Head Lice … Not AGAIN!!

Dear Mamas,

My 8-year-old daughter ended the school year last year with an awful case of lice. It ran through her classroom like wildfire, and every week a new bunch of kids caught it. Just as I finally managed to get her completely lice-free (including a visit from the very expensive lice professional) she was re-infested by the latest victim. She ended up missing most of the last week of school, which was pretty much parties anyway, and was traumatized by the whole experience. Or maybe that was me who was traumatized.

Anyway, school is about to start in a few weeks and I’m dreading it. What if they come back? I’m tearing my hair out. HA! Please — share your lice secrets.

Tammy O.

Hi Tammy,

You’re right. It’s been scientifically proven that the lice monster is lurking everywhere just waiting to pounce. Not only that, it’s likely that the last living creatures on earth will be lice and cockroaches. I’m not sure which are worse. But there’s good news, too.

A new report, published in this month’s Pediatrics, comes up with a new set of recommendations for the treatment of lice in the school setting, and the big change is that they no longer recommend sending an otherwise healthy child home from school because they’ve had the big ‘L’. The authors conclude that no-nit policies for return to school should not be enforced. The reasoning is that by the time a child is diagnosed and treated, the entire class has already been exposed. Keeping the child at home won’t prevent spread. Other recommendations in the report:

* For treatment of active infestations, over-the-counter 1% permethrin or pyrethrins are recommended unless resistance has been proven in the community.

* School staff and parents should be given detailed instructions on the proper use of recommended treatments. Current permethrin or pyrethrin products are not completely ovicidal, and must be applied at least twice at proper intervals. This is also recommended if live lice persist. To prevent spread, manual removal of nits is not necessary immediately. However, nit removal may be considered in the school setting to reduce diagnostic confusion.

* Reasonable alternatives include “wet-combing” or an occlusive method, such as petroleum jelly or a mild skin cleanser. Repetition using careful technique is needed.

* Appropriate training is needed for school personnel involved in detecting head lice infestation. School officials should review lice-related policies to ensure that this goal is achieved.

* Head lice screening programs have not been shown to be cost effective or reduce the incidence of head lice in the school setting. To manage head lice in the school setting parent education programs may be helpful.

* Optimal treatments are safe and rapidly effective, easy to use, and affordable. Because lice infestation has no medical risk, treatments should prove safe to ensure that the adverse effects of therapy are not worse than the infestation.

In other news, a new oral drug called ivermectin looks promising for the treatment of resistant lice, but it should only be used when topical treatments fail. You never want to use a systemic medication when a topical one will work, since all medicines have side effects and risk.

We’re fans of some of the more recent occlusive treatments that smother the little buggers without the use of strong insecticides, so take a look at this recent MOC post for the latest info on that front. Our bottom line with lice? Try to stay calm — they won’t harm you or your daughter, they’re just gross. Start with the most benign, least toxic treatment and work your way up from there. And if it helps to hire the expensive Nice Lice Lady, and you can afford it, by all means go for it. Consider it a quality of life issue.

Good luck!

~ The Mamas

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Ellen and Rachel are two old friends and “expert” mamas—one a pediatrician and one a family therapist—with fifty years of parenting experience between them.


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