Head lice: Misinformation, resistance in the pediatrician’s office

Summer is nearly upon us, and for many children in the United States, the season is about enjoying sun, sand, summer camp and sleepovers. However, many pediatricians will be spending the summer helping patients and their families deal with an unwanted guest:  Pediculus humanus capitis, or the head louse.

Considered one of the oldest parasites, head lice are known to predate modern Homo sapiens by about 1.18 million years. Unable to fly or jump, head lice are neither ambulant nor particularly hardy parasites, dying within 1 or 2 days once removed from the scalp; they are, however, uniquely adapted to anchor themselves to hair shafts on the human head. Additionally, as a species-specific parasite, head lice cannot be spread through contact with animals, leaving humans as their sole source of food as well as their only means of transportation and dissemination to new hosts.

“Head lice have been with humans for thousands of years,” said Joseph A. Bocchini Jr., MD, FAAP, a professor and chairman of pediatrics at Louisiana State University Health — Shreveport. “They are well adapted to humans and, in fact, their entire life cycle is completed on the scalp. It is a well-developed relationship for the head louse.”

Despite their largely immobile lifestyle, head lice are reported to be responsible for an estimated 6 million to 12 million infestations each year in the U.S. among children aged 3 to 11 years; this age demographic is also most likely to gather in settings where summer activities with the direct head-to-head contact that head lice need to thrive are likely to occur, such as playgrouds, summer camps and slumber parties.

Confronting head lice myths, misconceptions

Although a common issue among children, and not associated with any disease risk, head lice infestations nevertheless Confronting head lice myths, misconceptions. Among the widespread myths about head lice, their association with poor hygiene has been the most difficult to debunk, according to Ashley A. DeHudy, MD, MPH, from the University of Michigan’s Mott Children’s Hospital. “It is important for families to know that this is a very common diagnosis that many people deal with. Anyone is at risk for lice infestation, since according to the CDC, personal hygiene and environmental cleanliness do not play a role in lice.”

In a study published in the International Journal of Dermatology, Parison and colleagues determined that the societal impact of head lice countermeasures, including quarantine and overtreatment, may have a more damaging effect on parents and children than the actual head lice infestation itself. Compared with perceptions of head lice in traditional societies, researchers found that parent populations in the U.S., Canada and Australia exhibited overwhelmingly negative emotions regarding head lice, further contributing to persistent head lice stigma.

While affirming that head lice infestation is common, regardless of socioeconomic status or living conditions, pediatricians are often forced to confront the misconception that head lice spread diseases. Unlike their larger cousins — the body louse, known to carry diseases such as typhus and trench fever — head lice are not a disease vector, although excessive scratching can occasionally increase the risk of a secondary skin infections.

“Head lice do not carry disease, as [they are] different than the body louse,” Bocchini said. “Head lice do not transmit any known infection.”

Additionally, pediatricians are encouraged to spend time educating parents about lice transmission, namely that people become infested with head lice, but inanimate objects or homes do not. Sleeping in a bed formerly used by a person with head lice, for example, is unlikely to spread head lice; however, sharing a bed or spending extended periods of time with heads close together – such as at a sleepover – represents significant risk factors for transmission, providing lice with sufficient time to crawl from one head to the other.

“Head lice often become a problem when people are concentrated together in one place, so naturally we think about children in the classroom, yet even more so during activities like summer camps; whenever people are head-to-head, that is when there is the greatest risk of exposure,” DeHudy told Infectious Diseases in Children.

Don’t let head lice get the best of your family this school year

The bell is about to ring for the first time for the upcoming school year, meaning maladies, ailments and other health nuisances are coming soon.

One of those annoyances comes in the form of head lice — itchy, bothersome, parasitic insects that live solely on the scalp hair of humans and usually on children 10 and younger. As do all insects, head lice develop in stages from egg, or nit, to nymph and finally to louse.

There are many fallacies about lice, says D’Ann Somerall, DNP, an assistant professor and family nurse practitioner specialty track coordinator in the  University of Alabama at Birmingham School of Nursing. The biggest misconception, Somerall says, is that lice are a problem only for the poor.

