Head Lice 2023 |
I hope you don’t need to be reading this post except for a bit of Schadenfreude . Lice is a chronic problem that many families deal with throughout the year. My original post about lice back in 2013 actually went viral. I learned to accept that my moments of fame are generally poop or vermin related. Lice have become more resistant and the treatment and services available have changed over the years. I updated the post back in 2017 and in the 6 years since then I am struck by how much has changed! This time around I am delighted to be collaborating with Oath’s Shin-Yu who is a clinical pharmacist and has a wealth of information. Diagnosis: Learning that your child has head lice can be incredibly aggravating (understatement)! Trust me I know. You might be suspicious because your child is scratching their head or you may have gotten a call from school, daycare or summer program that your child was exposed. Not everyone gets itchy. Your child might be infested with them and never give a clue. This itching is caused by the saliva of the louse, not the crawling. Some people are more sensitive than others. I remember one instance, back when I was working at the pediatric office. I was measuring a child's height and as they stood tall against the wall there was actually a halo of lice scurrying all over their head...ugh. But most of the time it is rare to actually see live lice crawling around. Once a person gets head lice, the mature or adult head lice can lay up to 10 eggs or nits each day. These nits hatch in about 7 to 12 days. The fresh nits are usually close to the scalp. They feed on the blood from the scalp which makes your child’s head a vulnerable spot. Without treatment or removal, they can live on the scalp for up to a month. In the meantime they are busy multiplying. You can not wish this away. Baby lice or nymphs are about the size of a pinhead when they hatch, and quickly mature into adult lice in about 9 to 12 days. Lice don't like light. They don’t fly but they move very quickly. One site claims that the average speed of a louse is 3.75 inches per minute. This is equivalent to 18.75 feet in one hour, and approximately 450 feet per day. This is over the length of one football field! Because they are so quick at scurrying away from light, the diagnosis is often made by finding the nits since it is hard to spot the actual lice. How to check If you are suspicious, check your child's head in a methodical manner, paying special attention to the areas behind the ears, the nape of the neck and the crown. Make sure you are in a well lit area. Remember that if one person in the family is infested, you should check everyone. I have had more than one mom speculate that people with a Y chromosome don’t do too well at this task. The nits are small white, opaque or tan specks that adhere tightly to the hair shaft. They actually camouflage. They contain pigment to match the hair color of the host, making them even harder to see. If you flick something on a hair and it floats away, it may just be dandruff. If you don't have someone reliable to check your head, you may actually be able to feel a nit on your own hair; run your fingers through your hair from scalp to the ends. A nit will feel like a tiny little knot. If you feel something, yank out the strand of hair and take a look. A nit doesn't encircle the entire hair, but looks like a tiny sesame seed stuck on one side. If you are dealing with lice in your family, you may get some comfort in knowing that you are NOT alone! When my children were in elementary school we all got it. That was when I became somewhat of an expert and spent weeks doing head checks on their entire school. My eyes aren’t as good as they used to be, but I can still consider myself a better than average ‘nitpicker’. Is that a good thing? I am not sure. I thought I was done dealing with lice on a personal level, but when my daughter Alana was a SENIOR at Lowell high school in San Francisco, she and many of the peer helpers ended up with head lice. The culprit was an old couch in their break room that was infested. The reason that I share this is so that you know I have been there. I understand why some parents start insisting that they want to pour strong pesticides on their little darlings’ heads. Stop. Take a breath. There are other options. If you have found some bug or nits, it is time to treat. You have several methods to consider. Nurse Judy’s original method My old post had a several step protocol for using the over the counter medication. It still may be the most cost effective way to treat and I have parents successfully get rid of lice if they do all of the steps. Poison, Suffocate, Sizzle. Step one: Loosen the nits You can do this with either plain white vinegar or an “egg releaser” product. Either of these work well but might neutralize the active ingredient in the Nix, and should be used first and rinsed out thoroughly. Step two: Next step is to wash the hair with a strong stripping or clarifying shampoo such as Prell. This is a classic old shampoo that should be at a local, larger