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Head Lice

Head Lice

Much to many parents' annoyance, the head louse is a tiny, wingless parasitic insect that lives among human hairs and feeds on extremely small amounts of blood drawn from the scalp. Although they may sound gross, lice (the plural of louse) are a very common problem, especially for kids ages 3 years to 12 years (girls more often than boys).

Lice aren't dangerous and they don't spread disease, but they are contagious and can just be downright annoying. Their bites may cause your child's scalp to become itchy and inflamed and persistent scratching may lead to skin irritation and even infection.

How Can I Tell if My Child Has Lice?
Though very small, lice can be seen by the naked eye. What you or your child's doctor might see by thoroughly examining your child's head:

Lice eggs (called nits), which look like tiny yellow, tan, or brown dots before they hatch. After hatching, the remaining shell looks white or clear. Lice lay nits on hair shafts close to the skin's surface, where the temperature is perfect for keeping warm until they hatch. Nits look sort of like dandruff, only they can't be removed by brushing or shaking them off. Unless the infestation is heavy, it's more common to see nits in a child's hair than it is to see live lice crawling on the scalp. Lice eggs hatch within 1 to 2 weeks after they're laid.

Adult lice and nymphs (baby lice).
The adult louse is no bigger than a sesame seed and is brownish tan (although lice may look darker on people with dark hair). Nymphs are smaller and become adult lice about 7 days after they hatch. Most lice feed on blood about every 4 to 6 hours, but they can survive up to 3 days off the scalp.

With lice bites come itching and scratching. However, the itching may not always start right away - that depends on how sensitive your child's skin is to the lice. It can sometimes take weeks for kids with lice to start scratching. They may complain, though, of things moving around on or tickling their heads.

Small, red bumps or sores from scratching.
For some kids, the irritation is mild; for others, a more bothersome rash with crusting and oozing may develop. It's also not unusual for kids to develop some swelling of their lymph glands. Excessive scratching can also lead to a bacterial infection (the skin would become red and tender around the bite area). If your child's doctor thinks this is the case, he or she may treat the infection with a topical or an oral antibiotic.

You may be able to see the lice or nits by parting your child's hair into small sections and checking for lice and nits on the scalp, behind the ears, and around the nape of the neck (it's rare for them to be found on eyelashes or eyebrows). A magnifying glass and bright light may help. But it can be tough to find a nymph or adult louse - often, there aren't many of them and they're able to move fast.

Call your child's doctor if your child is constantly scratching his or her skin or complains of itches that don't go away, especially on parts of the body that are covered with hair. The doctor should be able to tell you if your child is infested with lice and needs to be treated.

Also be sure to check with your child's school nurse or child-care center director to see if other children have recently been treated for lice. If you discover that your child does, indeed, have lice or nits, contact the staff at your child's school to let them know about it.

Are Lice Contagious?
Lice are highly contagious and can spread quickly from person to person, especially in group settings (schools, child-care centers, slumber parties, sports activities, camps, and even playgrounds).

Though they can't fly or jump, these tiny parasites have specially adapted claws that allow them to crawl and cling firmly to hair. They spread mainly through head-to-head contact, but sharing clothing, bed linens, combs, brushes, and hats can also help pass them along. Children and teens are most prone to catching lice because they tend to have close physical contact with each other and often share personal items.

And you may wonder if Fido or Fluffy may be catching the pests and passing them on to your family. But rest assured that pets can't catch head lice and pass them on to people or the other way around.

How Are Lice Treated?
Your child's doctor can recommend a medicated shampoo, cream, or lotion to kill the lice. These may be over-the-counter or prescription medications, depending on what treatments have already been tried. It isn't uncommon for treatments to be unsuccessful because of incorrect use or because the lice may be resistant to the chemical in the shampoo.

It's important to follow the directions exactly because these products are insecticides. Applying these medications too much or too frequently can increase the risk of causing harm. Following the directions on the product label is also important to ensure that the treatment works properly. Your child's doctor may also suggest a special rinse to use on your child's hair that makes it easier to comb out the nits using a fine-tooth comb.

