Head Lice identification, treatment & management A parent’s guide to avoid pulling your hair out….much less your child’s!

“Lice Occur wherever there are humans”

Facts about Head Lice Wingless Cannot jump, hop, fly Ectoparasites-i.e. they cannot live independently of their hosts They are most commonly transmitted through close, head-to-head contact with another infested person. WHAT DOES THAT MEAN?

More Facts How about helmets, wigs, headphones? Head lice are adapted to hold onto hair, and this type of transmission is rare. Does swimming and/or water kill lice? Nope, they hold on tight, and can survive under water for several hours. Dogs, cats, and other pets do not play a role in the transmission of head lice.

How long have they been around? *3,000 year old Egyptian mummy with head lice *1,000 year old Peruvian with lice and nits visible in hair

“Woman combing a child’s hair” 1648 by Quiringh van Brekelenkam

A Mother’s Duty (1658-60) by Pieter de Hooch

Head Lice Identification & Treatment Flow END Parent Immediately Starts the Treatment Process (Repeat as needed) School Nurse Checks Student for Admittance back to School Call Provider Ask Friends for Advice or Conduct Internet Search

Risk factors for transmission Close Proximity Crowding in living conditions Sleepovers, camps, naptime, play groups, vacations Although uncommon, lice can be transmitted by sharing clothing or belongings

How common is head lice infestation? Pediculosis is the most prevalent parasitic infestation among humans Head lice infestations are pervasive among school-age children in the United States ~6 million to 12 million infestations occur each year in children 3 to 11 years of age More common in females All socioeconomic groups are affected Contrary to myth, “head lice prefer clean, healthy hosts”

Let’s take a closer look at the critters Louse Family Portrait *The adult louse is 2-3 mm long (size of a sesame seed). Usually pale gray; color may vary *The louse feeds by injecting small amounts of saliva and taking tiny amounts of blood from the scalp every few hours *Lice usually survive less than 1 day away from scalp at room temperature. Louse family portrait, left to right: nymph stages 1, 2, and 3; adult male, adult female.2

The life cycle of a louse 3 Female lives 3-4 weeks Without treatment, the cycle may repeat every 3 weeks 2 Eggs hatch in 7 – 12 days 3 nymph stages 1

Nymphs, Nits and Knowing what to do Diagnosis is made by finding a live louse or nymph on the scalp or head Nits attached >¼ inch (> 1 cm) from the base of the hair shaft are usually non-viable In some warmer climates, viable nits may be found several inches from the scalp Close inspection is needed Nits may be confused with dandruff, fibers, scabs, hair casts, droplets of hair spray, plugs of desquamated cells, or particles of dirt

Aaargh! My kid has it! Head lice infestations often cause psychological issues for children and parents. Immediate reactions of disgust, horror, feeling dirty Anxiety, stress, social stigma Exclusion from school, ostracism from social activities “Lice hysteria” in schools; an emotionally charged issue School policies on responding to infestations vary widely Myths are prevalent Annual US economic burden: $1 billion a year3 Costs of treatment, missed school days, lost work time for parents and caregivers, school system expenses Head

Treatment Diagnosis: often by school nurse, parent, or caregiver 00 72% of Households (n = 133) 28% of Households (n = 68) Contact Health-care Provider Treat On Their Own Availability and awareness of OTCa products; limited parent knowledge, poor perception of Rx choices Immediate access to OTC products (avoid delay in treating) Access to “trusted advisors”: school nurse, pharmacist 46% are instructed to try OTC first 54% receive a prescription for an OTC product or traditional Rx a OTC = Over-the-counter.

Treatment options OTC treatments Pyrethrin OTC (Rid) Permethrin 1% OTC (NIX)   Rx Treatments Natroba (spinosad) Rx Ulesfia (benzyl alcohol) Rx Sklice (Ivermectin 0.5%)Rx Ovide (malathion) Rx Lindane Rx (Black Box Warning) Combing & Home Remedies Nit Picking Salons

Why Some Cases Persist after Treatment Misdiagnosis (no active infestation or misidentification) Non-lice, not-nit debris may be mistaken for infestation Other conditions may be mistaken for head lice Contact or seborrheic dermatitis, eczema, psoriasis, insect bites, piedra Lack of adherence to the treatment regimen (such as not using enough product to saturate the hair) Reinfestation Lack of ovicidal or residual killing properties of the product Resistance of lice to the pediculicide1

National Association of School Nurses Position Statement “It is the position of the National Association of School Nurses that the management of pediculosis should not disrupt the educational process.” “Children found with live head lice should remain in class but be discouraged from direct head contact with others.” “The school nurse should contact the parents to discuss treating the child at the conclusion of the school day.”  

Key Points of NASN Policy No disease is associated with head lice, and in-school transmission is considered to be rare Students with nits only should not be excluded from school Treatment should be based on evidence in the literature from public health, medical, and nursing experts rather than anecdotal reports or advertisements. School nurses should prevent stigmatizing children and maintain the student’s privacy and the family’s right to confidentiality  

Key Points of CDC Policy Treatment is recommended for persons diagnosed with an active infestation of head lice Check all household members, other close contacts, and treat if active infestation found CDC does not make specific product recommendations for individual treatment of head lice infestation Suggests that patients contact their doctor, pharmacist, or health department for information on which products have been successful for treating lice in the community  

Keeping Our Kids in School The AAP and National Association of School Nurses state: No healthy child should be allowed to miss school time because of head lice “No-nit” policies for return to school should be abandoned School-based head lice screening programs have not had a significant effect on incidence of head lice in schools and are not cost-effective School nurses in concert with other health-care providers should become involved in helping school districts develop evidence-based policies

School Nurse’s Role Encourage parents to consult a health-care provider when seeking treatment of head lice infestation Take an active role in diagnosis and management of pediculosis and helping families sort through the treatment choices Develop collaborative relationships with school nurses, school administrators, pharmacists, public health officials, and their professional associations Educate families and the community to promote knowledgeable care and to dispel myths and misunderstandings about head lice  

Resources Centers for Disease Control and Prevention http://www.cdc.gov/parasites/ National Association of School Nurses, 2011 policy statement http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/ NASNPositionStatementsFullView/tabid/462/ArticleId/40/ Pediculosis-Management-in-the-School-Setting-Revised-2011 American Academy of Pediatrics, 2010 policy statement Frankowski BL, et al. Pediatrics. 2010;126(2):392-403.

More Resources American School Health Association, 2005 policy statement http://www.ashaweb.org/files/public/Resolutions/Pediculosis.pdf American Academy of Dermatology, parent resources http://www.kidsskinhealth.org/grownups/lice.html Web MD, Head lice slideshow: What parents should know http://children.webmd.com/ss/slideshow-lice-overview  

Questions? Let the Wild Rumpus Begin!