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Head Lice

Head Lice – The Facts

The fact is head lice are always present in the community and likely in our school.  The U.S. has 6 to 12 million cases per year among 3 – 11 year olds.  So let’s take a look at the facts and figure out how we can work together to minimize exposure, and the time and monetary expense of treating an infestation in your family.

  • Although they are frustrating, head lice are not dangerous. They do NOT spread disease and are NOT a sign of being dirty. 
  • However, they can cause itching and scratching that can lead to sores. Mild itching can come from the sensation of the crawling bugs, but the more intense itching comes from your body’s sensitivity to louse saliva.  *IT TAKES THE AVERAGE IMMUNE SYSTEM 4 - 6 WEEKS TO DEVELOP THIS SENSITIVITY.  So, even if your child is not complaining of itching (and some kids never experience this symptom) does not mean they are clear of head lice.
  • Conversely, an itchy head does not mean they have head lice. There is a good chance that the itching could be caused by eczema, dandruff, an allergy (or psychologically induced by the mere thought of head lice…have you scratched since starting to read this?)  Studies have also shown that pediculicides are overused and overprescribed.
  • Head lice can be seen with the naked eye under bright lights. Adult lice are about the size of a sesame seed and are a grayish or tan color.  They are quick to scamper away when you separate the hair for inspection.
  • Immature head lice, also called nymphs, are smaller and more difficult to see. Nymphs take between 7 – 10 days to mature into egg laying adults.
  • Nits, also known as eggs, are glued to the hair shaft. Viable nits are found less than ½ inch from the scalp and are darker in color than an “old” nit shell that turns lighter after the hatching.  Nits do not come off easily and must be removed mechanically by a nit comb or between the fingernails.  Lice eggs hatch within 1-2 weeks after being laid.
  • Most lice feed on blood several times a day, and depending on the temperature, can survive for just a few days off the scalp.
  • LICE CANNOT JUMP OR FLY. They crawl and cling to the hair.  They are spread mainly through head to head contact, but sharing items such as clothes, linens, hair accessories, helmets and hats can pass them along as well. 
  • Pets CANNOT catch head lice or SPREAD them around.
  • Recent studies show increasing resistance to over the counter pesticide treatments.

SCREENING AND IDENTIFICATION

  • Identification of an active infestation and prompt treatment is essential for preventing the spread of head lice. You don’t have to wait for our standard letter to check your children – make it a weekly routine.  If you receive our district exposure letter, please heed the advice and closely monitor your child for the next few weeks. 
  • If you find head lice on your child, please report this information to the school so we can monitor students and communicate with parents when necessary. If every parent identifies and treats an infestation at the same time, we can greatly decrease the incidence of head lice.
  • Researchers performed a study on 300 children in an elementary school that showed visual inspection of dry hair caught only 29% of active infestations, versus a “wet combing” method that caught 91% of active cases.  http://archderm.jamanetwork.com/article.aspx?articleid=711918

TREATMENT – There are options!

  • If you find lice, COMB, COMB, COMB!! If you are diligent about using the “wet-combing” technique, you don’t have to use pesticides or costly chemical treatments.  This is entirely up to you and your situation.  The bottom line is that these chemicals do not kill all of the eggs – and sometimes fail to kill all of the live lice.  Leftover eggs can hatch and lead to a reinfestation.  If you choose to use pediculicides, combing is still an essential part of the treatment plan.  If you are using the combing technique (as described below), you can remove live bugs and eggs.  Even if some eggs are missed during diligent combing, you will remove the immature bugs that hatch before they can mature to egg laying adults.
  • Be sure to check and treat every infested member of your household at the same time.
  • Wash all linens and clothing worn by the infested person in the last few days. Use the hottest settings possible for water temp and dryer setting.
  • Dry clean anything that can’t be washed OR put them in an airtight bag for two weeks.
  • Simple vacuuming of carpet and upholstered furniture (in your home and car) should be sufficient. Chemicals are not necessary for environmental eradication.
  • Soak hair care items like combs, brushes, and hair accessories in rubbing alcohol for an hour, wash in HOT water (>130 degrees) for 10 minutes, or just throw them away.
  • Talk to your kids about not sharing personal hair care items or clothing.
  • Report the exposure to anyone in close contact with your child.

WET-COMBING TECHNIQUE for IDENTIFICATION and TREATMENT

There are various step-by-step instructions that vary slightly, but the bottom line with this choice as a treatment is that you need to repeat it every couple days to ensure successfully stopping the reproductive cycle and eradicating the infestation.  Here is a helpful website: http://greatervancouverliceclinic.ca/wet-combing-instructions

  1. Either start by washing the hair in the normal way with ordinary shampoo or start with dry hair and apply ample conditioner to moisten it and allow the nit comb to easily slide through.
  2. Comb the hair with a normal wide tooth comb to get rid of tangles.
  3. Section longer hair into manageable portions.
  4. Switch to a fine toothed nit comb.  Nit combs have teeth that are VERY close together to prevent lice from slipping between, effectively combing them out.  Metal combs work best and are less likely to break than plastic combs.
  5. Slot the teeth of the nit comb into the hair at the roots so it is touching the scalp.
  6. Draw the nit comb through from the scalp to the tips of the hair.
  7. Make sure that all parts of the hair are combed by working around the head.
  8. Check the comb for lice after each stroke. A magnifying glass and bright lighting may help.
  9. If you see any lice, clean the comb by wiping it on a tissue or rinse it before the next stroke.
  10. After the whole head has been combed, rinse out the conditioner.
  11. Repeat the combing procedure in the wet hair to check for any lice that might have been missed the first time.

To use this technique as a treatment, you will need to repeat the above routine every 2-3 days until no lice or nits remain for at least 4 combing sessions.  By repeating every 2-3 days, you will be sure to remove any newly hatched bugs before maturity.  The number of sessions required depends on the last time you see lice. 

Additional Resources

VIDEO of wet combing and article -  http://www.consumerreports.org/cro/news/2014/09/to-get-rid-of-head-lice-comb-them-out-instead-of-using-nix-rid-or-other-chemicals/index.htm

American Academy of Pediatrics article - http://pediatrics.aappublications.org/content/126/2/392.full?sid=09ee8433-4f80-4676-89b1-ae906f2f178e

Iowa Department of Public Health head lice information - https://idph.iowa.gov/CADE/Disease-Information/HeadLice

 CDC guidelines for treatment -  http://www.cdc.gov/parasites/lice/head/treatment.html

Identify US, Pest Identification and Guidance, formerly the Harvard School of Public Health’s website -  https://identify.us.com/idmybug/head-lice/index.html

Wet combing steps - http://greatervancouverliceclinic.ca/wet-combing-instructions 

Iowa City Community School District Head Lice Protocol