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Don’t Bug Out about Head Lice

It’s the dreaded phone call that no parent wants to receive from their child’s school nurse – your child has head lice. Immediately panic starts to set in and feelings of denial, horror, embarrassment, anger, and despair quickly follow. Parents begin to wonder: How did my child get head lice? Will it spread to the rest of my family? Is our entire house infested? What will others think? Lice can unexpectedly crash into your life and turn your whole world upside down.

Facing a head lice infestation can be downright traumatizing, especially for parents. While there is a lot of information out there about how to deal with head lice effectively, some of it is good, but much of it is grounded in myths that drown out the best advice. As the executive director of the American School Health Association, even I fell victim to the noise that many parents hear when dealing with lice. As a recent survivor of head lice, I hope the information shared below will encourage other parents to be open about their battle against head lice, and ultimately help ease the journey for other parents down the road.

The Stigma of Head Lice

The social stigma associated with head lice continues to be perceived as a major barrier to reducing its spread. Stigma results in children being teased, isolated during lunch time, and made to feel dirty once news that they have contracted head lice circulates. They may also miss valuable time in school due to controversial no-nit policies. 

Parents, on the other hand, will go to great lengths to keep secret that head lice has hit their household, traveling miles outside of their way to seek treatment. Both parents and children may feel ostracized as a result of the myths and negative social stigma that surround the condition. 

To help dispel the most common myths that contribute to the head lice stigma and help parents deal with these pesky parasites quickly and effectively, I’ve enlisted head lice expert, Dr. Shirley Gordon. Dr. Gordon has devoted much of her research to examining conditions like head lice that contribute to social stigma. According to Dr. Gordon, below are a few of the most common stigma-causing myths that parents should be aware of when navigating the battlefield against head lice.

Equal Opportunity Condition

Head lice is an equal opportunity condition that can affect anyone, regardless of socioeconomic status – yet so many myths continue to surround head lice. According to the Centers for Disease Control and Prevention (CDC), head lice impacts an estimated 6 to 12 million children ages 3-11 each year. The CDC also lists head lice as one of the most common childhood diseases, alongside ear infections, chickenpox, and measles. However, unlike other common childhood diseases, head lice is typically not reported to a health care professional, making it more difficult to track and treat effectively.

Health, Not Hygiene

A widespread misconception is that head lice infestations are associated with poor hygiene or unclean living conditions. Contrary to this popular belief, it does not matter if the hair is clean, dirty, long, or short. Moreover, while an itchy scalp is a common symptom, if someone is infested for the first time, it may take up to 4-6 weeks for this warning sign to surface. Keep in mind, not everyone with a head lice infestation will develop itching.

Head Lice Don’t Jump

Head lice move from one person to another by crawling and cannot jump or fly. The condition is usually spread from direct head-to-head contact, not from sharing brushes, hats, or bedding (although these are possible). Children tend to contract head lice at school, camp, daycare, slumber parties, and sports activities, among others, which can contribute to how quickly the condition may spread within a community. However, it is important to note that anyone who comes into head-to-head contact with someone who has head lice is at risk for an infestation. Therefore, it can be commonly transmitted within families.

Key Takeaways

So what should you do if you find yourself in a battle against head lice? Speaking personally as a parent who has overcome this obstacle and Dr. Gordon speaking as a nurse who has counseled countless parents on how to overcome infestation, we know that you can get through this seemingly impossible challenge of ridding your loved ones and homes of these pests. Our best advice is as follows:

Keep Calm and Contact Your Health Care Provider

At the first signs of head lice, parents should consider contacting a health care professional who is equipped to provide accurate, effective information about the condition and available treatment options. 

After confirming the diagnosis of an active infestation and completing the recommended treatment, take proper precautions to clean personal items such as bedding or clothing and hair accessories worn during infestation to reduce the risk of reinfestation. Head lice do not infest homes, so you don’t need to spend a lot of time or money cleaning your house, but it is a key element of a thorough lice management plan.

Stomp out Stigma

Remember, a head lice infestation is nothing to be ashamed or embarrassed about. You are not alone, and chances are high that someone you know has also encountered head lice. Help to break the stigma associated with the condition by speaking up and sharing your story with other parents in your community. Together, we can debunk the myths, fight the stigma, and effectively combat head lice.

What’s new in the head lice arsenal?

In regard to school management, the new guidance reiterates its assertion that children should not be excluded from school or school events because of lice, and that screening for nits is not a good indicator of infestation. In fact, such screenings have been shown to have little effect on the incidence of head lice and are not cost effective. For example, the AAP highlights a study in which, of 1729 children screened for head lice, only 31% of the 91 children with nits had an active live lice infestation. Another 18% with nits developed an infestation within 2 weeks of observation.

“Because of the lack of evidence of efficacy, routine classroom or schoolwide screening should be discouraged,” the AAP says. “Although children with at least 5 nits within 1 cm of the scalp were significantly more likely to develop an infestation than were those with fewer nits (32% vs 7%), only one- third of the children at higher risk converted to having an active infestation. School exclusion of children with nits alone would have resulted in many of these children missing school unnecessarily.”