“It has nothing to do with how clean or dirty your home or school may be, or how clean or dirty your kids may be,” Somerall said. “Affluent schools, rural schools, urban schools — anyone from any socioeconomic background can get head lice, no matter how clean their hair or home.”

Somerall, a mother of six children, experienced firsthand the issues lice can create in her own home. Her oldest daughter came home from school one day and was violently scratching the back of her head. When Somerall first looked, she believed it was dandruff. A closer inspection revealed that it was actually nits, the eggs lice leave behind.

“My daughter has really thick hair, and when we pulled it up and looked, she had probably thousands of nits in her hair,” Somerall said. “Of course I was mortified at first. I had no idea she had them. But it is not something parents should panic about. You can take care of it. It is tedious because treatment can play out over the course of days and weeks, but it can be done. The main thing is to recognize, identify and treat as soon as possible.”

The first sign that lice may be an issue is bad itching on the nape of the neck and behind the ears. Children with long, thick hair also are more prone to acquire lice. The bugs are more difficult to see than the nits, which can be white or dark. If they are dark, it means the louse is inside of the egg. If nits are white, it means the louse has hatched.

Because the nits are bloodsuckers, they are typically found one-quarter of an inch from the skin. The louse itself is hard to find in part because of its size and because it travels quickly, moving up to nine inches in one minute.

Somerall says all infested persons and their bedmates should be treated at the same time. Rid and Nix are popular over-the-counter medications used to treat lice; but if crawling lice are still seen after a full-course treatment, it is recommended that you contact your health care provider. Parents with children age 2 and younger should call their pediatrician before using any over-the-counter treatment for lice.

Home remedies to treat lice, including the use of mayonnaise, vinegar or petroleum jelly in the hair and covering with a shower cap for several hours or days, do not work, according to the Center for Disease Control. However, Somerall says one of the home remedies did work for her daughter.

“It was a moment of desperation, really, because we used over-the-counter products to treat, and we thought they were all gone until a hairdresser found them again while my daughter was getting her hair cut,” Somerall said. “We covered her head in Vaseline and put a shower cap on for eight hours, and it did get rid of them.”

Somerall also says to use a lice comb on your child’s hair as directed, including after you get rid of the lice.

“It’s best to use a metal comb instead of a plastic one,” Somerall said. “Remember that lice infestation can be an ongoing battle, especially in group settings. There’s no doubt that they can be hard bugs to get rid of, so being persistent and following the directions of the medications used to treat your child’s hair is key.”

If you suspect your child does have lice, Somerall says you should check with the school nurse or child care center director to see if other kids have recently been treated for lice. If you discover that your child does have lice or nits, contact the staff at the school or child care center to let them know and to find out what their return policy is.

How to tell if your child has head lice.

When you became a parent, you probably never imagined yourself hunting for lice in your child's hair. But that's just what you (or someone) will have to do if you suspect that your child is infested.

When the bad news comes from a school

Many schools do regular lice checks during the school year, examining every child's head. If they find lice, they'll let you know. Be sure to do your own checking, though, to confirm their finding. You may instead get a note warning that someone in your child's class or school has lice. That's your signal to check your own child's head. It's best to do this as soon as possible, because the sooner you find the lice, the easier they are to handle. And if you do find lice, you'll need to check (and possibly treat) the whole family.

How to inspect your child's head

The sesame-seed-size creatures and their teeny-tiny eggs are quite hard to spot. To find out whether you need to take action, try the following two- to three-step process.

If you can't spot them via a visual inspection (step 2), try wet combing (step 3). A 2009 study in the Archives of Dermatology found that "wet-combing" accurately identified active head lice infestations in 90 percent of cases. In contrast, visual inspections accurately identified 29 percent.

You'll need really good light and a pair of strong drugstore reading glasses or a magnifying glass (unless you have the eyes of an eagle). If you move on to step three, you'll also need a metal lice comb and some hair conditioner.

Step 1: Look for the signs and symptoms of head lice

Your child may have one or more of these symptoms:

• A tickling feeling on the scalp

• A sensation that something is moving in the hair

• Itching caused by an allergic reaction to lice bites (kids may scratch or rub their scalp, especially around the back of the head or ears)

• Sores on the head caused by scratching

• Irritability

• Trouble sleeping (lice are more active in the dark)

  Step 2: How to search for lice, stage one (dry hair)

• Check your child's scalp.
  Part the hair in various places and check the scalp behind the ears and at the nape of the neck. You may notice sores or a rash where your child has been scratching.

