Common sense guidelines for children with lice

A new clinical report from the American Academy of Pediatrics is a rare beacon of coherent thought about lice and children.

Rather than humiliating children and driving them away like lepers, the AAP recommends common-sense steps to identify and treat lice. Some facts really shouldn’t be in dispute:

  • Lice is not a serious illness or a significant hazard to health. They don’t make anyone sick, and they do not spread any disease.
  • Lice is not a sign of poor hygiene or parental failure.
  • Lice cannot jump or fly from person to person — they’re only transmitted by close and prolonged personal contact.
  • Transmission via objects — combs, hats, and pillowcases — is uncommon.
  • Most lice transmission occurs in neighborhoods and households, notin schools.

Nonetheless, a case of lice in a school seems to cause hysteria and panic. Children are marched through the “nurse’s office”, examined by a (sometimes) poorly trained parent, and sent home — usually because of a few flecks of dandruff or debris. Most kids sent home because of lice don’t even have them. Parents miss work, kids are humiliated, and households are turned upside down with washing and spraying and vacuuming and combing and worrying. There are whole industries, now, of people who can comb your child’s hair or use special treatments guaranteed to rid them of the pesky varmints.  To treat what is, at most, an itchy scalp.

Here’s what parents should keep in mind when they suspect their child has lice:

  • Lice are not difficult to diagnose. They run around the scalp. Look. If they’re there, you’ll see them. You can also “catch” them on a comb.
  • Lice are not little fluffy bits of fuzz or little flakes of nothing.
  • Lice eggs (nits) look like sesame seeds, and they’re literally glued to individual hairs, down near the scalp. The live ones, ones that will hatch, are within ½ inch of the scalp. Any nits further out are dead or already hatched.
  • OTC lice treatments (like “Nix”) work very well when used as directed. Repeat the treatment in 9 days to kill newly hatched eggs before the little ones have a chance to mature and lay more eggs.
  • Most treatment failures are from improper use, failure to repeat treatment, or from re-infestation. True resistance to OTC products does occur, but it is not common. The people yelling about resistance are usually the same people who are trying to sell you something.
  • Combing can help treatment work (by dislodging viable eggs and removing live lice.)
  • Nit removal is not necessary for effective treatment, but some misguided schools insist that a child be nit-free before returning. That’s stupid, and it’s not recommended by legitimate health authorities. But, hey, I don’t make the rules.
  • It’s prudent to change and wash pillowcases — though even that is probably not necessary, as only 4 percent of pillowcases harbor live lice, even when someone with lice sleeps in the bed. Live lice cannot live off of a warm body for very long.
  • Consider washing items that have recently (within 2 days) come in contact with a child’s head, like hat or hair accessories, but exhaustive and widespread cleaning and vacuuming efforts are not needed. Widespread use of chemical sprays in the house is dangerous and unnecessary.

Most importantly, as the AAP says, it doesn’t make any sense to exclude children with lice or nits from school. That doesn’t decrease transmission, and it doesn’t prevent any important illness. Children with lice should be (correctly) identified and (correctly) treated, but they don’t need to be embarrassed, excluded, or humiliated.

Lice can make you or your child itch, and that’s not pleasant. But, really, they’re just another thing that you shouldn’t worry about. Safe treatment isn’t very difficult, and it usually works. It’s only our own sense of ick that’s turned lice and lice-removal into a big deal.

Now, excuse me while I scratch my head … writing this has made me itchy.

Roy Benaroch is a pediatrician who blogs at the Pediatric Insider. He is also the author of A Guide to Getting the Best Health Care for Your Child and the creator of The Great Courses’ Medical School for Everyone: Grand Rounds Cases.

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