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The Informed Parent

Questions & Answers: Head Lice Again

by Peter W. Welty, M.D., F.A.A.P.
Published on Jul. 01, 1998

Dear Dr. Welty,

I was very upset to find that my daughter had come home with an enormous amount of head lice. She had been exposed at school. Can other members of the family get lice from her? How much cleaning do I have to do after her treatment? Can I treat my 20 month old as well, or should I shave his head? I would appreciate any information you have on the subject.

Head lice are one of the leading communicable diseases in school age children. It is estimated that ten million children a year are affected by these tiny parasites.

The louse family live on the bodies of their hosts and feed on their blood. Head lice most commonly attack children, infesting in the scalp and occasionally the eyebrows and eyelashes.

Transmission of lice occur by direct contact with the infested individual, or contact with their combs, brushes, hats, etc. They do not jump or fly. Lice do not survive more that 24 hours off of their host. They cannot live on pets, and they do not wash or blow away. It is absolutely untrue that head lice are only associated with unclean people or unsanitary living conditions. They can easily infest people with clean hair as well.

The first awareness a parent has is often a report from the school nurse. Or the child may have uncommon itching. A close examination of the hair may disclose a reddish and tender scalp. The parasites or their nits (eggs) can be seen and are frequently found at the nape of the neck, behind the ears or at the crown. Some children do not have any itching; therefore, it is important to do periodic head checks.

When one member of your family is found to have this problem it is a good idea to check every member of the family. Anyone with symptoms should be treated. This treatment involves using a special shampoo, gel or rinse that kills the lice and nits, and is available by prescription or over-the-counter. These agents are pesticides. It is important to use them with care and in conjunction with your doctor. This is particularly true for children under two years of age, pregnant or nursing mothers, severely ill persons on medication, or if the lice are in the eyebrows or the eyelashes. Lice-killing agents are generally not recommended around the eyes. For any further questions, consult your doctor. Shaving your child's head may also cure the infestation, but is less cosmetically appealing to most people.

The next step is to clean all of the child's personal belongings and bedding. Clothes worn in the last three days and bed linen should be washed in hot water and dried in a hot dryer. Combs and brushes should be washed in hot soapy water and soaked for ten minutes. Rugs and furniture should be vacuumed thoroughly. Remember that head lice do not live for very long off of their hosts, so dangerous chemicals or sprays are not needed or recommended.

After your child has undergone the shampoo treatment, the dead nits need to be removed from the hair. This can be done with the special comb that is often included in the treatment kit,or they can be removed manually. All of the nits need to be removed to prevent an untreated one from causing another infestation. This is the reason many schools and preschools have a "no-nit" policy. They have the important role of screening for head lice so that others are not affected.

As you can see, head lice are not a serious condition, but the treatment can be rather time consuming. It is a good idea to teach your child not to share personal items such as combs and brushes. Regular periodic head checks are also very important and will minimize an infestation.

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