When I worked as a telephone advice RN for a large health insurance company, often our after-hour calls were from young parents with questions about their childrens' health. While most of the calls related to febrile and respiratory illness, parents called about any number of concerns. We regularly fielded calls from parents who were surprised and frustrated as they battled head lice that their children brought home from school.
Head lice is not a pleasant topic, and it tends to make one itch a bit at just the thought of these pests invading the sanctity of our precious children's hair and, of course, our beloved homes. I would like to say that it's a quick and easy fix to resolve a lice infestation, instead I'll have to assert that the steps taken to rid lice from your life require some dedicated effort and diligence.
Rich or Poor, Clean or Dirty: Lice do not Discriminate
Headlines were made in our local paper some years back when we lived in El Paso, Texas. The reason? An outbreak of head lice at one of the most prestigious private schools in town. The children of the ultra-rich were affected and local interest in the story piqued. There is a notion that lice infest only the poor and unclean, but that simply is not the truth--they have no such boundaries.
Don't Treat Unless You are Sure
A tickling feeling or an itchy scalp may be a sign that there are lice present, but it's absolutely necessary to visually inspect the scalp to be certain. Be sure to treat only the individuals who actually have lice or nits; this is so important when using chemical treatments as lice can become resistant to these medications when they survive repeated applications. Therefore, use such treatments sparingly and absolutely in accordance with the directions provided by the manufacturer.
Check for lice: In bright sunlight or with strong lamplight, carefully check the scalp and roots of the hair. Lice like to spend their time in dark areas so they are typically found in the nape of the hair behind the ears and at the bottom portion of the hairline. Nits (lice eggs) cling to the base of the hair by means of a glue-like substance, but those unfamiliar could misidentify normal scalp flaking or dandruff with nits. Ask your child's school nurse for guidance if you are not certain about what you are seeing. Note: A recent German study found that wet combing the hair was more effective in finding evidence of lice infestation than the naked eye.
Remove lice and nits: For best results, use a good quality fine-tooth-comb (like a metal flea comb) and a pair of reliable tweezers to remove the adult lice and the nits. (The directions never say what to do with them after they are removed, I would have to suggest disposing of them in a little container of rubbing alcohol to make sure they are dead, or perhaps in a hot soapy water.)
Getting Rid of Head Lice, Home Cures and Medications
Please check out the links below to learn more about head lice and the recommended methods for getting rid of the lice and their nits. There are a variety of home remedy or folklore cures that may help get rid of head lice without the use of chemicals. Nevertheless, such cures typically involve a fine-toothed-comb, some type of shampoo, and a thick gooey application of (mayonnaise or something similiar) to the scalp for an extended period to smother the lice followed by more shampoo and meticulous combing to remove the nits. As for home remedies, I'm not going to provide detailed information about any one in particular, but I urge you to please be careful and exercise good judgment if you go that route. Some home remedies call for wrapping the hair of the head in a plastic bag overnight and that is certainly NOT something that is safe for a child due to the risk of suffocation--I shudder to think of it.
The FDA recommends a first-line and second-line approach about the medications available to combat head lice. There are two alternate medical regimens which are suggested as first-line treatments. One of these first-line treatments is a very new one, approved in the Spring of 2009. It's a lotion for the scalp that is made with Benzyl Alcohol. Like some of the home remedies, this lotion is geared toward smothering the lice. Read more about this type of product here.
The other first-line FDA-approved medications are the lice-killing shampoos that can be purchased over-the-counter at any drugstore. Bear in mind that unless you approach this as a multi-stepped process, you will be disappointed with the result. When using these shampoos it's still necessary to comb for nits and be persistent in following a daily routine until you are certain that the eggs are all gone. In addition, hairbrushes, pillow cases, sheets, nightclothes, caps and hats, etc. need to be washed and dried using a HOT temperature to kill any vermin crawling on them. Look for more advice about cleaning the environment on the links provided below.
Second line chemical treatment for lice includes some powerful shampoos that are essentially pesticides. These are only available with a physician's prescription, and they are only meant to be prescribed if the first-line medication(s) are not successful in treating the infestation. These strong shampoos contain "black box warnings" because of the known possible adverse effects. They can be neurotoxic (harmful to the brain or nervous system) if used in excess or if used on vulnerable individuals. Seizures or even death may result if the directions are not adhered to. These medications are definitely NOT to be used on premature infants or individuals with known uncontrolled seizure disorders. When indiciated they are to be used WITH CAUTION because of the risk for serious neurotoxicity for infants, children, the elderly, anyone who weighs less than 110 lbs (50 kg) and individuals with skin conditions like eczema, dermatitis, and psoriasis.
Recommended Sites for More Information about Head Lice:
Comprehensive head lice information from Medicinet/WebMD
National Association of School Nurses: S.C.R.A.T.C.H. campaign
Fact Sheet for Parents from National Association of School Nurses
Center's for Disease Control Head Lice Fact Sheet
CDC's Head Lice Information Page
http://www.headlice.org/ (National Pediculosis Organization)
Links to information in Spanish about head lice or "Piojos de la cabeza":
- Center's for Disease Control and Prevention, http://www.cdc.gov/lice/head/sp/index.html.
- National Pediculosis Organization, http://www.headlice.org/spanish/index.html.
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