• Look for movement in the hair. You're not likely to see the lice themselves. They're very small, move quickly, and avoid light, so they're difficult to spot.

• Look for lice eggs, known as nits.
  These tiny white or yellowish tear drop-shaped sacs are attached to the hair near the scalp (within a quarter inch if they haven't yet hatched). Nits may be easier to feel than to see: They'll feel like grains of sand.

• Make sure the "nits" you see are really nits.
  Nits are often hard to distinguish from dandruff or flakes of hair products. The difference is that nits stick to the hair like glue while dandruff and other flakes are easily removed from the hair shaft.

• Make sure the nits you find are still alive.
  If the only nits you find are more than a quarter inch from the scalp, they may have already hatched and your child may no longer be infested. (Nits can only hatch in the warmth right next to the scalp. After they hatch, the empty egg remains attached to the hair and grows farther and farther from the scalp.) Only viable nits – those very close to the scalp – or live lice are proof of a current infestation.

  Step 3: How to search for lice, stage two (wet hair)

  You'll need to go on to this step if you can't tell whether there's an infestation by looking at your child's hair and feeling it, the way you did in step 2. Studies have found that a lice comb is the best tool for finding live lice. (A flea comb may also work.) The teeth on a regular comb are too far apart to nab the tiny lice.

• Wet your child’s hair

• Pour on lots of conditioner.

• Comb the hair out in sections, from the roots to the ends, with a lice comb.

• If there are lice in your child's hair, you should see them on the comb.
  (Shaking the comb out into a plastic bowl after every swipe can help you see them better.)

  If you determine that your child does have lice, check the other kids and adults in your house. You'll need to treat everyone to effectively rid your family of lice. If you follow these steps and you're still not sure, have your child checked by a caring technician at Larger Than Lice, we are open 24/7 and we will be more than happy to help you get rid of lice in your home!

Itchy head? Head lice advice!

It can be a bit of a shock, the first time you hear that a case of head lice has been reported in your child’s class. Possibly worse is to find that your own child has them.
Most schools have a head lice policy. This will usually include alerting all parents in your child’s class that head lice have been found in a classmate’s hair. You should check your child’s head immediately, and again on a regular basis over the next three weeks using a special fine-toothed lice comb.
Checking with a lice comb is best done after wetting your child’s hair, preferably after adding a small amount of conditioner. There are also treatments available from the pharmacy, such as Paranix, which help with the combing.
Comb through small areas of hair, in both directions. After each pass of the comb through the hair, wipe the comb on a tissue and check the tissue for lice or eggs. It may help to have a strong magnifying glass, and to use a bright light, as the lice can be quite pale in colour, and the eggs are quite small.
Comb the hair until you are satisfied that if there is an infestation you’ve found it and removed it. It may well take 10 minutes or more.

WHAT ARE HEAD LICE?

Head lice are very small pale wingless insects that live on the human scalp and in the hair. They will infest any kind of hair, long or short, clean or dirty, during close contact between children such as during play. Lice do not communicate disease, or do any harm to the child, but the itching can be uncomfortable.
Infestation is common among children from three to eleven years of age, with girls being infested more than twice as often as boys. Keeping long hair tied back will limit the amount of hair-to-hair contact, so reducing the likelihood of infestation.
Head lice are unable to crawl, jump, fly or swim. They like to stay in their normal habitat, hair and scalp, and are are mainly acquired by direct head-to-head contact with an infested person’s hair, such as during play, study or sport.
Occasionally lice can be transferred with shared combs, hats, hair grips etc, but they can live only for 1-2 days away from a human host. If you do find any on such items, they are probably already dead or dying.

HOW DO I DETECT THEM?

The first signs are usually an unusual itching, or even a sensation of something moving in the hair. There may also be an itchy reaction to the bites of the scalp, which in turn in extreme cases can cause sores as a result of scratching, which can become infected.

