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As an elementary school nurse, I have seen an unusual number of head lice cases this year.  I am fortunate to work in a progressive school system willing to address the problem head on (no pun intended), but not everyone is so lucky.  In many cases, school administrators prefer to ignore the problem, hoping it will go away on its own.  It's an unfortunate attitude that only serves to perpetuate myths and negative stereotypes.  The following is an information sheet that I sent out to parents at my own school.  If you have children, or know someone who does, you might find it helpful.

Lice (singular louse) are tiny, wingless insects that survive by feeding on human blood.  Contrary to popular belief, they cannot jump or fly, and they do not burrow under the skin.  Lice are known as obligate human parasites, meaning they must live on a human host, most commonly in the hair on the scalp and at the base of the neck.

A case of head lice is referred to as an “infestation.”  An infestation with head lice does not mean a person is dirty.  On the contrary, lice prefer clean, healthy scalps.  Head lice are easily spread – anyone can get them.  However, head lice are more common in children, who often spread them to each other during close contact while playing.  Each year 6-12 million children in the United States are infested with head lice.

Head lice are spread through direct, person-to-person contact or, less commonly, through contact with an infested person’s personal items, such as hair brushes and combs, hats, unwashed clothing, bedding or towels.  Head lice are commonly spread within households.  Head lice can crawl from an infested person or object to a non-infested person.  An infested person can continue to spread head lice to other people until he or she has successfully completed a course of treatment that kills all of the head lice and their eggs.  Pets cannot spread head lice.

A person infested with head lice may feel itchy (indeed, the mere mention of head lice is enough to make most of us start scratching!), especially behind the ears and at the nape of the neck.  But many children have no symptoms at all.  While there is some risk of skin infection from excessive scratching, head lice do not spread infectious diseases and, while a nuisance, are not considered a health hazard.

Lice themselves are small, grayish brown insects.  Adult lice may be 1/8 of an inch long; immature lice, known as nymphs, are less than half that size.  They lay their eggs directly on the hair shaft, close to the scalp.  These eggs, or nits, will appear as tiny, white, tan, grey, or brown oval specks on the hair.  They are easily mistaken for dandruff, but unlike dandruff they will not shake loose easily.  Nits adhere to the hair and must be manually picked off (the origin of the term “nitpicking”) or removed with a special fine-toothed comb.

     Nits in the hair

     Head lice size comparison

The most common treatment for head lice is shampooing the hair with an over-the-counter product such as Rid or Nix, which contain chemicals designed to kill the lice and their nits.  A number of companies, such as Fairy Tales offer all-natural lice-control products, which may be used in lieu of or in conjunction with more traditional treatments.  Many people have also reported success with vegetable oil, often with a few drops of thyme or tea tree oil added, left in the hair overnight (under a shower cap or wrapped in a towel).

No treatment is 100% effective.  Some lice or especially nits may survive.  Therefore it is important to thoroughly examine the hair following treatment and regularly thereafter remove any remaining nits.

Lice cannot survive long off of a human host, 24-48 hours maximum.  The following steps should be taken to avoid reinfestation by lice that have recently fallen off the head of an infested person:

  • Wash hats, headgear, pillows, pillow cases, sheets, blankets, towels, and stuffed            animals in hot water and, if possible, dry them in a machine dryer on the hot cycle.
  • Seal any items that cannot be washed in a plastic bag for a minimum of two weeks, long enough for any lice on them to die.
  • Wash combs and brushes in one of the lice-killing shampoos or soak them in hot water (130°F/54°C) for 5 minutes.
  • Thoroughly vacuum rugs, upholstered furniture, and mattresses.
  • DO NOT USE INSECTICIDE SPRAYS TO TREAT INFESTED PEOPLE.  These chemicals can be harmful to both people and pets.

Reinfestation is common and extremely frustrating for parents, teachers, and children alike.  Prevention is key.  Remind children not to share hats, scarves, and jackets.  Whenever possible, store these items in backpacks and throw them in the dryer on the hot cycle when kids get home from school.  Keep long hair pulled back in pony tails or braids.  Finally, and perhaps most importantly, examine children’s heads regularly, at least once a week, to ensure that they are lice-free.

