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.
(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
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.
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
• 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
• 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
• 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)
#4 Ineffectiveness of Treatment
#5 New Infestations
#6 Resistance to Product
~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.
~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