SIGNS AND SYMPTOMS TO LOOK FOR:

Head scratching, possibly resulting in scratch marks on the scalp especially behind the ears, near hairline and at the back of the head and neck. Live lice in the hair. Nits, smooth glistening specks stuck to the hair near the scalp. You may find a one or two, or hundreds of nits in the hair of an infested child.

SHOULD YOU CLEAN YOUR HOME? 

Research suggests that if adult lice do fall off the child’s head, they are likely to be already dead or dying, so will be unable to lay more eggs. It’s therefore unnecessary to treat your entire house. However, changing your child’s pillowcase, laundering or vacuuming car seats, washing hats and scarves, and cleaning hairgrips etc is worthwhile.

IT’S NORMAL!

Don’t feel bad! Head lice infestation is not a reflection on your parenting, or on your child’s cleanliness; the lice aren’t choosy like that.

Everybody Has Lice and Nobody’s Talking About It

What one mom learned after a fateful hair appointment…

It all started as a normal visit to a kids’ haircut salon. I’d landed simultaneous appointments for my two children so I could savor my cappuccino in peace. But halfway through the appointment, my daughter’s stylist stopped cutting and said, “Can you come over here?” 

She pointed to something that looked like a grain of brown rice on my daughter’s scalp. 

“That,” she said with an ominous tone, “is lice.” 

A Facebook post from two weeks prior flashed through my mind: There’d been a lice outbreak at school right before summer break. 

“We have to end the haircut now,” the stylist said as she squished the louse in a tissue before tying up my daughter’s wet hair in a ponytail. 

My daughter started to panic, itching her head compulsively. I took a breath.

“What, what do we do?” I stammered. 

The stylist pointed toward some lice kits on a shelf. For more money, she said, we could enlist a lice treatment service. I was mortified. We quickly paid and hustled out the door. 

A first time for everything

Believe it or not, this was the first time in nine years of motherhood that I had encountered lice.

Despite occasional lice warnings over the years in preschool and elementary classes, we’d managed to avoid these bugs completely. That gave me a false confidence that we were doing something effective (nope) and that we didn’t have conditions in which lice could prosper (nope again). 

While my daughter received her hair treatment — a 40-minute precision comb-through of hair soaked in a proprietary oil mixture while she watched a movie on my laptop — the lice technician told me what items needed to go in the wash vs. quarantine. I flung myself around the house, bagging stuffed animals, spreading sheets over couches and running the washing machine nonstop.

And wouldn’t you know it? I ended up having lice, too. 

Sharing the news

Since I document everything, I took pictures of my daughter and myself during our treatments. Her sad, sullen face says it all. Setting aside my own insecurities in an effort to embrace the moment, I shared the photos on Facebook as a way to show my kids that we needn’t be ashamed. 

What I didn’t expect were so many admissions of lice infestations from fellow parent friends — 15 to be exact! Good friends, close friends, had been through this same thing — some recently and others multiple times — and none had said anything.

When I mentioned this to our lice technician at the seven-day follow-up appointment, she wasn’t surprised. Lice, she explained, are a lot more common than you might think (the CDC estimates 6 to 12 MILLION “infestations” occur annually among U.S. kids 3 to 11 years old).

More importantly I realize lice aren’t an indicator of uncleanliness. Rather, they’re a natural part of life because kids share things even when you tell them not to, like hats, combs, clothing and personal space. 

Also good to know: Lice don’t carry diseases like ticks or mosquitos do and they can’t survive for more than 48 hours without a host. 

This experience cleared away some old assumptions and changed my perspective for the better. Now we know: Lice happens to a lot of people — all the time — and getting them isn't scandal-worthy.

We’re even heading back to the same kids’ haircut salon next week with heads held high — but no lice on them this time. 

10 Reasons to Chill About Lice (Seriously)

A case of head lice may seem like the worst hair day ever, but don't let it put you over the edge. Here's why you can (sort of) relax. 

1. Lice don’t carry disease.

Sure, scratching from lice could technically cause sores. But in the vast majority of cases here in the U.S., these bugs are not a health hazard. What they do spread is fear and disdain for those kids unlucky enough to get them. “Children may refuse to sit near others who have nits in their hair. Parents may blame other parents and not allow kids to play together. It’s pretty unfair considering how little danger lice pose. Try not to worry about whether others have lice: It’s more important to be nice. 

