With school back in session, I find myself trying to head-off so many questions about head lice.

What are they?  They are tiny reddish brown insects about the size of a sesame seed that love to live on the scalp of your child, bite into the scalp, cause itching and scratching and eventually lay their yellowish-white eggs or nits right on the hair shafts. They differ from a speck of dandruff in that they are tougher to remove from the shaft of the hair. If you are concerned that your child may have head lice, let me provide some hair-raising information on the topic.

First, head lice do not indicate a lack of hygiene or sanitation on the part of the person who gets them.  They are acquired by direct contact with an infected person’s hair transmitted by sharing combs, hats, and other hair accessories – something that can  happen frequently among children at school.  They are usually present for 4-8 weeks before you can actually see them.  Although parents are concerned with figuring out where the lice infection came from, usually it cannot be determined, and the focus should be on treatment rather than trying to identify which child is responsible for an outbreak.

Treatment usually involves the use of an over the counter shampoo that contains 1% of the anti-lice agent permethrin.  After applying the shampoo as directed, you then comb out your child’s hair with a fine-tooth comb to remove the now dead nits or eggs.  The treatment is repeated 7-10 days later to kill any remaining eggs that may have hatched after the initial treatment and/or did not respond to the first treatment.  Clothing or bed linens should be washed in hot water and hair care-items boiled or thrown away.

If the medication does not work, it may be because it is not lice at all but a bad case of dandruff, or the instructions for the shampoo were not followed carefully.  There is some evidence to suggest that some lice are resistant to the usual anti-lice shampoos and in these cases your child’s doctor can prescribe a different medication that should work.

Lice have usually been present for a month or more by the time they’re discovered, and because they present little risk to others and carry no health risks except for scalp irritation, a child with lice detected in school should remain in class but be discouraged from having direct head contact with others.  No healthy child should be excluded from or allowed to miss school because of lice, and that’s not just my opinion but that of the American Academy of Pediatrics as well.

Of course the best way to deal with head lice is to prevent them from occurring by telling your child not to share combs, brushes, hair ties, or hats with other children, and not to lie on bedding, pillows, and carpets that have been used by multiple children who might be carrying untreated head lice.

Hopefully, tips like this will do far more than simply scratch the surface of your child’s scalp when it comes to dealing with head lice.

Lewis First, M.D., is chief of Pediatrics at The University of Vermont Children’s Hospital at the University of Vermont Medical Center and chair of the Department of Pediatrics at the Larner College of Medicine at UVM. You can also catch “First with Kids” weekly on WOKO 98.9FM and WPTZ Channel 5, or visit the First with Kids video archives.

Lewis First, MD, is chief of Pediatrics at The University of Vermont Children’s Hospital and chair of the Department of Pediatrics at the Robert Larner, M.D. College of Medicine at the University of Vermont.

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