You are having coffee when the school calls. “Your child has lice.” (Panic.) “Wait, what are lice?”
Lice are small pale, tan to grey insects the size of a sesame seed, which cause an itchy scalp and scratching. They are a common problem affecting families worldwide. Lice spread easily from person-to-person in schools, daycare, and camps. They spread via shared clothing, hats, brushes, or linens.
Lice are not dangerous nor indictive of poor hygiene. They do not fly or spread disease. Pets cannot catch or spread lice. Schools may have no-nit policies; however, the American Academy of Pediatrics does not support banning children with lice from school.
The eggs (nits) are visible on the hair follicles. They are tiny (the size of a knot of thread) yellow or tan dots stuck to the hair near the scalp. They are stuck firmly and cannot be easily removed. By checking the hair behind the ear, you can find nits. Nits are easier to find than lice, as lice move. After the nits’ hatch, their white shells will remain.
The life cycle repeats every 3 weeks with 3 phases: nits (eggs), nymph (young), and adult (louse). The nits hatch in 6-9 days, the nymph become adults after 7 days, and an adult louse can lay 10 eggs/day. Lice feed on blood from the scalp. Treatment involves killing the lice and removing all of the nits.
Most cases of lice can be treated with over the counter (OTC) medication. Read and follow all the directions provided on the medication including the age limitations. Use only age-appropriate medication on your child. Rinse the medication off in the sink to avoid medication running onto sensitive skin. Do not rewash hair for 1-2 days after the medication has been applied.
Common OTC medications include permethrin products such as NIX (approved for 2 months and older) and pyrethrin product such as RID (approved for 2 years and older). Nix is placed on shampooed (but not conditioned), towel-dried hair, rinsed off after 10 minutes, and repeated in 9 days. RID is applied to dry hair, rinsed off after 10 minutes, and repeated in 9-10 days. Do not use pyrethrin-based products on those allergic to ragweed or chrysanthemums. Other pyrethrin-based products are A-200, Pronto, R&C, Triple X, and Licide. Follow package directions regarding re-treatment. Do not re-treat more than once without contacting your pediatric health care provider.
Medications will kill lice, but not nits. You must use a nit comb to remove nits. Nit-pick (yes, it’s a thing) with the nit comb wet or dry hair every 2-3 days for 2-3 weeks. Nit removal is essential to interrupt the life cycle. It is time intensive. Allowing a favorite movie or music is helpful. Use good lighting and place a towel over the shoulders. Comb the hair into sections, focusing on one section at a time. Start from the scalp and work downward.
Launder clothing, towels, and linens from the past two days in hot water and dry on high heat for at least 20 minutes. Items which cannot be laundered, such as pillows or stuffed animals, can be placed in an airtight bag for 2 weeks. Soak brushes in hot water (130° F) for 5-10 minutes. Vacuum the carpet and throw away the vacuum bag. Check family members and close contacts, treating those with nits (eggs) or lice.
Do not believe the myths that petroleum jelly, mayonnaise, or olive oil is effective in suffocating lice, as this has not been proven effective. Do not use a hair dryer after applying medication to the scalp, as certain medications (such as prescription Ovide) can be flammable. Do not fumigate your home. Never use pesticide spray on your child. Essential oils (such as tea-tree oil or ylang-ylang oil) are not approved by the Food and Drug Administration for such use. Never place gasoline or kerosene on anyone, especially children. Do not place a plastic bag on a child’s head. Do not leave a child alone with medication on their head. Store all medications out of reach of children.
Certain areas have lice that have become resistant to OTC medications and require prescription medication. Use the over-the-counter medications first, as insurance carriers may not cover the prescription medication unless the OTC medication fails. If you are unsuccessful at eliminating lice with an OTC medication and diligent nit-picking, contact your pediatric health care provider.