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Lice
Head Liceā€¦ A Lousy Problem

Information and Advice from Elementary School Nurse Terri Richards, RN

What are Head Lice?
Pediculus Humanus Capitis (peh-DIC”-you-lus HUE-man-us CAP-I-TUS), or “head lice,” refers to a nuisance condition caused by parasitic insects found on the heads of people

*Other types of lice will not be discussed here


Definitions
Head Check - Inspection of one's head hair. Hair is separated to the scalp in order to visualize the scalp and hair.
Infestation - The condition of having live lice on one's head which are reproducing and growing in numbers.
Lice - more than one louse.
Louse -One bug.
Nit -Lice egg. 
Pediculus Humanus Capitis or Pediculosis -Scientific name for human head lice.
Pediculocide - Lice killing product.
Product - In this presentation it is used to mean a substance used for the purpose of killing head lice.
Transmission - Passing lice on to another person.
Treatment - In this presentation it is used to describe the process of applying a lice killing product.
Viable - Able to continue normal physical development.

Nit
A nit is a ‘Louse egg’.
• A teardrop shaped egg laid on the hair shaft close to the scalp.
• It is attached with an extremely strong glue-like substance, and remains firmly attached until manually removed.
• The nit may go through several color changes in the 8-12 days it takes to develop and hatch.

♦ Note: Presence of any lice or nits in the eyebrows or eyelashes are indicators of body or pubic lice, not head lice. In these cases normal treatment can not be used – consult your physician.

Louse
A louse is a wingless insect with 6 legs.
• About the size of a sesame seed.
• Does not hop, jump, or fly!
• Can adapt to the color of your hair.
• Matures about a week after hatching.

♦ A louse cannot survive long off the head.
• Begins to die immediately when off the head, but may stay alive up to 48 hours.
• Needs Human blood to survive and grow (Animals have other types of lice unique to them).
• Needs the heat of the human head to survive.
♦ The female must mate before it can lay eggs(nits).
•It can lay 3-6 eggs daily, usually at night.
• It will only lay eggs on the hair shaft.

Stages
Nit (Louse egg)- Nits are laid on the hair shaft, close to the scalp. They are oval in shape and may undergo several color changes as they develop. They take 8-12 days to develop and hatch. With magnification, the developing nymph may be seen within the egg. Eggs that have died or hatched will remain firmly attached to the hair, but will never again produce another louse.

Nymph- The nymph is the immature stage of the louse. These look just like an adult louse, only smaller and are unable to reproduce yet. They mature into adults about 7-15 days after hatching. Nymphs must feed on human blood to survive and grow.

Adult- Adults are about the size of a sesame seed, have 6 legs, are wingless and may be tan to grayish-white or even have a reddish tinge. Adult females may live up to 30 days on the head of the infested person. They feed once or more often each day, and will die within 24 hours when off the head.


Myths
• Lice hop, jump, & fly
• Shaving the head will take care of the problem
• Pets carry lice
• Flea & tick products are safe on people
• Treatments “just in case” are safe
• The products work as well as advertised
• Lice only live on dirty people
• Lice carry disease
How do you get lice?
• Head to head contact
• Sharing combs and brushes
• Head to head contact
• Sharing hats, helmets, hair accessories
• Head to head contact
• Sharing coats and scarves
• Head to head contact
• Sharing beds and pillows

Important Information
• Head lice are easier to control when caught early. We strongly encourage parents/ guardians to inspect their child’s hair daily as part of their normal hygienic routine: A few seconds daily can save many hours later. Prudent practice of frequent screening is based on the fact that most cases of head lice are contracted at home.
• Never assume you will know if or when your child is exposed to head lice. Exposure to an infested person is common, and can occur in any public or private gathering (playground, church, school, doctor's office, movie theatre, your own home, etc.)
• Although head lice may be discovered at school, it is ultimately the parent’s responsibility to treat and manage their child’s hair.

Inspect Hair Frequently!!!!
What do I look for?
• Good lighting is important for accurate inspection.
• A nit comb can assist in identification and removal of hard to find lice / nits.
• Begin inspecting by separating the hair to make the scalp visible. The fast crawling lice are hard to find as they move quickly away from light.
• Look for nits (eggs) close to the scalp, especially behind the ears, nape of the neck, and crown of the head.
• You may also find sores or scabs where the child has scratched.
• Be thorough! Those live ones are fast & hard to find
 
 

I found them… Now what?
• Relax!…don’t panic.
• Don’t be embarrassed…lice can happen to anyone.
• Notify school nurse or office, babysitter, close contacts, etc.
• Realize that when discovered, lice have probably been present in the hair for at least 2-4 weeks.
• Follow your Health Professional’s directions – DO NOT OVER TREAT!!
• Do not use lice control products on children under 3 years old, anyone with open wounds on the neck or scalp, or anyone pregnant or nursing. Likewise, do not apply the products to anyone else's hair if you are pregnant, nursing, or have open cuts or scratches on your hands.
• Call your School Nurse if you have questions, aren’t sure of what you are looking at, to report names of close contacts of your child or if you just need reassurance.


