on the head.
- Even if a child does have lice, they aren’t as contagious as people think. Lice don’t fly, or jump. They can live on hairbrushes and hats—but very briefly. It’s really head-to-head contact that spreads them. Just because one kid in a class has lice doesn’t mean that everyone else will get them. But the mere rumor of lice sends parents to the store. Which brings us to the third main concern of the AAP…
Children are being over- and under-treated for lice.
- Clearly, insecticides are not necessary for dandruff. No child should be treated for head lice unless it’s certain that they have them.
- There are lots of remedies marketed for the treatment of head lice, with limited evidence that they actually work.
- Many families turn to home remedies. Some can be dangerous (like gasoline!). Some can be really messy (like petroleum jelly). And there’s no good evidence that any of them work either.
Here’s what the AAP recommends for treatment (if you’ve seen live lice):
- Use a permethrin (1 percent) or pyrethrin creme rinse (available without a prescription). Shampoo first, using a shampoo without conditioner, and follow package instructions carefully. Rinse it out over the sink, not in the tub or shower (so the chemicals don’t touch the rest of the body).
- Repeat the treatment in 7 to 10 days. This is important, as there is resistance, and the treatments may not kill all the unhatched lice.
- Do some basic home cleanup. You don’t have to go crazy. It’s really pillowcases that need washing (in hot water), but go ahead and throw all the bedding in. Stick whatever can’t be washed into the dryer at a hot setting (or bag it in plastic for two weeks). Same goes for clothes, hats, and coats that come in contact with the head. Clean hairbrushes and combs really well (get all the hairs out, and use really hot water). While you’re at it, make sure everyone has their own. Don’t use anti-lice sprays for furniture—vacuuming does the trick.
The AAP doesn’t recommend combing alone as a treatment. But from both professional and personal experience (we had lice once), I think it can be very helpful to do along with the creme rinse (and getting rid of nits makes school nurses happy). Here are some tips:
- Look for a lice comb with long metal tines that are very close together
- Always wet the hair first. It slows the live lice down, and makes it easier to get a comb through. Use conditioner if your child is in the tub, or a detangling spray if they aren’t.
- Divide the hair into small sections (hair clips help).
- Have good light.
- After each pass, inspect the comb for bugs or nits. Have a cup of water handy for rinsing it.
- Have entertainment handy too—this takes a while.
- Do it every single day until you don’t find anything for a few days.
In some cases, a prescription treatment is necessary. Your doctor is the one who can help with that decision. In fact, a call to the doctor is a really good idea if you think your child has lice. That way you can be sure—and be sure you are doing everything right. Most of all, don’t panic. Having lice isn’t the end of the world—and with patience and perseverance, you’ll get rid of every last one.