New Lice Recommendation Has Parents Scratching Their Heads

In a surprising recommendation, pediatricians say kids with lice shouldn't stay home from school, and they explain the best treatment and prevention methods.

The Short of It

It's enough to freak any parent out: Someone in your kid's classroom has head lice. Many of us have had notes sent home telling us to look for signs of the little parasites and to keep our child home if they have them. But, the notes home may end. And in fact, according to a new recommendation, kids with these creepy crawlers should be welcomed in school with everyone else.

The Lowdown

The American Academy of Pediatrics (AAP) announced its new policy, which may raise some parents' eyebrows, Monday.

"Most cases of head lice are acquired outside of school," says the announcement. "The AAP continues to recommend that a healthy child should not be restricted from attending school because of head lice or nits (eggs). Pediatricians are encouraged to educate schools and communities that no-nit policies are unjust and should be abandoned. Children can finish the school day, be treated and return to school."

The recommendation is based on a clinical report published in the "Journal of Pediatrics," which found that only a third of kids with five or more nits actually developed an active infestation. Taking those kids out of school would have been unnecessary.

"In addition, head lice infestations have been shown to have low contagion in classrooms," says the report. (The report also said the bugs don't hop or jump—who spread that nasty rumor?)

Researchers found that the best way to treat nits is to use an over-the-counter treatment containing 1 percent permethrin or pyrethrins. If there's a chronic lice problem, use an OTC pediculicide and follow the manufacturer's instructions. Then reapply it at Day 9, and if necessary, at Day 18. If that doesn't work, your child should see a pediatrician.

The Upshot

This busts a big lice myth we've all come to believe: That your child is mostly likely to contract—or spread—lice while at school. And while this might worry some parents (anyone who's been through an infestation knows it isn't pretty), it may be a relief to not have to take days off work or have their child miss valuable school lessons when a few nits are found.

Head lice can't be completely prevented, but you can lower your child's risk by teaching them to never share combs, brushes or hats. Check your child regularly for signs of nits, and if one family member gets them, everyone in the household should be checked. Anyone with nits or an active infestation should be treated right away.

7 Things You Don't Have to Do When Your Kid Has Lice

Not only am I the editor of our latest story on lice, which does a great job of outlining all of your possible treatment options, I'm also the proud mother of two little girls who've been infested. The first time, the call from the  school nurse downright paralyzed me. Stunned, I told my coworkers, who were all sympathetic either because they'd been in my shoes themselves or because they hadn't and live in fear of the concept. Then I sort of wandered around the office aimlessly, quite frankly dreading going home. The second time, I found the buggers myself and was more aggravated than panicked. I called Sally Kelly, R.N., the amazing professional nitpicker and school nurse who helped me the first time, and simply resigned myself to several days of laundering and combing. She's so wonderful not only because she can do a comb-out like nobody's business (and for a much lower price than her competitors), but because she's filled with helpful tips on the things that aren't necessary when your kid has lice. Thanks to Sally, I've learned what you don't have to do.

1. You don't have to freak out. 

   Of course you don't want bugs living in your kid's hair. But technically, from a health perspective, it's not worrisome. Lice don't spread disease. As Sally told me during our first call, "This is a nuisance. Nothing more." You lice vets out there know: Your first instinct is to wash or toss everything your child has ever come in contact with. But that's overkill. (The CDC backs this up--they point out that because lice can't live off the human head for more than two days max, "you do not need to spend a lot of time or money on housecleaning activities.") Speaking of...

2. There's no need to wash your child's bedding every day. 

   Wash the pillowcase, but the comforter/blanket, sheets, and stuffed animals and other lovies can simply go in the dryer on high for 20 minutes. As for the bottom sheet, you don't even need to remove it from the bed. Sally's tip is to take a roller lint brush--the kind with tape--and run it thoroughly over the top half of your child's sheet. Her logic: The odds of a louse or nit falling off your child's hair and getting under the pillow and remaining alive is remote.

3. Don't bother with the dust ruffle. 

   Lice won't be able to scoot all the way down past the mattress without dying, and your kid's head doesn't come in contact with it anyway.

4. You can skip vacuuming curtains and drapes. 

   Unless your child was, say, playing Hide & Seek and wrapped herself in the curtain in the 48 hours prior to you discovering she had lice, there's just no way that the bugs made their way over to your windows. Spare yourself. But you should vacuum any cloth furniture that your child's head may have touched in the two days before you realized she had lice.

5. You don't need to throw out your brushes and combs. 

   I drop my girls' brushes in a pot of boiling water immediately after I use them, turn off the water, and fish them out after a few minutes, by which time any bugs that were there are long dead.

6. You don't have to treat family members who don't have lice. 

   Once everybody has been thoroughly checked and you've determined who is and who isn't infested, just make sure that there's no head-to-head contact between the two groups. (No snuggling, sadly; no hunching side-by-side over a video screen--or Rainbow Loom kit, and so on.)