Medicated lice treatments can usually kill the lice and nits, but it may take a few days for the itching to stop. Your child's doctor may recommend repeating treatment in 7 to 10 days to make sure all the nits have been killed, to avoid any risk of reinfestation.

If your child is 2 years old or under, you should not use medicated lice treatments. You'll need to remove the nits and lice by hand.

It's also a good idea to use a fine-tooth comb on your child's hair after regular shampooing every 3 to 4 days for 2 weeks. Wetting the hair beforehand is recommended because it temporarily immobilizes the lice and they become easier to comb out.

Keep in mind that head lice don't survive long once they fall off a person. So it's unnecessary to spend a great deal of time and money trying to rid the house of lice. here are some simple steps you can take to help get rid of the lice and their eggs, and help prevent a lice reinfestation:
  • Wash all bed linens and clothing that's been recently worn by anyone in your home who's infested in very hot water (130 degrees Fahrenheit, or 54.4 degrees Celsius) then put them in the hot cycle of the dryer for at least 20 minutes.
  • Dry clean any clothing that isn't machine washable.
  • Have bed linens, clothing, and stuffed animals and plush toys that can't be washed dry-cleaned. Or, put them in airtight bags for 2 weeks.
  • Vacuum carpets and any upholstered furniture (in your home or car).
  • Soak hair-care items like combs, barrettes, hair ties or bands, headbands, and brushes in rubbing alcohol or medicated shampoo for 1 hour. You can also wash them in hot water or just throw them away.
Because lice are easily passed from person to person in the same house, other infested family members will also need treatment to prevent the lice from coming back.

In your efforts to get rid of the bugs, there are some things you shouldn't do. Some don'ts of head lice treatment include:
  • Don't use a hair dryer on your child's hair after applying any of the currently available scalp treatments, because some contain flammable ingredients.
  • Don't use a cream rinse or shampoo/conditioner combination before applying lice medication.
  • Don't wash your child's hair for 1 to 2 days after using a medicated treatment.
  • Don't use sprays or hire a pest control company to try to get rid of the lice, as they can be harmful.
  • Don't use the same medication more than three times on one person. If it doesn't seem to be working, your child's doctor may recommend another medication.
  • Don't use more than one head lice medication at a time.
Can Lice Be Prevented?
Having head lice is not a sign of uncleanliness or poor hygiene. The pesky little bugs can be a problem for kids of all ages and socioeconomic levels, no matter how often they do - or don't - clean their hair or bathe.

However, you can help to prevent your child from getting lice - or from becoming reinfested with lice - by taking the following precautions:
  • Tell your child to try to avoid head-to-head contact at school (in gym, on the playground, or during sports) and while playing at home with other children.
  • Tell your child not to share combs, brushes, hats, scarves, bandanas, ribbons, barrettes, hair ties or bands, towels, helmets, or other personal care items with anyone else, whether they may have lice or not.
  • Tell your child not to lie on bedding, pillows, and carpets that have recently been used by someone with lice.
  • Examine members of your household who have had close contact with a person who has lice every 3 or 4 days. Then, treat those who are found to have lice or nits close to the scalp.
Will They Ever Be Gone?
As many parents know firsthand, lice infestation can be a persistent nuisance, especially in group settings. If you feel like you're following every recommendation and your child still has lice, it may be because of one or more of the following:
  • there are still some nits left behind
  • your child is still being exposed to someone with lice
  • the treatment you're using isn't effective
There's no doubt that they can be hard bugs to get rid of. If your child still has lice for 2 weeks after you started treatment or if your child's scalp looks infected (with pus or sores), call your child's doctor.

No matter how long the problem lasts, be sure to emphasize to your child that although having lice can certainly be very embarrassing, anyone can get them. It's important for kids to understand that they haven't done anything wrong and that having lice doesn't make them dirty. And reassure your child that as aggravating as getting rid of the annoying insects can be, there is light at the end of the tunnel.

Be patient and follow the treatments and preventative tips as directed by your child's doctor for keeping the bugs at bay, and you'll be well on your way to keeping your family lice-free.

Reviewed by: Barbara P. Homeier, MD
Date reviewed: April 2005

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