1. Head Lice – A Lousy Problem Developed by: Updated 9/15

2. Head Lice – A Lousy Problem The facts about head lice How to detect head lice Treatment and management Recommendations for child care and schools Resources

3. What are Head Lice? Head lice are small insects (about the size of a sesame seed) that live on the human head and feed on human blood. Head lice are specific to humans; they do not and cannot live on animals. Head lice are flat and wingless and can not fly, hop or jump.

4. What are Head Lice? Head lice vary in color depending on their surroundings. Head lice have six legs, a diamond shaped head and an elongated body. The mouth is shaped like a stylet; this allows the louse to pierce the skin to feed (blood meal). Actual louse on a hair shaft (highly magnified)

5. Life Cycle Eggs Nymphs Adults

6. Transmission Person-to-person transmission (direct contact)

7. Transmission Vector Transmission (indirect contact) Once away from the human host, the adult louse can usually survive no longer than 24-36 hours.

8. Transmission Head lice may be brought into the home by a person’s contact with an infested person, but the most rapid spread of head lice occurs in the home because of the close proximity of family members.

9. Transmission Head lice can infest all people, regardless of age, race, social- economic status or hygiene practices. It is a myth that head lice infest dirty hair over clean hair.

10. Detecting Head Lice Signs and Symptoms: Itching Sores in the head caused by scratching Tickling feeling of something moving in the head Sleeplessness Or there may be no symptoms

11. Detecting Head Lice The most obvious sign that someone is infested is the presence of nits or lice.

12. Treatment and Management Careful inspection and screening of the hair and scalp Use of a head lice treatment product Manual removal of nits Cleaning of personal items and the environment Daily checks of the hair and scalp

13. Inspection of the hair and scalp to identify lice and/or nits correctly Supplies needed: Time Good light source Magnifying glass (optional) Disposable tools (optional) Vinyl or latex gloves (optional)

14. Inspection of the hair and scalp to identify lice and/or nits correctly Examine the entire head; pay special attention to the areas behind the ears, near the crown and at the back of the neck.

15. Inspection of the hair and scalp to identify lice and/or nits correctly Nits vs. hair debris: Improper identification of nits is a common problem which can lead to unnecessary treatment, absence from child care, school or activities and stress.

16. Use of a Head Lice Treatment Product or Alternative Therapy Pediculicidal products (those products that contain permethrin or pyrethrin, such as Nix or Rid) Alternative shampoos and/or therapies Prescription only

17. Use of a Head Lice Treatment Product or Alternative Therapy Head lice treatment products/shampoos are to be used for the treatment of head lice only. They should not be used as a regular shampoo. Head lice treatments products will not prevent someone from getting head lice. They should only be used on those people that are infested.

18. Use of a Head Lice Treatment Product or Alternative Therapy As with any product, it is very important that you follow the label directions EXACTLY. – Many will instruct to retreat the hair in 7-10 days. All safety precautions and contraindications for use listed on the product label should be observed. Despite product claims, no product is 100 percent effective in getting rid of all the lice and eggs.

19. Pediculicidal Products Products that contain permethrin or pyrethrin, such as Nix or Rid Treatment failures may occur due to:  Misdiagnosis  Noncompliance  Repeat infestation  Resistance

20. Pediculicidal Products Do not use a pediculicidal product if:  The person has a known sensitivity to any component in the product.  The child is younger than age 2.  The person has an infestation of the eyebrows or eyelashes.

21. Pediculicidal Products The following groups of people should consultant their health care provider before treating themselves or others:  Those with neurological conditions  Pregnant women or nursing mothers  Those with skin conditions such as psoriasis or open sores

22. Pediculicidal Products The following groups of people should consult their health care provider before treating themselves or others:  Those with cancer  Those with asthma or allergies  Those with an allergy or sensitivity to ragweed or chrysanthemums and roses

23. Pediculicidal Products Products containing Lindane, such as in the prescription product Kwell, should be used with extreme caution. Neurotoxic reactions have been reported as a result of the normal use of Lindane shampoos. No longer recommended by the American Academy of Pediatrics

24. Alternative Therapies Remember, “natural” doesn’t always mean safe. FDA approval recommended Products should provide toll-free numbers and a list of product ingredients.

25. Home Remedies Examples include:  Olive oil  Mineral oil  Vaseline  Mayonnaise  Vinegar  Listerine  Cetaphil

26. Home Remedies Oil-based products appear to work by clogging up the breathing pores of the lice. These products are hard to remove from the hair. Few scientific studies have been conducted that show these treatments to be effective.

27. Use of a Head Lice Treatment Product or Alternative Therapy Despite product claims, no product is 100 percent effective in getting rid of all lice and eggs! Daily head inspections and the manual removal of lice and nits is necessary following the use of any treatment product.

28. Never Use: Toxic and/or flammable household products such as gasoline, paint thinner, pesticides intended for use on insects and/or bugs other than head lice, pesticides intended for animals, bleach or any other household cleaners.