drugstore. You can certainly get it online. Experts say that this helps the Nix or whatever product you choose to be much more effective because it strips the hair of any oil and makes it hard for the lice to hide. Step three: Do a 30 minute application of Nix. Ignore the package that tells you to leave it on for 10 minutes. Keep in mind that a more concentrated version is used to treat scabies and is left on the entire body for 24 hours. This 30 minute application is significantly less toxic . I always used Nix for this. If someone is giving you a free box of Rid, it is fine to use that. Permethrin products kill the lice but not the unhatched eggs, so the next steps are essential. Step four: Comb out the hair while it still has the conditioner in it. This slows down the bugs and makes it easier to catch them. When you comb out, it is important to use the right comb. There are special combs made specifically for lice. A good metal flea comb also works well. Your budding scientist might be interested in taking a close look at the nits and bugs that you catch. One wise mom shared that seeing the eggs helped convince her children that the combing out was indeed necessary. It isn’t always easy to get kids to sit still. Combing out is exactly what screen time is for. You are dealing with head lice, for goodness sakes. Give yourself a break and take advantage of it. Step Five: for kids who are old enough is to sizzle any survivors with a hair straightening flat iron, wait until the hair is completely dry. Lice can’t survive temperatures hotter than 130 degrees, so even the lowest setting is adequate. Before using heat, make sure you haven’t used any products that contain alcohol. Step Six: In a couple of days it is time to suffocate any survivors. Cover the head liberally with your choice of cetaphil lotion, olive oil, mayonnaise or the greasy substance of your choice. Put a shower cap over the oily hair and leave on for 4-6 hours before washing off. Wrapping a scarf or bandana on top of the shower cap can keep it in place. Repeat this every 4 days, for 5 total treatments. You get used to it! Do NOT put your child to sleep wearing a plastic shower cap on their head. This should be done during waking hours. The Prell shampoo will come in handy once again to help you rinse out so that the hair doesn’t feel too oily. Comb out daily to make sure you aren't finding new nits. If they are further up the hair shaft, likely they have been around awhile undetected and got farther away from the head as the hair grows. If you are still finding new nits close to the scalp, you still need to be in treatment mode or are dealing with some hardier bugs. Super Lice Even the name is the stuff of nightmares, but in some regions, the lice are resistant to the standard products. You might want to ask your pediatrician if they are seeing lots of treatment failures. I have had parents report that they can almost hear the lice laughing at them and they dance along in a puddle of Nix. For the pyrethroid based resistant bugs, there are some good options. ClearLice contains natural enzymes and essential oils that break down the physical bodies of lice to prevent them from laying eggs and maturing. There is no reason not to make this plan A if you like. It was fairly new and went under my radar when I did my last post. The reviews suggest that you will do best if you get the entire kit. One reviewer noted that some lice that had looked dead after the shampoo step, started moving around again several hours later, so when you are combing out, put any lice you get in a baggy. When all the steps are followed, most folks report success. NIX Ultra and Cure Pesticide Free Lice and Eggs Removal Kit These products contain dimethicone, a silicone-based polymer that suffocates the lice and nits. They also lubricate the hair to help with removal of nits and lice. That same greasiness that helps with the combing, can be messy and slippery. You have been warned. Ivermectin Lotion (Sklice) This was obtained by prescription only, when I last ran the post. It became over the counter in 2020. This is approved for kids over 6 months old. They claim that one treatment works and you don’t need to do any nit picking. Thanks to the absolute nonsense that Ivermectin could be used to treat Covid-19, it might be hard to find. If you ask your pharmacist to special order it, you might be able to get your hands on some. Aside from being hard to get, it can also be pricey. The name brand single tube can be as much as $300. Fortunately it also comes in generic form that is much more reasonable. Just the thought of nit-picking makes me break out into hives and I will pay to have someone else do it. Lucky for you there are many services out there that will help get rid of the lice and pick out the nits. Some will even come to your house. This can be quite expensive so make sure you ask some questions so that you don’t get sticker shock. Ask for an estimate of the costs in advance. Find out what is included. Is there a guarantee if the lice come back within a certain amount of time? Check the online reviews to