7. Hard as it may be, you really don't have to make your kid feel like she's a leper. 

   I distinctly remember one night when I'd finished the hours-long comb-out session with my girls and gotten them both bathed and brushed; I then went downstairs to wash their towels and boil their brushes. I came back up to my bedroom to find one daughter sprawled out on my bed. "OH MY GOD, GET OFF!" I shrieked, nearly causing her to have a heart attack. I immediately apologized, but the poor kid was wide-eyed, saying, "Mommy! You scared me!" Not to mention I made her feel as though she was repulsive. I quickly got a grip... and stripped my bed.

Life Lessons from Lice, and the Kardashians

School’s almost out for summer, so I thought this would be a great time to share some major lessons I’ve learned this term, in pursuit of my advanced degree in Pediculosis Studies.

Head Lice can be our greatest teachers.  There’s an old saying, “When the student is ready, a teacher appears.”  It may be hard to imagine, but head lice can actually teach us A LOT about ourselves, beginning with the way we react to news of something unexpected and unpleasant.

I’ve noticed that a few families respond to an infestation of head lice with equanimity, while most react by initiating DefCon 5. The latter type is in full-on crisis mode, which might be marginally more helpful during an actual nuclear attack than it is when a small child comes home with head lice.

Discovering head lice IS scary when all you know about them is how icky they are, and when you believe that they’ll multiply forever.  Like the Kardashians.

It’s hard to solve a problem from freak-out mode.  Fear narrows our point of view, both literally and figuratively.  Our primal fight/flight/freeze fear response physically prevents us from seeing anything beyond the immediate threat, so we can’t focus on our options.  We feel so overwhelmed we can barely move.

Knowledge is a powerful antidote to fear.  Seek it out whenever possible.

I’ve seen the emotional fallout from an infestation cause more harm than the infestation itself.  In a society that values appearances, the appearance of head lice proves to the entire world that you aren’t perfect.

Because, of course, the entire world is watching you, along with the Kardashians, to see what ridiculous sham marriage or baby naming stunt you’ll perform next.

Imperfection is the normal, natural state of things.  Perfection exists only in the airbrushed, Photoshopped, glossy photos in magazines.  So why do we feel so ashamed when our kids come home with lice?  Why do we want so badly to make it someone’s fault?

The shame and the blame only serve to keep us separate from the one thing that can ease our emotional pain—other people.

Connect with others who have experienced the same thing, rather than withdraw into the dark, quiet prison of shame, and your deficiencies will seem less remarkable. 

Admitting your shame to someone who has been there before will lighten the heavy burden of feeling like a failure, a bad parent, or an unworthy human being.  And they’ll probably say something nice, like, “Oh, honey, all kids get lice.  But only a Kardashian kid gets named after a compass point.”

The most horrendous experiences teach us life’s most important lessons.  As much as we might have preferred not to learn them this way, apparently the universe is fond of serving up traumatic circumstances to get our attention.  If you think getting lice is one of the worst things that has ever, or will ever, happen to you, consider yourself lucky and celebrate getting schooled.

You’ll survive the lice episode, and if you’re lucky, you’ll laugh about your neurotic behavior.  Lice have never actually ruined any lives.  They might change your plans, be highly inconvenient, and give you the heebies, but the world won’t end.  You’re not a bad parent or inferior housekeeper, and in a few days, I’m sure the neighbors will stop talking about you behind your back.  Treated properly, the lice WILL go away, unlike the ants in my kitchen.

Or the Kardashians.

Lice in the Modern Family

I’m always up for a bit of comic relief when it comes to head lice, a welcome addition to the “calm-ick relief” which I practice often. Anyone who can make people laugh about lice is ok by me.  (I also like jokes about unmentionable bodily functions, but that can be our little secret.)

This is why I am so delighted that a recent episode of “Modern Family” (#515, in case you are interested) featured head lice, and the ways in which each character reacts to the news, tries to avoid contracting them, and in one scene, ultimately uses them as a weapon of revenge.  Predictably, the laughs are generated by behavior that is based on misconceptions, because it wouldn’t be funny if they calmly went about the business of taking care of the lice without first freaking out completely.

[Program Notes: If you haven’t seen “Modern Family,” Cameron and Mitchell are the gay fathers of little Lily.  Claire is Lily’s aunt and Mitchell’s sister.  Phil is Lily’s uncle and Claire’s husband.  Gil is Phil’s nemesis. Got that?  Good.]

Here’s the story line:

• Lily’s school calls Mitchell to report head lice in her class.  Cameron immediately blames another child, whom he refers to as “filthy.”

Misinformation #1
Clean children are just as likely to have head lice as filthy ones.  Lice don’t care if we wash behind our ears. 