29. What About Head Shaving or Cutting Hair? Cutting or shaving a child’s head to get rid of head lice will work, but it may be at a high emotional cost to the child and is not necessary.

30. Manual Removal of Nits A good lice comb is important! Metal combs are sturdier and stand up better to cleaning. Light colored combs allow for better visualization.

31. Manual Removal of Nits Comb hair one section at a time, removing all the lice and nits.

32. Manual Removal of Nits Removing nits is a very time-consuming but important process!

33. Cleaning of Personal Items and the Environment Even though cleaning the environment is important, excessive cleaning such as scrubbing down walls is not necessary. Concentrate on heads, where head lice live and feed. Daily head inspections and nit removal will go much farther in the management of head lice.

34. Cleaning of Personal Items and the Environment Soak all family combs and brushes in hot water (130 degrees F) for at least 10 minutes or boil for five minutes.

35. Cleaning of Personal Items and the Environment Wash all recently worn (within two days) clothes and/or bedding in hot soapy water (130 degrees F) and dry using high heat for at least 20 minutes.

36. Cleaning of Personal Items and the Environment Vacuum rugs, carpets, upholstered furniture, pillows, mattresses, car interiors and car seats. A sticky lint remover can also be used on upholstered surfaces.

37. Cleaning of Personal Items and the Environment The use of lice sprays is NOT recommended and is strongly discouraged, as they may be harmful to family members and pets. Lice Spray

38. Daily Checks of the Hair and Scalp For those treated, hair should be inspected and nits removed once daily for seven to 10 days. Inspect all household members daily for seven to ten days. – Treat anyone who was not treated previously, but is found to be infested through daily inspections.

39. Recommendations for Schools and Child Care There is no state law that governs the management of head lice control in school or child care.

40. Recommendations for Schools and Child Care Develop a head lice control policy that addresses:  Screening procedures  Parent/guardian notification  Exclusion protocol  Readmission criteria  Definition of and district response to excessive absences

41. The “No-Nit” Standard/Policy Controversy exists in the medical literature regarding the “no-nit” standard.

42. The “No-Nit” Standard/Policy The American Academy of Pediatrics, Center for Disease Control and Prevention and the National Association of School Nurses no longer support the “no-nit” standard.

43. Disadvantages of a “No-Nit” Policy: “No-Nit” policies can be carried out too rigidly. Children are often excluded due to misidentification of nits or the presence of nonviable nits. Exclusion may hinder academic performance and increase social stigma. No other minor medical condition excludes children, including upper respiratory infections, which are often more contagious.

44. Proactive Community Education Provide the community with a baseline understanding of head lice, modes of transmission and the importance of safe and effective treatment and control measures – before outbreaks occur.

45. Routine Screening and Early Detection Scheduled and announced group screenings encourages parental compliance and promotes community cooperation and individual accountability. Opponents of “no-nit” policies do not advocate for group screenings. Rationale: Mass screenings may be disruptive and have not been proven to have significant effects on reducing the incidence of head lice in schools. ForAgainst

46. Inform All Parents of a Case of Head Lice When a case of head lice has been identified in a classroom, a written notification should go out to all parents. – Allows for precautionary head lice checks to be done in the home environment. Opponents of “no-nit” policies do not advocate for classroom or school- wide notifications. Rationale: Such notifications may increase public alarm, disrupt school productivity, strain school resources and bring undue attention to those children with head lice infestations. ForAgainst

47. Recommendations for Schools and Child Care No child should be excluded from school or child care for long periods of time because of head lice! If the child is sent home more than twice, the information being supplied to the family may not be adequate.

48. Recommendations for Schools and Child Care Frequent infestations and excessive absences may be signs of other problems. Get the family some support by involving your local public health unit or social services.

49. Recommendations for Schools and Child Care The use of insecticides, lice sprays or environmental fumigants of any kind to fog the school or child care room, or to treat walls, floors, desks and carpets are of no value in the control of head lice.

50. Head Lice – A Lousy Problem Remember to keep things in perspective. Although head lice are a nuisance, they do not carry disease.

51. Head Lice – A Lousy Problem Be sensitive when communicating with children and families who have head lice. Although not dangerous, head lice can be emotionally traumatic and cause a lot of frustration.

52. Resources Fact sheets: – Head Lice: A Lousy Problem booklet – Head Lice (Pediculosis) – Quick Guide for Removing Head Lice Available from: The North Dakota Department of Health Division of Family Health 1.800.472.2286 701.328.2493 http://www.ndhealth.gov/head-lice/

53. Resources National Pediculosis Association P. O. Box 610189 Newton, MA 02461 781.449.NITS (6487) www.headlice.org American Academy of Pediatrics 141 Northwest Point Boulevard Elks Grove, IL 60007-1098 847.434.4000 www.aap.org

54. Resources Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30333 404.639.3311 www.cdc.gov National Association of School Nurses 1100 Wayne Ave, #295 Silver Spring, MD 20910 240.821.1130 www.nasn.org