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You receive the dreaded call from your child's school, "Your child has lice. Please come pick her up immediately." You feel like the world's worst mom. Doubts go through your mind: maybe you don't bathe your child often enough; perhaps your need to vacuum the house more often; is your whole house infested now? Should you move? These fears may sound a little over done, but in our society lice has gotten a bad rap. Your child, and perhaps your whole family, will be shunned by the school and the neighbors until you can prove to them that your entire family and house has been sterilized and is now lice-free. The schools inappropriately make a much bigger deal about lice then they should.

The truth about lice is that it is a harmless infestation that will affect many people at one time or another. It has nothing to do with hygiene, socioeconomic status, or ethnic background. Most importantly it has no health consequences. Here is a brief discussion about lice, how to treat it, and how to get your family accepted back into society again.

Lice (singular – louse) are tiny insects called mites. They are not microscopic – they can be seen with the naked eye. The proper name is pediculosis. Adult lice lay eggs on the hair shafts of the head, about 3 mm from the scalp skin. After one week, the eggs hatch and an immature, mobile louse nymph emerges. This nymph hides in the scalp and after 2 to 3 weeks it matures enough to begin laying eggs. Adult lice can only live 1 or 2 days away from a warm body, and the eggs must be close to the warm scalp in order to hatch. They feed on human blood through tiny bites in the skin.

There are several things to look for:

• Itchy scalp – this is the most common symptom, although very light infestations (5 or less lice) may not itch.
• Visible live nymphs or adult lice – this are tiny, clear to white mobile bugs visible on the scalp or hair shafts. They are most often seen in the hair behind the ears and the nape of the neck. Adult lice are quite fast and therefore more difficult to spot.
• Visible nits – "nits" are tiny white shells that are glued to the hair shaft near to the skin. The nit can either contain a live egg, or can be empty (the egg already hatched). Nits close to the scalp are more likely to contain eggs, and those more than ½ an inch away from scalp are probably empty. Nits are often difficult to distinguish from normal dandruff in the hair shaft. One way to tell is that dandruff will easily slide off the hair with your fingers, whereas nits are glued to the hair shaft and are not easily moved.

Lice are passed from person to person by direct contact with the hair of an infested person. They can also be passed through brushes, combs, and hats. Remember, lice can only live 1 to 2 days off of a person, so it is rare to catch lice just from being in the same room with an infested person. Pets don't carry lice.

No. The only thing that lice does is cause itching on the scalp. They do not cause any other diseases. Some children may scratch so much that the scalp will get sore and slightly infected. This may cause the glands in the neck to swell. Sore, crusty areas can be treated with antibiotic ointment 2 to 3 times a day.

No. The only way to prevent lice is to keep your child locked in her room 24 hours a day, 7 days a week, 365 days a year. There are many myths about lice that have led to its bad reputation. Here are some truths about lice that will help dispel these myths:

• Lice are not a sign of uncleanliness – it does not matter how often you wash or brush your hair because normal shampoo does not kill or prevent lice.
• Lice does not only occur in lower socioeconomic classes or in certain minority races. If fact, some minorities are much less likely to get lice than Caucasians.
• Long hair does not increase your chance of catching lice – the only difficulty that long hair poses is that it is harder to find lice and nits in long hair.

• Non-medicated treatments – here are several harmless, but messy treatments that may eliminate lice.
  • Olive oil
  • Mayonnaise
  • Petroleum jelly (Vaseline)

  These work by suffocating the lice and their eggs. Simply massage thoroughly into hair, put on a shower cap, and allow to sit overnight. Wash the hair in the morning with regular shampoo. The main drawback of these treatments is that they can be very difficult to rinse out, sometimes requiring several washings over several days. Because of this, we recommend you try a shampoo first.

• Pesticide-free Shampoo
- There are several different ways to treat lice, both medical and non-medical. Over the years some lice have become resistant to the commonly used medicated shampoos, we recommend first trying a pesticide-free shampoo treatment.
• Dimethicone
- (brand name LiceMD) A new pesticide-free breakthrough treatment that helps parents take control of lice outbreaks and achieve peace of mind while restoring their household to its normal balance. This head lice treatment is pediatrician-tested and clinically proven to effectively and safely eliminate eggs, lice and nits in three simple steps. Its primary ingredient is dimethicone, a safe and effective synthetic lubricant with a well-known safety profile, and that is odorless, non-irritating and hypoallergenic. The LiceMD gel formula lubricates and allows the comb to glide effortlessly through even long, thick or very curly hair, so parents can concentrate on removing the lice and eggs, not struggling to pull a fine tooth comb through tangled hair. Since LiceMD is pesticide-free, there is no treatment application limit. And because it uses a physical instead of a chemical mode of action, lice resistance is not a factor. To learn more about treating head lice and preventing future outbreaks, visit www.LiceMD.com.

