Pediatric Associates of Richmond

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Lice

Background

Heading back to school each year brings excitement and challenges.  Unfortunately for some families, the start of the school year means your child is bringing home more than homework and forms for you to fill out.  Infestations of lice are common during the school year, with approximately 6 to 12 million cases in the US reported every year.

Physicians and researchers have started to notice that there are now particular strains of these pesky bugs that are resistant to the popular over the counter treatments for lice.  The most common active ingredient in over the counter medications, permethrin, disrupts the nervous system of live bugs, killing them.  Some strains seem to have developed a genetic mutation that provides resistance.   Scientists postulate that the overuse of these medications has contributed to this, much like the overuse of antibiotics contributes to antibiotic resistance.

While your intuition is to do so, there is no need to panic.  There are many treatments available for head lice, many by prescription.  In addition, there are many strategies you can employ to ensure that your child does not get infected.

Head lice are tiny, crawling grey insects about the size of a sesame seed.  They can live for about 28 days on a scalp, but will not survive more than one day if not on a person’s scalp.  They multiply very quickly, laying many eggs per day and maturing from hatchling to adult in 12 days.  Thus, if lice are not treated, they may become a persistent, itchy problem.  Common symptoms that indicate that your child has lice include persistent itchiness of the scalp, a red and bumpy rash on the nape of the neck or around the ears at the hairline.  It is important to be able to differentiate the nits, or egg sacs, from flakes due to dandruff, dust or hair product residue.

Head lice don’t jump or fly. They spread by crawling from one head to the next during close contact. This is why they are most commonly found among preschool and elementary school aged children. Contrary to popular belief, having lice doesn’t mean that a person has poor hygiene.   In fact, lice are sometimes easier spread on clean scalps.

Preventing Your Child from Getting Lice

The best way to prevent head lice from infecting your family is to instruct your children on prevention strategies.  Teach your kids not to share items such as brushes, combs, hats, headbands or other hair accessories.  Lice are actually less likely to spread from the sharing of these personal items as they are directly from head to head.  Encourage your kids to keep their heads from touching classmates’ heads as they work and play.  Keeping hair shorter or pulling back longer hair in ponytails or braids may help prevent the spread, as well.

Lice Treatment

Should your child become infected, click here for step-by-step instructions on how to proceed with eradication.  If you find that over the counter treatments do not kill the lice within 48 hours, please contact our office for advice.

Commonly used prescription medications for lice include Malathion (Ovide), Benzyl Alcohol (Ulesfia), spinosad (Natroba) and ivermectin (Sklice).  Malathion is applied to dry hair, left to air dry for 8 to 12 hours and then washed out.  It is flammable, so hair dryers should not be used to dry the product on the hair.  It is effective at killing both live bugs and eggs, but has an unpleasant odor.   Benzyl Alcohol is approved for children over 6 months.  It works by smothering the lice, but does not kill the eggs.  It is applied to dry hair for 10 minutes before washing out.  Treatment should be repeated in 10 days.  Spinosad appears to kill both eggs and live insects.  It is applied on the dry scalps of children 4 and over and rinsed 10 minutes later.  It sometimes causes irritation of the scalp after application.  Ivermectin disrupts the muscles of the louse, preventing them from feeding. Therefore, although it does not kill the eggs, the hatchlings do not survive.  It is also applied to dry hair and scalp and rinsed after 10 minutes.  If over-the-counter treatments are ineffective and a prescription strength application is necessary, it is helpful to call your insurance company (or look up on their website) which prescription-strength products of those listed above are covered. Most are not cheap if paying out of pocket.

In concert with any over the counter or prescription medication, combing of the nits is highly effective. In addition, combing has the added benefit of time spent with your child, reassuring them that lice are common and that you know just how to handle them!

Helpful Links:

http://www.cdc.gov/parasites/lice/head/parents.html

http://www.webmd.com/children/ss/slideshow-lice-overview