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The Informed Parent

Questions & Answers: Head Lice

by Louis P. Theriot, M.D., F.A.A.P.
Published on Jan. 01, 1997

Dear Dr. Theriot: My daughter's pre-school just sent home a letter saying that there was head lice at the school. I was told to check her for lice. I've heard alot about lice, but in reality, I don't know much about it. Could you help me?

Answer: Head lice is caused by a parasite, Pediculosis capitis. It is common in day care settings and schools throughout the country. It has reached epidemic proportions in some school districts. Head lice affects ALL children, and crosses all socio-economic lines. It is in no way a sign of uncleanliness.

The louse, or actual parasite, is around 2-3 millimeters in length. It has three sets of legs and can be difficult to see, particularly if the affected individual has long or thick hair. It is much easier to see the nits (the eggs) of the lice which are gray to white in color and firmly attach themselves to the hair shaft.

An infestation of lice can cause intense itching of the scalp. Upon close inspection, the scalp may be red and irritated, and there may be linear abrasions from scratching. Some of these abrasions can become infected and can lead to crusted lesions and enlarged glands (lymph nodes) in the back of the neck or behind the ear.

Lice can be spread by direct contact with an infected individual, or by sharing items with someone who has lice such as a comb, a hat, head bands or brushes. The treatment of lice is easy enough. It involves shampooing the hair with a special anti-lice preparation. There are a number of these shampoos available, and some are better than others. The better shampoos contain the ingredient permethrin, and these will kill the adult lice, as well as the nits. Once treated, the nit will remain attached to the hair shaft even though it is dead. It virtually has to be physically removed from the hair, it won't just fall off. There are ultras-fine combs called "nit combs" that help in the removal of the nits, but sometimes it is just a matter of trying to remove them by hand, one by one. This is where the saying "nit picking" came into being as this can be a laborious task. There are also preparations available that can help loosen the nits to facilitate their removal. One important fact from the Public Health Department states that if the nit is at least one-half an inch from the scalp, it is no longer alive.

After one proper treatment with an appropriate shampoo, that person should not be considered contagious and should be allowed to return to school. Some schools have adopted a no-nit policy which means that if one nit can be seen, they are sent home. This policy has not been shown to reduce the incidence of lice in schools. Clearly, each case must be looked at on it's individual merit.

Once lice has been identified in the home, it is wise to treat all family members at the same time. This can safeguard against re-infection. ALWAYS check with your doctor before treating an infant or toddler. It is critical to disinfect bedding, clothes and towels by washing and drying them in the hot cycles of the machines. Lice and nits can not survive in temperatures greater that 128 degrees for over 5 minutes.

Combs, brushes, headbands and hats can be treated by putting them in a plastic bag and storing them for 10 days. The lice cannot survive without human contact for more than 2 days. The reason for the TEN days is to be sure the lice, as well as the nits that will subsequently hatch, will both be killed. If this doesn't answer your questions, or if someone in your family gets lice, check with your doctor.

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