see if others have had a positive experience. I can’t afford the service and just want to treat with the ‘big guns’, Please don’t judge me! There are prescriptions available that might be more toxic, so they are not my first choice, but I understand that some parents are fed up. These may require a prescription from your doctor. Malathion (Ovide)Malathion (the generic name for brand-name, prescription head lice treatment lotion Ovide) kills live lice and some lice eggs. It is approved only for kids over two. It can be reapplied in a week if you are still seeing any new lice or nits. This is quite effective but the Centers for Disease Control and Prevention cautions that it is important to keep it away from mucous membranes -like the mouth and eyes, during application. Malathion is flammable so keep the medication and wet hair away from heat sources such as hair dryers, electric curlers, cigarettes or open flames. No flat irons if you are doing this method Natroba/SpinosadSpinosad is approved for use in eliminating lice for children older than four years and can be used to treat both lice and scabies. This one wasn’t around when I did the last update. It is pediculicidal and ovicidal, meaning it kills the lice and their eggs in all stages, this eliminates the need for all that combing. The liquid medication is applied to the scalp, hair and skin. After the application, it should be left to sit for 10 minutes before being washed completely out of hair. Just like with the Ovide, stay away from heat sources and no flat irons!! Ovide, A second treatment is recommended if live lice are present a week after the initial treatment cycle. For children with long or thick hair, the entire bottle may be needed to coat the scalp and hair. This also contains alcohol, so don’t use heat around the hair when it is still wet. Call me a granola parent if you like, but I hate the idea of using any chemical on my child. Do I still have options? You can skip all the products entirely and focus on suffocating/nit picking and sizzling. You can use vinegar in place of the commercial nit removers.This is the least costly and most natural way to deal with lice, but it takes time and effort. If you don’t follow all of the steps, you are likely to keep getting them as the hardier, surviving nits keep hatching. Suffocation is a critical part of the protocol. You will still need the Prell, or clarifying shampoo to wash out whichever grease or oil you are using. Do the Oil treatment on days 1, 2, 5, 9, 13, 17, and 21. Clean up: Sadly, getting rid of the bugs might be the easiest step. It is essential to make sure you eliminate any lurking lice in your house (and car) that are waiting to crawl right back into your treated hair.
The good news is that lice can not live for more than 48 hours or so off of a host. (Much easier than bedbugs!) Prevention Lice do not jump or fly. Since they travel by crawling, it is important that your children learn not to share brushes, hats, hair bows or headphones. Crowded coat racks are a good way to catch them. (As are old nasty couches in a Peer Helper break room). Teach them to hang their coats separately. If your child is in a class or daycare with a lice outbreak, talk about eliminating any dress up or costume boxes. Are you at an event with a photo booth that has all of those creative hats to try on for the picture? Tag, you’re it. If your child has long hair, pull it back into a ponytail or braids to minimize the risk. Although it is unproven, some people say that washing the hair on a routine basis with tea tree oil shampoo or vinegar rinses may act as a prevention. Lice can be sensitive to smells. Coconut, tea tree oil, lavender, eucalyptus, rosemary, lemon grass, and peppermint are scents popularly believed to repel lice. Potential remedy around the corner There are some studies going on in Israel about Ylang Ylang essential oils. A combo of Ylang Ylang, coconut and anise oil is showing quite a bit of promise, but the evidence is not yet quite strong enough to recommend it. . Final tidbits and thoughts Heads might be itchy for several weeks due to sensitivity to the saliva. Your doggy might be guilty of giving you that case of poison oak, but they are innocent when it comes to lice. Pets do not transmit or carry human lice. Remember that lice do not care about family income, education, lifestyle or cleanliness. 10 million Americans are infested each year. If you decide that this is the right time for a buzz cut, do it outdoors. If you are going to a salon, warn them first. As icky as lice are, there are worse things out there, really. I had one patient who found out that her kids had pinworms and head lice at the same time!! She laughed about it, so can you. Here are some amusing tweets from parents who also managed to keep their sense of humor while dealing with this. Make sure your kids don’t feel shame. Reading some books about lice might make them feel better. If this post made you itchy just reading it, trust me, Shin-Yu and I have been scratching our heads all week! |
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