2. They also don’t spread that easily.

Does just thinking about soccer huddles or group selfies give you the creeps? Relax. It almost always takes sustained contact (think: a long car ride with kids squeezed in the back or a full episode of Sofia the First on the couch) for a louse to move from one kid’s head to another’s, says Dr. Gordon. Lice don’t jump like fleas or fly like mosquitoes—they crawl and can barely move off a human head. To keep children from catching them, send kids with long hair to school and sleepovers with their hair in a braid or a bun, says Katie Shepherd, founder and CEO of The Shepherd Institute for Lice Solutions, in West Palm Beach, Florida.

3. Without a human host, they’re toast.

Lice only thrive on human heads and hair—not on pets, furniture, toys, or dress-up costumes. They need a blood meal at least every 24 hours, or they’ll quickly dehydrate and die. If a louse should happen to go rogue and land on, say, a pillow, it would need luck and acrobatic prowess to attach to a new person’s head. Although it’s theoretically possible for this to happen when kids share items like hats and headphones, lice are not generally spread this way,” says Shepherd. (Even so, tell your kids not to swap caps and headbands.)

4. Nits aren’t contagious.

Mama lice superglue their teensy eggs to hair strands right next to the scalp, which makes them nearly impossible to dislodge, says Shepherd.

5. Lice don’t like adults’ hair as much as kids’.

Lice claws hook most easily onto thin, straight hair shafts, and hair gains girth with age. This, combined with knowing what “personal space” is, may be why parents often escape them, says Albert Yan, M.D, a pediatric dermatologist and spokesperson for the American Academy of Pediatrics (AAP).

6. Those eggs are pretty easy to see. 

You just have to learn what they look like. The nits don’t brush away like dandruff or slide up a strand the way scalp secretions and globs of hair product do. “If you see a fleck on a hair and it doesn’t slide easily, you’ve found a nit,” says Dr. Gordon. Opaque white flecks stuck firmly to the hair but more than a centimeter from the scalp are usually empty egg cases from which the nits have hatched. “These can remain after a child has been treated and aren’t a threat,” says Dr. Yan. Still, remove them while you’re combing, especially if your school has a no-nits policy. (In warm climates, unhatched nits can be found farther from the scalp too.)

7. Your kid may not have to miss school.

Thanks to recommendations from the AAP, schools are slowly but steadily backing away from strict “no nit” policies and allowing healthy kids to attend as long as they don’t have live lice on their head. If the school nurse finds lice on your child during the day, the AAP suggests that he stay in class until dismissal, get treated at home that night, and come back to school the next morning.

8. Many kids don’t get itchy.

Itching is an allergic response to louse saliva that only about half of people have, which means your child may not be bothered at all. Just keep an eye out for other symptoms—red bumps on the neck, scalp, and ears; and relentless, immovable “dandruff” that could actually be nits. 

9. Lice are much less of a nightmare than bedbugs. 

Bedbugs stay on humans just long enough to feed, then crawl into their surroundings. (Ick!) Lice, on the other hand, pretty much stay put on their human host and leave your belongings unscathed. If someone in your home has lice, there’s no need to tear your house apart or fumigate, simply wash and tumble dry (on a high temperature setting) any bedding or clothes that have come in contact with your child’s head in the past 48 hours, and soak brushes, combs, and hair ornaments in hot water (at least 130°F) for ten minutes. Place nonwashable items (down pillows, precious stuffed animals) in tightly sealed plastic trash bags for two weeks to starve outliers, or toss them into the dryer on the highest setting for half an hour.

10. Hey, at least there’s no pee in his hair.

Lice don’t go number one. Instead, they cast off fluid via their windpipe. If your kid wakes up with a wet head, it’s just sweat. Phew!

You may have lice and not even know it

Could you have an infestation of head lice and not even know it?

The truth is that within the first weeks of an initial infestation the case often goes on without any evident symptoms. Even the itching commonly associated with head lice may not come on for several weeks.

