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Dear Dr. Lanny: My 5-year-old is starting kindergarten in September, and I’ve heard about lice outbreaks at his elementary school before. No outbreaks I knew of at his preschool—but now I worry that he’ll be exposed to lice in the new place. Any advice on what to do if he happens to bring any of those things home? I’m pretty squeamish about the idea of lice, not to mention worried about the time involved in getting them out of our household.
A: Outbreaks of head lice at the elementary school! Why is it that I hear the theme music from Jaws in the background? They may not be the size of that malevolent great white shark, but they do evoke fear and revulsion in most people. And yes, school is the place where it is a reasonable possibility for your child and lice to have close encounters of the unpleasant kind.
Although there are not dependable statistics, because many cases are never reported, the Centers for Disease Control (CDC) estimate 6 million to 12 million Americans are infested each year. Head lice are found in all schools, and in all socioeconomic groups. For reasons that are not completely clear, they are exceedingly infrequent in African-American children.
Body and pubic lice are closely related to head lice, but they are not identical. Head lice are far and away the greater public health concern. Although there is some disagreement among researchers, head lice do not appear to pose a significant likelihood of carrying any disease.
Lice are a strictly human parasite, which explains why school, where many children are physically in contact, is the likely site of contagion. Lice do not survive for long if away from a human host, so transmission from clothing and furniture is not a major problem. Good vacuuming, but no fogging with insecticides, is all that is recommended. Sharing hats, combs and other frequently used personal items can spread lice. If any of these items have been unused for several days, they are very unlikely to still be contagious. Since lice are a strictly human parasite, Fido and Fluffy are off the hook. Lice cannot hop, skip, jump or fly. They travel only by crawling.
So, let’s say your son or daughter comes home with the dreaded note that states that lice have been found in a classmate, or possibly a teacher. Do not panic. I’ll repeat that: DO NOT PANIC! The probability is still that your child is not lousy. That lice have been found in school or in class does not mean everyone is infested.
Sit down in front of a good light source. Let him watch television (this one time only) and slowly and methodically check his scalp. Do little sections at a time, particularly toward the back and behind the ears. Seeing moving lice is infrequent, but diagnostic and certainly creepy.
More likely you will see the egg cases, called nits. These are small sail-like white or brown flakes attached to hair shafts. They are likely to be within a quarter-inch of the scalp. They look much like dandruff but are difficult to remove from a hair, whereas dandruff slides off with little effort. Itching will likely be the only symptom. If you don’t find lice or nits, everything is probably fine, except that you will undoubtedly feel itchy when you are finished. Don’t worry. Doctors also feel like this whenever we see someone with a rash or lice. To be prudent, repeat this procedure for a few nights. If you find nothing, do not buy medicine or ask your doctor for a prescription. It is not necessary or appropriate.
Only if you find a moving louse or a nit is treatment advisable. There are several different medications, none of which is perfect; for this reason, you should consult your family’s health care provider before using one of these medications. Pyrethrins (Rid, A200), derived from the chrysanthemum, and permethrin (Nix), a similar but synthetic pesticide, are the principal products used on lice. They are effective on crawling lice rather than nits, and should be reapplied after a week. However, quite rare but severe reactions, including death, have occurred in some individuals--especially those who experience ragweed allergies or asthma--exposed to pyrethrins and pyrethroids. Lindane (Kwell) has fallen out of favor because of potential side effects and lack of efficacy. Ovide (Malathion) may be beneficial but is flammable. Whichever medication is used, it should be combined with mechanical nit removal. A fine-toothed comb, patiently and methodically worked through the hair, as in searching for nits, is an important supportive therapy. A sturdy comb, such as the LiceMeister, is a wise purchase.
Trying to suffocate the lice with mayonnaise, Vaseline or Dippity Doo is messy in the extreme and probably of little value. Heat, applied by hair dryer, may kill the lice, and may do bad things to the patient as well. Cutting off all the child’s hair will address the problem but is unacceptable to most people. Always remember that when your doctor’s methods are imperfect, there will be products on the Internet promising spectacular results. Take them with large grains of salt.
Some school districts may have no-nit policies, excluding children from school if any nits are found. Both the National Association of School Nurses and the American Academy of Pediatrics disagree with this stance, and feel that once treated, children should return to school. Periodic rechecking by the nurse is reasonable to assess any signs of recurrence.
Lice can be a significant individual and community problem, but excessive treatment with toxic pesticides can be worse than the original problem. Follow directions on medications carefully. Clean sheets and clothes, and comb with hot water and hot drying. Compulsively fine toothcomb the scalp, and repeat in one week. A diligent and comprehensive effort will likely resolve the problem in short order.
You may scratch your head now.
Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at email@example.com.