Nurse Emily is a professional lice nurse with a company called Lice Happens. Last year, Nurse Emily attended a Parent Association meeting to provide education to parents about lice. She explained early detection and treatment prevent problems from extending to the entire household. Nurse Emily’s presentation was about what to look for and how.
Emily started off by noting that lice are parasites, but do not carry disease and therefore do not present a health hazard. The signs to look for include (I) scratching the scalp; (ii) a rash, especially at nape of the neck or behind the ears; (iii) nits (lice eggs) that may look like dandruff, but don’t brush off; these are typically down close to scalp on hair shaft; and (iv) the “gold standard” for diagnosis - spotting the bugs. She noted that spotting lice is difficult because they are fast, small (the size of a mustard or sesame seed) and light sensitive. Although lice do not have wings or hind legs (e.g., they cannot fly or jump) they do crawl very fast. While they can move when they are not on a scalp, they do so more slowly. Emily showed the group some pictures of nits, nymphs and lice; laminated business cards with examples of lice and nymphs were passed around.
Emily explained that the nits are the egg sac from which the embryo emerges. Lice have tiny claws at the end of their legs that allow them to navigate around hair; however, they cannot cling to plastic, hard wood or slippery/shiny surfaces. Once they are off the body, the can live up to 48 hours before dehydrating.
How lice are transmitted
Emily stated that the most common way to transmit lice is head to head contact; specifically, this means hair touching hair (as when two children are reading a book together). They move fast, so this can happen in an instant. This might explain why girls, who often have longer hair, are more likely to contract lice than boys. While lice can be transmitted more topically, from using the same hats, helmets, brushes, combs, etc., less than 5 percent of cases are transmitted this way. She added that lice found on combs are likely to be injured or dead. Emily reiterated that having lice is not a sign of being ‘dirty’; in fact, lice LOVE a clean head. Once they have settled in, a female will live from 3-4 weeks and will lay up to 10 eggs a day. Eggs are incubated by body heat and hatch within 14 days. A key fact is that the adults are the ones that transfer; not nits. So, if you can get rid of the adults early it goes a long way to slowing the outbreak. Hatched lice are called nymphs and these are very difficult to see. Nymphsleave the white shell casing, grow and become sexually mature in 9-12 days, then mate and the cycle begins anew.
Treating head lice
The first step a parent should take is to assure their child that they have done nothing wrong. To reinforce this assurance, try not to react in front of them if you are upset. Secondly, check all members of your household to determine if they are infected and treat everyone who is affected. After using an over the counter product to kill the live adults (see below), the most effective method to get rid of lice is to do a thorough comb out daily for at least two weeks and then twice a month as part of your family routine. Emily noted that the commercially available products will kill adult or nymph lice, but none will address nits. Thus, it is essential to comb out the nits and to do this on a daily basis during an infection and for up to two weeks to remove all the nits. It is more effective to do the comb through on wet hair. This has a detection rate of 90% compared to 30% with dry hair. Applying a few tablespoons of conditioner will help to get the comb through wet hair, and will serve to help catch the nits. A stainless steel comb is the best one on the market. It is not advised to use “folk” remedies which have not be proven to work and is best to stick with an over the counter product.
With respect to over the counter remedies, RID or NIX will kill adults and stop nits from being laid. It is advised to use this treatment first as directed on the instructions and then begin combing. Once lice have been treated initially with RID or NiX,, the child can return to school. However, it is critical to 1) continue carefully combing every day for the next two weeks to catch the eggs and get them off before they hatch and 2) retreat with an over the counter product in 7-10 days to kill newly hatched nymphs.
House Pets
Emily noted that lice present no danger to house pets, as dogs and cats have a different blood type that lice cannot digest.
Home cleaning
Lice can live for a short time on items such as towels, pillows, carpets and sofas. However, it makes more sense to vacuum than to spray these items. For sheets and pillowcases and any items that a child sleeps with, if possible put them in the dryer at the highest heat setting or seal these in a plastic bag for two weeks. There is no need to throw away combs, but do give them a thorough cleansing.
Telling others
Emily encouraged parents to do their part to remove the stigma and de-mystify lice. In order to break the cycle, it is important to tell others who have played with your child at school, play dates, parties, etc. This will go a long way to break the cycle of infestation at school. Although lice can be shed everywhere, they only live off of a body for about 48 hours. Thus, the school building will begin every week with a clean slate after having the weekend off. The key to managing a continued outbreak is, therefore, at home monitoring and combing, particularly on Sunday night before kids return to school
Prevention
It is recommended that girls tie their hair back into a bun, pony tail or braid and that children be reminded to avoid direct head-to-head contact where possible. Children should also be reminded not to share space, hats, combs, brushes, headbands, etc. Finally, lice are not fond of certain aromas, including rosemary, tea tree oil and mint. Lice Happens sells a spray that can be used as a preventive measure. Also, families should perform a thorough combing at least twice per month so that if they are present they can be caught early and treated. Parents may want to consider reducing playdates and sleepovers until the outbreak has passed.
What if they come back
Emily noted that it is possible that lice are becoming more resistant to pediculicides. However, persistent outbreaks are usually due to incomplete removal of remaining viable nits. She noted that outbreaks have, within last five years, gotten worse. The speculation is that this is due in small part to pediculicide resistance and also because the population increasing, globalization and people are traveling more.
Summary
If you find lice, don’t panic! Check everyone in the household and use an over the counter product such as Nix or Rid for treatment of the affected household members and retreat in 7-10 days; Herculean cleaning measures are not necessary or beneficial. Rather, a good house cleaning on initial discovery, then combing daily for two weeks to prevent an ongoing infestation. Lice are unlikely to habitate or hatch at room temperatures because they require very warm temperatures. If you live in the Philly-South Jersey area, and you need lice removal services, you can contact Emily directly at 610-952-3691 or at info@licehappens.com.
Online information
Center for Disease Control
American Academy of Pediatrics
