Even though head lice is very common, parents are incredibly upset when the louse shows up on their child’s head.  I want you to remember two things, you will probably deal with head lice at your home at some point and you all will get through it.  Head lice are not dangerous, just annoying and anxiety provoking. Lice have been plaguing humans for thousands of years. Approximately 12 million children have head lice between the ages of 3 and 12 years.  Although head lice cannot be completely prevented, there are ways to decrease spread.  Also, it is very, very important to check your children regularly (weekly) so that it can be detected and treated early.

1.  How do I know if my child is exposed to head lice?  How do I check them?

It is likely that your child is exposed to head lice.  Just assume it is true.  Schools usually have a notification policy where a note is sent home to parents informing them that a child in the classroom has head lice.  However, many parents are too embarrassed to notify the school so many cases do not get reported.  I suggest checking your children every week to catch things early.  Try to do this in a matter of fact way so that the children do not become overly anxious. Say something like, “Sometimes little bugs like to live in people’s hair so I am just checking to see if there are any in your hair”.  I know this sounds a bit outrageous but if you are going to talk to your children about preventing head lice (see #2) they are going to need a basic understanding of what it is.  To check your children, you need a bright light and a fine toothed comb.  The louse (singular of lice) are quick and tiny (adults are about the size of a sesame seed).  They can look gray or black.  Part the hair in several different places and see if you see movement.  It is much easier to see the nits.  Nits are lice eggs that are laid close to the scalp.  Once they hatch they remain on the hair shaft and move away from the scalp as the hair grows.  They look a bit like dandruff but they are not easily removed from the hair shaft.  They usually cluster above the ears and at the nape of the neck.  I find it best to first to concentrate on finding the live louse then start again and look for the nits.  It is difficult to look for both at the same time.  Some children will develop itching and red bumps after about 4-6 weeks.

Here are some helpful photos:

Size and shape of a louse

Nits on hair shaft

2.  How can I prevent head lice in our family?

Lice are wingless creatures that do not jump or fly.  They cannot trapeze through the air and land in the hair of your unsuspecting little one.  The most common method of spread is through head to head contact.  A louse can live for 1-3 days off of a human body so combs, brushes, hats, barrettes, hair ties and pillows can also be a source of spread.  Teach your child to not share personal items.  Children can also be taught to avoid head to head contact with other children especially if there is an index case in the classroom.  There are products that claim to repel lice such as an all natural product line from www.fairytaleshaircare.com.  Although large, well controlled studies for these products do not exist, they are not dangerous and may help.  Some parents have sworn that keeping their daughter’s hair in tight braids and/or under a scarf helped them avoid a classroom outbreak but again, the evidence is purely anecdotal.

3.  What are the mainstream treatments?

For an initial case of head lice, usually your doctor will direct you to the pharmacy for an over the counter cream or shampoo (RID and NIX are some commonly used treatments).  If you have tried an over the counter product as directed and you still are finding live lice, it is time to revisit the treatment plan with your pediatrician.  Failure can be due to resistant lice (lice that are no longer susceptible the certain medications)  However, misdiagnosis, re-infestation and incorrect use of the medication must be considered.  Although it is tedious, I usually recommend removing all nits if possible.  (The Terminator Metal Lice Comb is very helpful).  Leftover nits can cause diagnostic confusion (is it old or new infestation?) and unnecessary treatment.  If you and your pediatrician decide that another treatment is necessary, a topical prescription medication may be recommended.  There is also evidence that a 7 day course of Bactrim (an antibiotic) can clear head lice especially if used in conjunction with a topical modality.  In rare cases Bactrim can cause serious side effects so it is reserved for resistant cases.  Children under 2 years old should not use the over the counter regimens.  The lice and nits need to be removed manually.  Talk to your pediatrician for other treatment options in this age group.

4.  Are there any alternatives treatment methods available?

Although the topical medications used to treat head lice are quite safe when used as directed, they can have side effects and are essentially pesticides.  There are many “natural” herbal products available online that claim to eradicate head lice.  I have never seen a well controlled study of their efficacy.  Occlusive agents such as olive oil, baby oil and petroleum jelly can be effective.  I usually recommend that parents use a topical medication (like RID or NIX) on the first day that the lice is noticed and repeat treatment 7-10 days later.  In between that time, I recommend 1-2 treatments with baby oil or petroleum jelly.  (Note:  In order to remove petroleum jelly, you will need do massage baby oil into hair and then shampoo a few times with a clarifying shampoo.)  There is also some evidence that Cetaphil can kill lice.  A multi-tiered regimen usually works and minimizes the need to re-treat.  As I mentioned in #3, Bactrim, an antibiotic can be effective, however, there is a risk of serious side effects so this must be used only in very difficult to treat head lice.  There is also something in development called the LOUSEBUSTER.  It uses warm air to kill the lice and initial studies are promising.  DO NOT get creative and try to make your own LOUSEBUSTER at home with your hair dryer because you may burn your child’s scalp.

Make sure you thoroughly inspect the adults who have close contact with your child. Adults definitely get head lice!!

5.  Are head lice attracted to dirty hair or poor hygienic conditions?

The answer is no.  People from different socioeconomic classes with varying living conditions get head lice.  It is true that frequent showering can inhibit multiplication of lice but it will not prevent it or eradicate it.

If your family is dealing with head lice, try to keep perspective.  It is common, it is not dangerous and it is treatable.  I know it is upsetting to think of bugs making your child’s hair their home but remember, your children are watching.  Remind them that it is not their fault and it is not because they did not keep clean.  Follow your doctor’s instructions and educate your children on how to decrease spread but don’t let it become a family obsession.  There are much more fun things to obsess about!!