Additionally, says the AAP, lice infestations have low contagion in classrooms. Between that and the fact that children who are diagnosed have likely been infested a month or more by the time of diagnosis, students diagnosed with a lice infestation should remain in class but close head contact with others should be discouraged. Alerting an entire classroom of parents also should be questioned, the AAP says, citing sentiments from experts that “because of the relatively high prevalence of head lice in young school-aged children, it may make more sense to alert parents only if a high percentage of children in a classroom are infested.”

“No-nit” policies that exclude children from school activities until all nits are removed also should be abandoned according to many health professionals, the report says. “International guidelines established in 2007 for the effective control of head lice infestations stated that no-nit policies are unjust and should be discontinued because they are based on misinformation rather than objective science,” the report states. “The American Academy of Pediatrics and the National Association of School Nurses discourage no-nit policies that exclude children from school. However, nit removal may decrease diagnostic confusion, decrease the possibility of unnecessary retreatment, and help to decrease the small risk of self-reinfestation and social stigmatization.”

Do head lice change color?

According to the research of R. Hoeppli, ancient Chinese medicine used lice to cure “high fever and severe headaches as if the skull is cracking.” A paste made from 300 – 500 black lice, spread on the head, was said to do the trick. I must admit, I’d rather have 500 pureed lice on my head than 500 live ones, but the question this raised for me was where one would find black lice. Is there such a thing?

Head lice that I’ve seen have ranged from pale ivory through a golden – sometimes reddish – brown; magnified, they are transparent. Lice that have fed have a black mass inside – presumably blood in the process of being digested – but are not, themselves, black. There is a colour range, to be sure. But black? A literature search turned up some interesting things:

  • Head lice may have a natural way of blending in without actually changing color. Ibarra and Hall wrote: “Eggs and lice are well camouflaged, reflecting the colour of their surroundings.”

  • Newly hatched lice that have not fed are transparent (Meinking) and do not have color until after they’ve fed.

  • Color that matches the background has been shown to have evolved in other species of lice. This, however, refers to colour change over generations, not within the life span of a single organism.

The ‘wisdom’ that human head lice change color depending on the hair color of the host is oft repeated on websites and in non-academic publications. Published scientific information to back it up, however, appears nonexistent. Similarly, parasitology texts and laboratory identification references do not mention it

I remain highly skeptical that our head lice can change color within one generation, or that black head lice actually exist. I conclude that the Chinese remedy called for human head lice that had fed and had blood in their guts..

Lice Facts for Kids

  • Even though they are extremely small, both lice and their eggs can be seen with the naked eye.

  • A single female produces between 80 and 100 eggs in her lifetime.

  • A single host can be infested by thousands of lice at one time!

There is a handful of human lice species found worldwide and throughout the United States. The most common types of lice include head lice, body lice and crab lice. Only the body louse can transmit diseases to people.

Chewing Lice

There are over 2,500 different kinds of chewing lice. They get their name because their mouths are designed specifically for chewing. They have claw like features on at the end of their legs that enable them to stay on a host.

Diet:

Chewing lice feed on feathers, hair, blood, scales and skin

Habitat:

They live on mammals and birds but are not found on humans.

Impact:

Chewing lice can cause itching and small welts on the skin. Their bites can result in hair and feather loss, blood loss and even skin infection if not managed.

Depending on how well animals are groomed, some may become weak due to blood loss and become vulnerable to disease while some animals may be infested with lice and show no ill effects.

Prevention:

Keep animals clean and treat with specialty flea and tick shampoo and grooming products.

Sucking Lice

There are over 500 different species of sucking lice. The most commonly found species of sucking lice are "head lice" and "crab lice". They get their name because their mouths are designed specifically to suck blood.

Diet:

Sucking lice are parasites. They feed on blood and only appear on mammals. In fact, most species of Sucking lice prefer to feed off rodents. "Head lice" and "crab lice" are more commonly found on humans.

Habitat:

The only way "head lice" can get food and water is by sucking blood from the scalp but they can be found on other parts of the body. They can spread from one person to the next through contact with bedding, clothing or by sharing combs. "Head lice" are common problems in crowded places, such as elementary schools, since children tend to share clothing more and frequently come into close contact with each other. 
”Crab lice" are usually found in other areas containing hair, such as beards, eyebrows, armpits and the pubic region. "Crab lice" are not as common in places such as schools, since they can only be spread through direct physical contact.

Impact:

Hundreds of years ago, due to lack of hygiene and over crowding in dirty conditions, lice were considered deadly because they carried deadly diseases such as typhus. Today, Sucking lice are not really considered a health threat, but their bites may result in itching and redness around the area of the bite. 

If you suspect exposure to lice, wash all clothes, bedding, combs, towels, etc. You can also use special combs, shampoos and conditioners designed specifically to treat lice. Also, try saturating hair with baby oil at night to kill both lice and their eggs. If you do this, wrap a towel around your head to keep from soiling your bedding and be sure to wash your hair thoroughly in the morning.