I don’t see anything… Now what?
• Relax for now, but don’t let your guard down. 
• Remember: you can be exposed to head lice anywhere, anytime. The next time you may not be so lucky.
• Make head checks a routine part of your day/week.


Treatment
(Pediculicide + Nit Removal) + Retreatment in 7-10 Days = Recommended Guidelines

Current recommended treatment for pediculosis, based on scientific research, is vigilance with louse and nit removal in conjunction with an over-the-counter pediculicide (and retreatment in 7-10 days if live lice are seen).

Treatment (application of lice killing product) is recommended only for individuals found with live lice or viable eggs. Research indicates that nits found further than about 1 inch from the head are probably hatched and no longer viable. Although removal of these old nits is not mandatory for eradicating the infestation, it is advantageous for decreasing confusion when detecting new infestations, and necessary for school attendance. This will decrease unnecessary retreatment, and decrease the risk of self-reinfestation.

All pediculicides are pesticides. Use with caution, and always follow directions on the container.

No product should be:
• Inhaled or swallowed.
• Be used near eyes. 
• Come into contact with mucous membranes (eyes, nose, or mouth).

Always have person cover eyes, and hold head over a sink or tub to avoid unnecessary contact with skin. Never use when sitting in tub of water.


Types of Pediculicides
1. Pyrethrum
2. Permethrin
3. Malathion 
4. Lindane
5. Herbal, Enzymatic & Other “Alternatives”

1. Treatment with Over-the-Counter Pediculicides
Examples: R&C, Rid, Pronto, A-200, Clear, Nix

Over-the-counter pediculicides are not hair care products meant for frequent use. Always read the warnings and instructions carefully. The active ingredient in every pediculicide is a chemical insecticide, which kills by damaging the nervous system of the louse. Newly laid eggs have no nervous system, so are not affected. Thus, the need for re-treatment in 7-10 days.

Remember, there are no quick fixes when it comes to head lice. Be prepared to take additional steps to eradicate this nuisance.
Pyrethrum
Made from extracts of natural plant materials mixed with piperonyl butoxide.
• Available products Over-the-Counter = Clear, RID, A-200, Pronto, & other generics.
• Must be applied to dry hair to be effective. Do not leave on longer than 10 minutes.
• Kills slowly so may see some lice still moving after treatment.
• Retreat in 7-10 days to kill any remaining nits/lice.

*Not recommended for those with allergy to ragweed

Permethrin
• Synthetic pyrethroid, Over-the-Counter preparation: Nix & other generics.
• Requires initial clean hair: wash before treatment. 
• Do not use conditioning shampoo or conditioner. 
• Do not shampoo again after treatment to avoid reducing residual activity of the product. 
• Use of an “egg loosener” product must be before treatment. 
• Re-treat in 7-10 days only if see live bugs.
• Continue to check daily and remove all nits and lice.

*Caution with those who have asthma

Malathion
• Prescription only: Ovide
• High alcohol content makes it flammable.
• Has a strong odor.
• Long treatment time: 8 hours.

2. Enzyme Treatments
• Becoming more popular are a type of non-pesticidal product designed to kill lice. Parents are becoming more aware of the dangers of pesticide exposure to their children and are looking for a safe alternative that works. These products are designed so that daily application is safe, as well as safe to use on children under 3 years old, pregnant women, etc.
• The use of these products with frequent combing with a good lice comb, and daily head checks is the safest way to prevent lice infestation.
• As are all other products available, the eggs are not always affected so vigilant nit removal is the key

3. Alternative Treatments
• Alternative treatments such as petroleum jelly, margarine, herbal oils, gasoline, kerosene, olive oil, baby oil, etc. show no conclusive evidence that they are effective, and they can be very dangerous. Removal of these substances from the hair can be very difficult.
• Vinegar and products containing vinegar such as mayonnaise have been reported to help loosen the nits for easier removal, but there is no scientific evidence.
• Hair care products such as hot oil treatments, Queen Helene’s Conditioning Cream, shampoos with sodium laurel sulfate, coconut oil, etc. have not been proven to kill lice, but may assist with nits and lice “combing out” process.
4. Prescription Lice Medications
• These products contain other insecticides that require greater care for treatments.
• They should be used only under a physician's care, and only if live lice persist following treatment with the over-the-counter products. 
• Ask your health care provider about specific instructions for use of these products, potential risks and benefits and other possible treatment options

5. Lindane
• Prescription only.
• Previously Kwell (no longer manufactured in the US)
• Lindane is a strong chemical able to penetrate skin, and is toxic to the central nervous system.
• Overexposure can cause seizures and death. 
• It is also toxic to the person applying it.


