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Head Lice... What a Parent Should Know

As parents we all dread that note coming home from school saying that your child has been exposed to, or even worse, appears to have head lice. For the most part this is an anxiety provoking but essentially harmless condition that requires a bit of understanding and some very simple treatment.

Head lice infestation, or pediculosis is a very common condition in preschool and elementary school age children. The lice are actually small insects that live on humans and survive by feeding on blood. It is this feeding which produces the characteristic itching. Usually they are spread from one person to another through close bodily contact or through sharing personal items such as clothing, hats or hairbrushes. Contrary to popular belief they cannot fly and they do not jump form one body to the next. This infection can affect people from all incomes and social levels. It is not specific to those who do not bathe or wash their hair regularly. There seems to be a higher incidence found in the white population than in African Americans in North America. Typically lice are found most often behind the ears and at the back of the neck.

The most common symptom of head lice is itching and this may develop weeks or even months after lice have infested the individual. Scratching the affected areas can make the skin raw and tender. Occasionally a secondary bacterial infection may occur as a result.

The diagnosis is usually made by simple inspection of the hair shaft exposing the presence of live lice or nits. Sometimes a professional may need to look for this under a microscope. Nits are head lice eggs. Most of the nits you see aren’t living things. The eggshells left over from hatched head lice can easily be seen as white casings that may be confused with dandruff. One common misconception about nits is that their presence implies a child has lice. In fact, fewer than one in five children with nits go on to get a true infestation of lice. This results in many children being sent home from school for having head lice, when in fact, they don’t. Treatment for lice should only begin when adult lice are found.

Lice will not go away without treatment. The live lice may continue to lay eggs, or nits, and the condition will worsen. So what is the typical treatment for head lice?

The most common treatment is the application of a cream lotion or shampoo that contains an ingredient that kills lice. There are both prescription and over the counter medication available. The more common ones include ingredients known as permethrin or Lindane. None is 100% effective. Lindane can be toxic to the nervous system if used incorrectly and has been repoted to cause severe seizures in children. There is a consumer group know as Pubic Citizen that has called for a ban on this drug, however the FDA still permits its sale. Some groups have advocated the use of herbal treatments, such as tea tree oil, but this has not been studied enough to be deemed safe and effective. Occasionally, oral therapy is indicated if there is repeated failure using topical medication. Children are often treated if nits are seen during an outbreak of lice. There are some schools that have a “no nit” policy and these children may return only after all nits have been removed

The best time to contact your doctor is after you have tried a nonprescription product first or if you are unsure of the diagnosis. You should also contact your doctor if you develop any serious side effects after using an OTC product, or signs of a skin infection develop. These are increased pain, swelling, heat redness or tenderness, red streaks extending from the affected area, a discharge of pus, or an unexplained fever of 100 or higher without obvious cause.

For the most part lice is an easily treated, an often misunderstood infection. Most children are successfully treated without further recurrence. Although spread among household contacts is possible, proper and early treatment will usually prevent spread.

Photos of lice courtesy of University of Nebraska Cooperative Extension in Lancaster County - http://lancaster.unl.edu

Doc Gary's information is for educational purposes only. He strongly recommends that for definitive medical advice to please consult with your personal physician.