Prevention:

  • Avoid using other people's combs, hats, towels, etc.

  • Have someone check your scalp at least once a month to make sure you have not been exposed.

Lice: Overview

Lice

Few phrases can make a parent recoil faster than “head lice.” Nobody wants their child anywhere near someone who has been diagnosed with them or—heaven forbid—have to treat a case crawling on her kiddo's scalp.  But guess what? Head lice are actually no big deal. Yes, they are tiny, wingless parasites that like to live in hair and off the blood in our scalps (seriously gross). But, head lice are not an actual health threat, and public health experts around the country want us all to calm down, breathe, and not overreact when our child comes home with that dreaded note from the daycare center or school nurse declaring: "there has been a case of head lice in your child's classroom."  

“If your child gets head lice, stay calm,” says Barbara Frankowski, M.D., a pediatrician in Burlington, VT and former chair of the American Academy of Pediatrics (AAP) Council on School Health. Coming home with a case of them is as inevitable as scraped knees or the common cold, says Dr. Frankowski. “It’s a normal risk of being a healthy, active social child.”

In July 2010, a clinical report for the AAP, co-authored by Dr. Frankowski, issued new guidelines for schools, stating that since lice don’t spread disease, and since by the time a case of lice has been discovered it’s already been present for at least a month, no child should miss school because of them and recommended that no-nit policies be abandoned. (Typically a child is sent home as soon as head lice are discovered and cannot return to the classroom until he has been treated and the nurse has checked his head for nits, the small dandruff-like egg casings that stick to the hair.) This has proven controversial, with some parents and teachers saying that a child with lice disrupts the classroom- despite attempts at confidentiality -- and that an infected child should be shielded from teasing by being kept home. It’s yet to be seen how many schools will adopt the AAP’s guidelines.

The upshot is this: if your child gets lice, don’t panic. Instead read our guide to spotting and stopping the buggers – without bugging out.

Lice: Symptoms

A very itchy scalp. An allergic reaction to the saliva of lice causes itching, but only after an initial exposure period. A child who has never had lice won’t start itching until several weeks into the infestation. But when he starts to scratch his head with vigor, or reports a tickly feeling, it’s time for a lice check.

Nits. The tiny un-hatched lice eggs are about the size of a pinhead and are tan-colored if they are alive or darker if not (if hatched, their discarded shells are white and more visible). Unhatched, they are usually attached to the hair close to the scalp and are difficult to remove  (hence the term nit-picking -- more on that later!). Nits, which don’t move, are usually easier than actual lice for a parent to detect.

Adult lice in the hair.  Look for tan-colored or brown bugs about the size of a sesame seed. They frequently hang out in the hair behind the ears, and on the hair above the nape of the neck and will crawl quickly away from light. If your child doesn’t have a lot of them, they might be hard to spot.

Because it is easy to mistake dandruff or other debris in the hair for lice, experts recommend getting a diagnosis from your pediatrician or the school nurse before starting treatment. 

Lice: Causes

Lice have been around since prehistoric times; they’ve even been spotted on Egyptian mummies. They are not as contagious as most people think; they’re spread by direct contact between individuals (such as when your child is huddled over her desk working on a group art project, or snuggled close to her buddy during story time). They can also be spread by sharing personal items such as combs, brushes, or hats. Contrary to popular belief, they cannot jump or fly from one person to another, and contracting lice has nothing to do with hygiene or how often you wash your hair, says Joseph A. Bocchini Jr., M.D., chairman of the department of pediatrics at Louisiana State University Health Sciences Center in Shreveport and the other author of the AAP’s clinical report. 

Lice: Diagnosis

Your pediatrician or school nurse will part your child’s hair to get a good view of the scalp, where she’ll be on the lookout for adult lice or nits. She may use a special light in a darkened room to help her see the little buggers better, or may catch them on a piece of tape, and examine them under a microscope. 

Lice: Prevention

There’s not much you can do to keep lice from finding its way onto your child’s head other than asking him not to share combs, brushes, hats or earphones. But since lice much easier to treat if caught early, why not make a good comb-through a weekly ritual? Done well (with a little detangler beforehand), it can even be a pleasurable experience for your child and help them cooperate if (or more likely when) they do bring lice home. 

Lice: Age-by-Age Guide

Baby to Toddler

Although lice is most common in preschool and school-age kids, smaller children can get it too, often from daycare or infected older siblings. When infestation does occur, it can be hard to treat since this age group isn't known for their ability to sit still, and some treatments are not appropriate for children under 3. If you suspect your baby or toddler has lice, talk to you doctor about the most age-appropriate way to deal with it.

Preschool to Grade School

Lice often first strikes during the school years – think of it as a big kid rite of passage.  Since you’re likely to still be washing and combing your young child’s hair anyway, it’s a good idea to always be on the lookout for nits or lice in the hair behind the ears and at the nape of the neck. “If parents do that once a week, they are more likely to pick up an infestation early when it would be easier to deal with,” says Dr. Frankowski.