Online Resources:

Kids' Health head lice page

Mayo Clinic head lice page

Centers for Disease Control head lice page

National Institutes of Health head lice page

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Comment Preferences

  •  Tip Jar (22+ / 0-)

    "We must move forward, not backward, upward not forward, and always twirling, twirling, twirling towards freedom." - Kodos

    by Jon Stafford on Thu Nov 10, 2011 at 08:15:02 AM PST

  •  Lice Trauma (13+ / 0-)

    Your diary is giving me the sweats.

    I had an experience like which you speak of last year at my daughter's school, where thankfully she is no more.

    She got lice FOUR times at school.  They wouldn't check the kids, they wouldn't make kids stay home for lice, they wouldn't make any classroom accommodations (keeping coats separate, putting them in bags, etc).

    The regional nurse, was, not to put too fine a point on it, a total b*tch.  She told me I wasn't completing the treatment properly, that's why my daughter kept getting lice, and that it wasn't the schools responsibility, and it wasn't a health risk, it was "just a nuisance".

    I ended up hiring one of those lice removal specialist who showed me the proper way to eliminate all nits and eggs, which was remarkably different from the package insert on the over the counter treatment.  The over the counter treatment conveniently left out several key facts about lice removal, which conveniently forced me to keep buying the product over and over again.

    Imagine that!

    When I pointed this out to the school nurse, I was condescendingly told that  all the information I needed was on the package.

    Aaargh!  Thanks for the diary, it's important info as we come up on lice season once again.

    I blog about my daughter with autism at her website

    by coquiero on Thu Nov 10, 2011 at 08:21:23 AM PST

    •  I'm always surprised... (7+ / 0-)

      ...and disappointed when I hear about school nurses like that.  Unfortunately, I've dealt with a few myself.

      She was right in the sense that lice themselves pose no health risk.  But that doesn't mean they should be treated dismissively.  And yes, they are VERY difficult to get rid of once you get them!  I posted this diary because lice have been rampant in the school systems in my area (northern Massachusetts), yet no one is really talking about it.  I've heard through the grapevine that it is a highly resistant strain, and my own experiences would seem to bear that out, but there has been no official information.  

      "We must move forward, not backward, upward not forward, and always twirling, twirling, twirling towards freedom." - Kodos

      by Jon Stafford on Thu Nov 10, 2011 at 08:32:25 AM PST

      [ Parent ]

      •  That was my point to her (4+ / 0-)

        that this seemed to be some kind of super-strain of lice.  Obviously I had no proof other than the fact that they came back again and again, but she was evasive about how bad the problem was in my daughter's classroom.  If we can't talk about it, how are we supposed to get rid of it?  

        It was clear to me that we parents and the lice in the classroom were just a headache to her that she wanted to go away.

        Anyway, the best tip I got from that specialist is that you must go for the RED eggs right up on the scalp.  Once they are white, as the ones in you photos are, they are dead.

        It doesn't say that on any information that I could find on the matter.

        I blog about my daughter with autism at her website

        by coquiero on Thu Nov 10, 2011 at 08:39:32 AM PST

        [ Parent ]

      •  while not a solution for everyone (3+ / 0-)
        Recommended by:
        coquiero, buddabelly, corvaire

        years ago I came up with an infestation (long story) and was advised to remove the environment.  An investment in professional quality clippers and no more infestation (and a lot cooler too) and seemed preferable to the toxic shampoos available OTC (I have been sprayed with enough chemicals in my life to not need to increase the amount)

  •  My sister and I got lice after a visit to a (6+ / 0-)

    friend's lake cottage. At that age about 10 it was more of a chore for my mom than an embarassment.

    Unfortunately stuff like scabies, lice, ringworm, crabs etc., are part of living on the planet with all kinds of annoying creatures..:-)

    "Time is for careful people, not passionate ones."