• Cam confirms the news by saying that Lily’s head “sounds like Pop Rocks.”

  Misinformation #2
  I have never heard lice make a sound, although it would be great if they did, sort of like the popping sound that precedes the flames in the Fire Swamp from The Princess Bride.  Who couldn’t use a little warning?

• Cam’s response is to make up games like “scary robot,” during which Lily is forced to wear a large cardboard box over her head, even though she and her “head pets” can’t breathe, and “who wants to pretend they’re a dog, and go for a ride in the car?”—a game in which the only rule is that Lily must ride with her head sticking out the window.

  Misinformation #3
  I won’t insult you with reasons why this is So. Wrong.

• Aunt Claire picks Lily up at school and shoots a selfie of the two of them: “Here we are!  Having fun!”  We all know where that’s headed (no pun intended), after the recent spate of articles claiming that selfies spread head lice.

  Misinformation #4
  It’s possible, but unlikely, that brief head-to-head contact results in a new infestation.  On the other hand, multiple takes to get the perfect selfie for worldwide internet exposure may increase exposure of an unwelcome kind.

• In the next scene, Claire’s client insists on ending a business meeting with a long hug.

  Misinformation #5
  Head lice aren’t equipped with a radar system alerting them that two heads are about to come into close contact with each other.  Even a long hug is over and done before head lice have the opportunity to hug back.

• Finally, Phil attempts to exact revenge on his rival by insisting that he give Lily a piggy-back ride.

  “Lily LOVES piggy-back rides,” says Phil.

  “No, I don’t,” Lily protests, as Phil swings her onto Gil’s back and begins alternately ruffling her hair, then Gil’s, and laughing like a maniac while Lily rests her head against Gil’s.

Still no score for the Larger Than Lice Team.

What remains a mystery is whether this involuntary head-to-head contact results in Phil getting his sweet revenge, or if Phil’s inadvertent contact with Lily earlier in the week will come back to bite him!

Whoa: Now There’s a Way to Track Head Lice Outbreaks in Your Area!

Find out in real time where head lice are 8 havoc and if you should check your kids ASAP.

I'll never forget seeing a tiny bug in my daughter's hair one evening after a bath and thinking, "Ew, it's a gnat!" Um, then I saw another "gnat." And another. My heart sank, as the realization that I was looking at head lice hit me. Oh, did I mention all three of my girls ended up with it? Let's just say it was not a fun week.

Later, I would learn our school district was being hit especially hard by an infestation of head lice. If only I'd known ahead of time lice was running rampant in our area, I might have been more on top of checking my kids' hair.

Well, now there is a way to track lice's whereabouts. One of the over-the-counter head lice treatment brands, recently launched an online tracker that allows parents and school administrators to see where outbreaks are happening so they can be prepared. Using IRI data from lice product sales and crowdsourced data from school nurses and parents (you can even report a "sighting!"), and Google Trends data to track lice outbreaks, the Lice Tracker shows in real time where those pesky buggers are wreaking havoc.

I decided to try it out and was relieved to see the incidence level is low in my area at this time. But, according to a study by Johns Hopkins Medical Institutions, the peak time for head lice to hit hard is in August and September when kids go back to school.

First, what should we be looking for? "Sometimes it's difficult to tell whether you are seeing lice or just some other scalp condition like dandruff, or even sand," Dr. Altmann says. "Adult lice are usually light brown in color and look like sesame seeds. They often move quickly and can be found on the scalp or hair. Eggs are yellow, brown, or tan. They look like tiny seeds that are firmly attached to the hair shaft and do not move."

Dr. Altmann suggests dividing hair into small sections to search for lice and their nits, or eggs. This can be pretty challenging with thick, long hair like my daughter has, and may take a while. But trust me, you'd rather catch lice early before it spreads to other members of the family. Unfortunately, according to Dr. Altmann, it's pretty darn near impossible to prevent your child from getting lice because it spreads easily in schools and daycares. But, she recommends taking these preventative measures:

• Teach your children not to share hats, hair accessories, combs, or other items that come into contact with hair. Discourage your children from sharing or stacking blankets, jackets, pillows, and towels, because lice can crawl from item to item.

• Check your children regularly for lice if there is an outbreak at their school, even if they aren't showing any signs or symptoms (like, itching and irritability) and especially if there is an outbreak in school or in the region.

• If you suspect your child has lice, make sure to wash all clothing, linens, and toys used by the infected person in hot water or through dry cleaning.

If your child ultimately gets lice, Dr. Altmann advises parents to act quickly to kill the lice, remove the nits, and stop the problem from spreading. 

P.S. Don't feel bad if your child gets it! When it happened to us, I didn't want to tell anyone due to shame, but guess what? As soon as I shared my experience, I found out almost everyone I know has had either a scare or their own encounter with the pests!