You may have a co-worker who has recently discovered that they are infested, and so you suspect that you could have lice without even knowing it, too. It is common for no symptoms to occur for up to six weeks of infestation, so you may have lice and not yet know it. Also, up to half of the people who get head lice never have any itching.

Lice experts recommend doing a head check regularly, especially when you have been in contact with people who have identified lice in their hair.

Where lice are most likely to be hiding in your hair

Lice can be hard to spot, so knowing the first places to look can help. Lice favor the areas around ears and the nape of the neck, so check there first.

The best method for checking for Lice

Using a fine-toothed lice comb is the expert-recommended way to check for lice. The combing method is much more efficient at spotting lice than a visual screening on its own.

It can be difficult for the untrained eye to see the difference between dandruff, dirt, dry skin and lice. You may need the services of a health care expert who is knowledgeable about the differences. They recognize lice and their eggs so you can have an official diagnosis rather than only the best guess.

You can be sure you’ve spotted lice when you see them moving around on the lice comb. You may need a magnifying glass to detect them, and using a light source like a flashlight can help because lice flee from light.

Choosing the best treatment for confirmed infestations

When you’ve confirmed that you have lice, the first tip is to take it in stride. Lice infestations happen to good parents and children, too. An outbreak does not mean you are a poor parent or that your home is unclean. And, there are new treatments that can solve your lice problem quickly and efficiently.

The most professional and effective treatment available for lice

Over-the-counter treatments are woefully ineffective as lice have become resistant to the medicines used in them. To treat and eliminate head lice, you’ll need professional help for total eradication of the infestation.

An excellent alternative is to use the services of Larger Than Lice, with natural lice treatments and caring technicians, you can rest assured that your child is in good hands. We even offer a 31-day guarantee after your initial treatment for your peace of mind. We look forward to speaking with you soon!

Keep kids in the game and Lice Free

As a parent, seeing your children out on the sports field supporting their team gives you a feeling of pride. Their effort on the field in support of their team builds their character. But, with the bumps and bruises that can also happen out on the field, you may question whether sports are doing good for your kids. Everything is relative, but here are some of the most significant benefits kids gain from sports:

Playing sports gets kids active

These days, getting kids away from their phones and video games isn’t always an easy prospect. Their enthusiasm for electronic devices and video games isn’t equaled when compared to doing chores or their homework.

But, sports being the fun, energizing activities that they are, kids tend to respond well to the idea of playing a game with their peers. Building outlets outside of video games is healthy for them, and it can encourage them to seek positive things in every aspect of their lives.

Sports instill good qualities in kids

Playing sports builds character in your kids. They learn about teamwork, dedication, and pursuing goals. The natural leaders emerge and develop their skills, and kids learn how to work together to achieve common goals. The fun of playing sports helps kids become more outgoing and confident as they work together alongside their peers.

Sports are a good outlet for stress for kids

Let’s face it: the world is a stressful place. And, this is true for kids, too. We all need an outlet to get out the angst of the average day. On the field, working out the stressors of life can help them be at ease.

Kids who play sports together build strong, healthy relationships

When kids work together at a common goal, they build bonds with their teammates that can last through their whole lifetime. Few other situations have the same innate team-building and relationship-building qualities. Kids who play together get to know one another and the cooperation in sports activities can build the same spirit in everything they do with their sports friends.

Playing sports gets kids outdoors

Remember the days when every neighborhood had its gang of kids running around, riding their bicycles, playing basketball, tag, or follow the leader? For most blocks, those days are long gone, but one thing that helps sports are great for kids, but watch out for Lice!

Encouraging your kids to get involved with sports is a great thing. And, so is following these tips to help them avoid getting head lice:

• Tell kids to avoid sharing equipment like hats, towels, or jackets.

• Ensure your kid has their own locker, not one shared with another kid.

• Encourage your kids not to throw their belongings in a pile with everyone else’s. Putting them in their own space prevents lice.

• Tell your kids to avoid direct head-to-head contact with other kids.

• Stay vigilant and pay attention to your kid’s hair. Watch for signs and symptoms of head lice so you can catch them early to bring back that old spirit is playing sports.

When kids play sports in school, they’re more likely to play when they’re at home, too. Kids playing a game outside can draw other kids out of the house to play, and the positive impact on your neighborhood is palpable.