• Medicated shampoos – we will discuss these in order of least toxic to most toxic. While the first several shampoos are very safe when used as directed and have virtually no chance of side effects, the last two – Lindane and malathion are more potentially toxic. We suggest you try some of the non- medical treatments before resorting to these two strong prescription shampoos.
• Pyrethrin or pyrethrum (brand names RID, A-200, Clear, Pronto, R & C) – these over-the-counter products are natural extracts from the chrysanthemum plant, and are approved for all ages, even young infants. They effectively kill live lice, but they do not kill the unhatched eggs. Therefore, you must repeat it in 7 to 10 days to kill any new lice that have hatched in the meantime, even if you don't see any. These new lice can't lay eggs for 2 to 3 weeks, so no need to keep repeating. Don't use these if you are allergic to ragweed. Some itching may continue after use due to minor irritation from the shampoo. General instructions for this type of shampoo are to apply it to dry hair thoroughly, wait 10 minutes, then add water to form a lather, massage for a minute, and then rinse thoroughly. You should follow the instructions on the box.
• Egg (nit) remover rinses – because the above products leave the live eggs in the hair, they often come with a rinse product to help rinse out the eggs (nits). Use the rinse as directed after the shampoo.
• Nit removal combs – these often accompany the shampoo. Comb the hair thoroughly after the above shampoo and rinse to help get out any leftover nits.
• Permethrin 1% (brand name NIX) – this over-the-counter rinse is a synthetic pesticide. It is the safest of all the pesticide-type lice shampoos. It is not recommended for infants under 2 months of age. The best thing about this shampoo is that it kills both the live lice and the unhatched eggs. It also keeps working for 2 weeks. Therefore, re-treatment usually is not necessary. Don't use this if you are allergic to chrysanthemums. This product usually comes with a nit comb and it should be used. This product, however, does not come with a nit remover rinse (even though it kills the egg nits, they may stay stuck to the hair shafts). You can either buy one separately or just rely on the comb. Alternatively, white vinegar can be used to unstick the nits from the hair – just apply some to the hair and leave it on for 30 minutes, then rinse and comb.
  Instructions for this shampoo are to first wash with a normal shampoo, towel-dry the hair, then apply Nix thoroughly to the hair and scalp. Let it sit for 10 minutes, then rinse thoroughly. You can repeat this after 7 to 10 days if new lice appear.
• Malathion (brand name Ovide) – this pesticide is available by prescription. It is for kids 6 years and older. You may have heard of this pesticide – it is sprayed from aircraft over cities to control certain agricultural insects including fruit flies. This shampoo lotion was previously used in the U.S., then was taken off the market for a while (although it was still used in other countries), and is now recently approved again by the FDA for use in the U.S. Because of its potential toxicity, we do not routinely recommend using this product unless virtually everything else has been tried. Instructions - apply thoroughly to dry hair. Let it sit overnight for 8 to 12 hours, (do not blow-dry) then rinse off thoroughly. Use a nit comb afterwards. May repeat only once after 7 to 10 days if new lice appear. Precautions – product is flammable, do not use hot curlers or hair driers, and do not smoke while product is on. Rinse off immediately if significant irritation occurs. May irritate the eyes. Wash hands thoroughly. Minimize contact with face and other parts of body.
• Lindane – this is another pesticide available by prescription. It is approved for children of all ages, although should be used with extreme caution in kids under 2 years. It is the most potentially toxic of all the lice shampoos and therefore should only be used when everything else has failed twice. Because of its potential toxicity we do not recommened its use, especially considering the harmless nature of head lice. It does not kill the lice eggs; therefore care should be taken to use a nit comb to remove all nits after use.

No. You can either diagnose and treat the lice yourself, or if you are not sure, ask the school nurse or a teacher who has had a lot of experience with this to check your child. You can also come in to see the doctor if you choose.

• Examine household and close contacts – check for nits or live lice. Anyone with visible lice or symptoms of scalp itching should be treated. You do not need to automatically treat everybody that has come into contact with your child. The only exception to this is that you should treat bedmates whether you find lice or not. The best preventative treatment in this situation is permethrin.
• Disinfect household and personal objects –
• Brushes and combs can either be washed in one of the medicated shampoos or soaked in hot water (more than 128 degrees F) for 10 minutes. Water that is close to boiling is plenty hot enough.
• Pillow cases, sheets, hats, clothing worn in the past few days, coats and ornamental hair clips and ribbons can be machine washed in the hot cycle then dried on the hot cycle.
• Anything that cannot be washed can be tied up in a garbage back and placed in the closet for 10 days. This will kill any lice or eggs.
• Vacuum the bedroom, sofa, bed and pillows will get rid of any stray lice.
• Check your child's scalp every 2 to 3 days for any new lice or nits. Use a nit comb.
• You do not need to go all out and disinfect the entire house. You don't need to wash all your child's clothes. You don't need to have the house fumigated.

It depends. If you use permethrin, which kills lice and eggs too, you don't need to remove all the nits. If you use a treatment that only kills live lice, but not the eggs, then you do need to try to get all the nits out. This is where the term "nit-picky" comes from – being meticulous about picking out all the nits.

Some schools have a "no nit" policy, stating that your child must be completely free of nits before returning to school. This policy has not been shown to decrease the spread of lice, but some schools remain strict nonetheless.

Your child can return to school the day after treatment is given.

• Immediate recurrence – if you still notice live lice on the scalp within a day or two after using the medication, this can either mean that the lice are resistant to that particular shampoo or your child has a particularly heavy infestation. The best course is to repeat the treatment immediately with a different medication, and repeat this treatment 7 days later. Make sure you have cleaned all potential sources of lice around your child.
• Recurrence after a week or more – this probably doesn't indicate resistance. Rather, it indicates some nits were missed and have hatched into live lice. In this case, you may repeat the same treatment again (which is often recommended anyway), taking special care to make sure you remove all the nits over the next week.
• Stubborn recurrences – if you continue to have trouble, there may be an unidentified source of lice in your family or at school. You may treat other family members in this case, even if you don't find lice or nits. You should also try several methods of treatment simultaneously such as a medicated shampoo followed by one on the non-medicated suffocation methods.Some experts have also recommended using both permethrin and pyrethrin together (one right after the other). This is safe to try.We do not recommend using Malathion until all other alternative have been tried at least twice.