    "Life without emotions is like an engine without fuel."

    by roseeriter on Thu Nov 10, 2011 at 08:22:49 AM PST

  •  I heard that people using Best Yet for head lice (2+ / 0-)
    Recommended by:
    Statusquomustgo, TexMex

    were successful  (Cedarcide)

    Bumper sticker seen on I-95; "Stop Socialism" my response: "Don't like socialism? GET OFF the Interstate highway!"

    by Clytemnestra on Thu Nov 10, 2011 at 08:36:35 AM PST

  •  Comb Through. A place in Chicago called Hair Fair (3+ / 0-)
    Recommended by:
    coquiero, Statusquomustgo, TexMex

    ies uses a natural conditioner (eucalyptus).  They cover your hair and spend at least 90 minutes combing through the hair section by section.  If you are combing the hair for 10-15 minutes, it is not nearly enough.  

  •  Interesting that they transmit no disease (3+ / 0-)

    A trait shared, I believe, with bedbugs.

    I'm guessing it is because of their exclusivity in choosing human hosts only?   They need to keep us healthy to keep the banquet open?

    Contrast with fleas, tics, who (literally) jump between any number of  mammalian hosts, spreading any number of diseases along the way.

    I guess from an evolutionary standpoint, keeping the host healthy is important to lice, but not to fleas.


    I used to write here as VeganMilitia. I let that user name pass into the history books.

    by Shuksan Tahoma on Thu Nov 10, 2011 at 08:37:47 AM PST

  •  Some important things I learned (2+ / 0-)
    Recommended by:
    coquiero, TexMex

    as an adult. I got infested with a resistant type (I think from a hat I purchased). The toxic stuff just flat out did not work. I used an alternative product to suffocate/dehydrate them. It has to be left on for an hour, then repeated in a week.

    Also lice they are racists! When I was a child, only whites were subjected to lice checks. It seems that their claws are very specific to grabbing on to round hair shafts (whites). Then I learned in Africa there are species of lice that can only attach to oval shaft hairs, but this species isn't found in the US. Australia seems to have both types. Lice that infest humans can't infest birds and vice versa.

    •  African-Americans and lice (1+ / 0-)
      Recommended by:

      I have a few African-American students.  The boys have very short, close buzzed hair, so there's really nothing for lice to live in.  The girls have very thick, long, curly hair, which would be a nightmare if lice moved in!

      "We must move forward, not backward, upward not forward, and always twirling, twirling, twirling towards freedom." - Kodos

      by Jon Stafford on Thu Nov 10, 2011 at 09:29:35 AM PST

      [ Parent ]

  •  Treating lice (4+ / 0-)
    Recommended by:
    mookins, coquiero, TexMex, Jon Stafford

    This happened at my daughter's school several years ago.  She has very long, thick hair, and the OTC remedies did not work, possibly because of not enough product, but what did work was Listerene.  Saturate the child's head and hair in Listerene, cover with a shower cap for 20-30 min, shampoo and then comb.  We repeated every other day for about 2 weeks, and also washing sheets,blankets, and pillows every day in hot water.  We tried oil first but it did not work.  Very helpful diary.

  •  Bugs... ain't they grand..... (1+ / 0-)
    Recommended by:
    Jon Stafford

    "How quickly these kids have affected the public dialogue. So proud of them." Clarknt67

    by TexMex on Thu Nov 10, 2011 at 10:53:24 AM PST

  •  So why can't we let the head become dirty? (0+ / 0-)

    If lice prefer clean scalp, one simple solution would be to let the head get a little dirty and may be the lice will die.

    Is it possible the head lice problem and asthma problem are on the rise because of the over use of anti-bacterial and anti-germ sanitizers in the modern world?

    The respiratory system that was never exposed to pollen at young age never learns that pollen is harmless, and over reacts and produces allergy.

    Is it possible excessive shampooing and personal hygiene has stripped the scalp of its natural protectors in the form of oils and symbiotic bacteria?

    [Disclaimer: I have absolutely no qualifications in the field of medicine or epidemiology. Most likely I have failed to understand some basic issue. So please don't flame me.]

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