Reasons for Chronic Infestations
#1 Failure to remove all live lice and nits
#2 Non-Compliance (not following treatment protocol)
#3 Misdiagnosis
#4 Ineffectiveness of Treatment
#5 New Infestations
#6 Resistance to Product


Interesting Facts…
~Infestations have been documented since the beginning of recorded time.
~According to the Holy Bible, A plague of lice was brought upon man and beast throughout the land of Egypt.
~Desiccated head lice and eggs have been found on scalps of Egyptian mummies, and Incan Princes.
~In Ancient Mexico, the Aztecs offered lice to Montezuma, and Montezuma paid people to pick nits off subjects. He dried the nits, and saved them in his treasury. 
~Women of Northern Siberia threw lice at their men as a sign of affection.
~In the Tonga, kids eat their parent's head lice as a sign of respect.

Interesting Treatments…
~In the 16th Century BCE, Egyptian nobles used date flour on the scalp to treat lice.
~In 23-79 CE, Pliny, a Greek naturalist, prescribed the application of viper broth to the scalp and body.
~In the 1700's wigs were popular with men and women as a way to hide their lice infested heads, or their baldness after shaving their heads to get rid of it.
~W.C. Coles in 1657 book Adam in Eden, or Nature's Paradise, oil from hyssop "killeth lice".
~In 1681 Nick Culpepper The English Physician Enlarged recommended tobacco juice to kill lice on children's heads.
~At the beginning of the 20th Century, herbal remedies were popular including tobacco leaves, larkspur, and chrysanthemums.
~During WW II, synthetic DDT was introduced as a treatment.
~Vodka applied to the hair is a common treatment in some poor Russian countries.

And the search continues for the perfect cure…….

 


Policy Guidelines for Management of Pediculosis in the Teays Valley Schools
An Evidence-Based Approach to Caring for Our Children

The Teays Valley Local School District recognizes the parent’s role and responsibility in prevention, detection, and management of pediculosis. Routine screening of children’s heads by their parents is strongly encouraged for early identification of pediculosis infestation or other scalp/skin conditions. 

Mass screenings for identification of pediculosis will not be performed in school.

School personnel may request a head check on any student suspected as having head lice (scratching their heads, visible nits in hair, live bug noted, etc.) If a classroom has more than two students identified with active infestations, the students of that class may be screened if time is available. 

All efforts will be made to ensure the privacy of each student. Appropriate areas for pediculosis screening include the health clinic or other areas not easily visible to others.

Parents of identified students may be notified by phone, or by letter at the end of the school day.

Effective treatment can be accomplished overnight, allowing readmission the following day. It is the parent/guardian’s responsibility to treat the student at home, and to accompany them to school the next day.

Students may be readmitted to school when NO active infestation is present. If a student continues with active infestation (the presence of live lice or no progress in nit removal), the parent will take the student home for further treatment.

Prevention, education and treatment information regarding head lice and occurrence may be distributed to students and parents at the discretion of the
principal and /or school nurse.

If a parent/guardian is not compliant with treatment options, resulting in the student missing more than two days of school, the following measures may be implemented:
1) Review of attendance and truancy guidelines. 
2) Conference at school or home with the school nurse, principal and/or counselor with a plan developed for treatment and return to school. 
3) Referral to an outside agency for assistance.


Resources and References
• American Academy of Pediatrics Article, “Head Lice,” http://www.aapnews.org
• Centers of Disease Control and Prevention, http://www.cdc.gov/ncidod/dpd/parasites/headlice/default.htm
• Harvard School of Public Health, http://www.hsph.harvard.edu/headlice.html
• National Association of School Nurses, http://www.nasn.org/positions/nitfree.htm
• School IPM (Integrated Pest Management in Schools), http://schoolipm.ifas.ufl.edu/tp2.htm
• The Center of Health and Health Care in Schools, http://www.healthinschools.org/ejournal/june01_3.htm
• American Academy of Pediatrics, Clinical Report; Pediatrics; Guidance for the Clinician in Rendering pediatric Care Vol. 110; 3 :638-643
• Meinking, T, Taplin, D. In: Schachner LA, Hansen RC, eds. Current Problems in Pediatric Dermatology. 2nd ed. New York, NY: Churchill Livingston; 1999; 11: 73-120 “Infestations”
• Pollack, RJ, et.al, Pediatric Infectious Disease Journal, Vol. 110 No. 3 September 2002; 19: 689-693, “Over diagnosis and consequent mismanagement of head louse infestations in North America.”

~Information compiled by Elementary School Nurse Terri Richards, RN

 
Teays Valley Local Schools
385 Viking Way
Ashville, OH 43103
P: 740.983.5000
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