Ages 6-10: The Hair-Raising Diagnosis of Lice
“Lice” is a four-letter word. No one wants to think about them, hear about them or, heaven forbid, see them on a child’s head. These tiny parasitic mites have the power to deliver panic and shame upon families, not to mention itchy scalps. “There are lots of things that can make parents frantic, and this is high on the list,” says Virginia Zwilling, a registered nurse at Wake County Human Services Child Health Clinic. Jeff Ryan, a pediatrician at Capitol Pediatrics in Raleigh, sees two categories of people when it comes to lice cases. One group is dreading the suspected diagnosis, while the other is totally unaware. He vividly recalls a 15-year-old patient with beautifully coiffed locks who was stunned by her diagnosis. “Parents come in with a child who has an itchy scalp and they don’t know why, and then they get a shock when they are told it is lice,” Ryan says. Parents then wonder if something they did, or didn’t do, brought this plague upon a child’s hair. Not so. Head lice (Pediculosis capitis) infestation is common in the United States among children 3 to 12 years old. Approximately 6 to 12 million children in this age group have infestations each year, according to a report by the American Academy of Pediatrics (AAP). One problem with lice is that parents don’t talk about it. “If a child comes down with strep, a parent will call Johnny’s playmate and tell the friend about it,” Ryan says. But when a child has lice, mum’s the word. “We do see it, and it seems to run in clusters,” Zwilling says. “It is very common. It’s not a condition that occurs because people are not clean.” Living with lice If you suspect your child has lice, tamp down the urge to overreact. Staying calm keeps a child from feeling like a freak with “bugs” in his hair. Confirm the diagnosis with a health-care professional. Sometimes dandruff is mistaken for lice. “The nits [eggs] are usually attached to the hair strand, and they look exactly like a microscopic piece of rice, about 1/16 of an inch long,” Zwilling says. “Sometimes they are very difficult to see unless the child is very heavily infested.” The best place to look is around the hairline and ears, she notes. The most common symptom is itching, but infestations also result in many unnecessary days lost from school and work, and millions of dollars spent on remedies, according to the AAP. School systems are in a difficult position, says Catherine Medlin, a registered nurse and elementary and exceptional children school nurse supervisor in Durham County. “Some parents don’t want children at school putting others at risk, and another group of parents who can’t get rid of the nits say children are missing too much school,” she says. Check with your child’s school to find out when she can return after a bout with lice. Some allow children with nits who are undergoing treatment to attend. Effective treatments Medications that kill lice are called pediculicides. Over-the-counter remedies usually are effective if parents follow directions. Many treatments eliminate adult lice, but not eggs (nits) or emerging lice (nymphs), so a second treatment may be necessary. Treatments do not kill 100 percent of nits. Nits can be removed for aesthetic reasons or ease of future diagnosis. They are easiest to remove when hair is wet. Some reports suggest applying vinegar to the hair to loosen nits. Treatments listed by the AAP in a 2003 issue of the Journal Pediatrics include: Permethrin (Nix or Elimite) – This is the recommended treatment because of its low toxicity. It leaves a residue designed to kill emerging nymphs, but should be reapplied if live lice are seen seven to 10 days later. Resistance to 1 percent permethrin has been reported. Pyrethrins plus piperonyl butoxide (Rid) – Patients allergic to chrysanthemums should avoid this treatment. Twenty to 30 percent of nits remain viable after treatment. A second treatment is needed seven to 10 days later to kill newly emerged nymphs. Resistance of adult lice to these products has been reported. Malathion (0.5 percent) – Malathion is a prescription lotion that is applied to the hair, left to air dry for eight to 12 hours, and rinsed. It kills lice and a majority of nits, but should be reapplied if live lice are seen in seven to 10 days. It is highly flammable and should be used only in resistant cases. Natural products – Several products are marketed by health food stores but are not required to meet FDA standards. HairClean 1–2–3 was found to be at least as effective as Nix by one investigator. In addition to treating the hair, be sure to wash all bed linens, combs and brushes in hot water. Items like stuffed animals can be bagged in plastic for two weeks. Treatments not recommended include Lindane, or Kwell, and sprays for the home. Also unproven are anecdotal remedies such as plastering a child’s head with mayonnaise, a technique parodied in the recently released rhyming children’s book Nit-Pickin’ by Nancy Van Laan and George Booth. In a few years, science may save us all from nit-pickin.’ The LouseBuster, a machine that uses high-powered air and a special comb, kills the majority of lice and nits in a single treatment. Recently invented by researchers at the University of Utah, the machine is currently under commercial development. Unfortunately, a conventional hair dryer doesn’t have the same effect, so for now, louse busting will have to be a bit more hands on. Carol McGarrahan is a Triangle-area mother and freelance science and health writer.