Back-To-School Head Lice Infestations: It’s War; How To Arm Yourself

ACROSS AMERICA — Head lice are having a moment, just as they do every year with the lovely togetherness of back-to-school time — and it is a beautiful thing to see children playing with and hugging their friends.

There is a tiny-sized “but” here. Any head-to-head contact, including affectionate embraces, is the main route head lice use to crawl into your life and take, perhaps not complete control, but a significant amount of control before they’re gone for good.

Head lice spread easily from person to person, especially in group settings like those found in classrooms, daycare centers and camps. Just the thought of a head lice infestation and what to do about it is literally a head-scratcher, causing a psychosomatic itch that psychologists can result in genuine physical symptoms.

This woman commenting on a Reddit thread on lice this week, did just what Johns Hopkins Medicine’s “No Panic Guide to Head Lice Treatment” advises against.

“I am freaking out,” she wrote after a salon found lice in her stepdaughter’s hair and sent her home. “She’s been at my house for three days, she’s been using my hairbrush because she lost hers, and I spent 20 minutes detangling her matted knots this morning.

“What do I do to limit this getting worse? They’re at the store now getting a lice treatment. What about the bedsheets and pillows?”

“So, I have lice, and I’m doing the proper protocol to treat it,” another person said. “However, how do I stop freaking the (expletive) out over lice? Like I’m so freaked out at the thought of little critters doing the hula-hoop on my head. How do I stop the anxiety?”

Still another mom wondered if she was following the right treatment after finding lice in one of her kid’s hair on a recent Sunday. An urgent care doctor recommended the Nix treatment for two days for the entire family.

“I’ve been nit combing daily after showers, my husband has been feverishly cleaning sheets and linens on hot with a hot dryer,” she said. “With each combing, it’s less and less. Yesterday and today, I only found one each day. … In the last two days, she’s said her head doesn't itch anymore.”

Still, she wondered, “How do I know if I'm doing this properly or is it overkill?”

All good questions. Here are some answers to help parents navigate head lice season:

There’s No Reason For Shame

Part of not panicking means getting over the thought this can’t possibly be happening to your family or that only people with dirty hair get head lice. Don’t worry that other parents will think poorly of you if you tell them your kid has head lice. Be upfront about it. This is need-to-know information, and there’s no shame in it, no implied judgment about housekeeping skills. Head lice infestations happen to everyone.

Well, not everyone, but millions of people a year do get head lice, according to Centers for Disease Control and Prevention, which estimates between 6 million and 12 million head lice infestations a year among children 3 to 11 years old.

It happens in wealthy families and those who aren’t. Head lice are more common in Caucasian children, especially girls between the ages of 3 and 11, according to Johns Hopkins Medicine. But anyone, regardless of race or hair type — curly or straight, dyed or natural — can get head lice. Some experts think lice prefer fine, straight hair.

What’s Happening In Your Kid’s Hair

Thinking too much about parasites crawling around your kid’s scalp can be paralyzing. But you do need to know what’s happening, because fear of an exponential explosion of nits in your kid’s hair will spur you into action.

There’s no time to waste. Lice reproduce quickly. Females can lay up to 8 eggs a day from a single mating and continue laying eggs for 16 days. During this time, the eggs, called nits, effectively glue themselves to the base of the hair near the scalp. Left untreated, these eggs will hatch into baby lice, or nymphs, that need blood within minutes.

They mature quickly, becoming adults in seven days and the circle of life, the “hula-hoop” on the Reddit user’s head, continues.

Get After The Lice!

A nit comb with narrowly spaced long metal teeth (or use a metal flea comb from a pet store) will catch nits, which look like tiny seeds or beads, that are stuck in the hair. Lice and nits are most often found behind the ears and around the nape of the neck. A LiceMD Pesticide Free Lice and Eggs Removal Kit includes a lice comb and a pesticide-free, odorless liquid gel that’s applied to dry head and then combed through. It can be washed out with regular shampoos.

Combs are an important part of a head lice defense kit, but once the nits, or eggs, have attached, they can’t be combed or washed out.

A variety of medicated shampoos, lotions, creams and sprays, available either over the counter or by prescription, are effective. Be sure to closely follow product directions when using them, though.

Non-prescription shampoos containing permethrin, sold under the brand name Nix, are usually the first option, according to Mayo Clinic. It’s a synthetic version of pyrethrin, a chemical compound extracted from the chrysanthemum flower, that is toxic to lice. It’s often sold under the brand name Rid.

Lotions containing ivermectin are toxic to lice. The non-prescription Sklice is approved for use in adults and children 6 months or older by the Food and Drug Administration. Apply it once to dry hair and rinse with water after 10 minutes, but don’t repeat the ivermectin treatment unless a health care provider recommends it.

Be aware this treatment can have side effects that include eye irritation or redness, dandruff, dry skin, and a burning sensation at the application site.

Mayo notes that in some parts of the country, lice have become resistant to the active ingredients in nonprescription treatments. If lice persist after the recommended treatment regimen, prescription shampoos and lotions with other active ingredients may do the trick.

Ivermectin is available as the oral prescription drug Stromectol when other treatments don’t work. It typically takes care of lice in two doses, taken eight days apart. Kids must weigh at least 33 pounds to take it, though, and side effects can include nausea and vomiting.

Ovide, a prescription medication containing the synthetic drug Malathion, can be applied to the hair and rubbed into the hair and scalp. It has a high alcohol content and is flammable, so those using it should take care that they’re not near a heat source such as a hair dryer, electric curlers or cigarettes.

You May Have Head Lice And Not Know It

Again, don’t panic. You may have head lice and not know it, according to the CDC. People getting head lice for the first time or who have a light infestation may not have recognizable symptoms.

Itching, the most common symptom, is caused by an intense allergic reaction to louse bites. Itching may not occur for four to six weeks the first time a person has lice.

Other symptoms may include the following:

• A tickling feeling or the sensation that something is moving in your hair;
• Irritability and sleeplessness;
• Sores on the head caused by scratching, which can cause a secondary infection with bacteria normally found on your skin.

On the plus side, head lice don’t transmit any diseases to humans and aren’t considered a health hazard.

Is A Deep Cleaning Needed?

The CDC and Johns Hopkins Medicine both say it’s unnecessary to spend a lot of time and money disinfecting your house. Lice need a warm-blooded host to survive, and they don’t live long if they fall off the host and can’t feed. The transmission of head lice from inanimate objects is rare, according to the CDC.

It’s a good idea to wash hats, pillow cases and other items that touch the head in hot water to prevent spreading of head lice to other members of the family. You may also want to wash stuffed animals if they’re part of a bedtime routine and clothing worn within two days of treatment and vacuum carpets and upholstered furniture, though

Do Kids Have To Stay Home?

Be sure to check your individual school district’s policies and guidance.

The CDC recently updated its head lice guidance to schools and no longer recommends that kids with head lice be sent home early from school. They can finish the day, receive a home lice treatment and return to class as soon as the following morning.

The American Academy of Pediatrics and the National Association of School Nurses also have moved away from the “no nit” policies of the past. Initial treatments should kill the crawling lice, which significantly reduces the risk of transmission, the groups say.

Among other reasons cited by the CDC and others, the burden of missing school outweighs the minimal risk of transmission, especially after the initial treatment with a lice-killing compound. Also, misdiagnosis of nits is common when performed by people other than medical professionals, the groups argue.

‘The Lice Will Always Win’

The war on lice is as old as humanity, and “the lice will always win,” Caitlin Gibson recently wrote for The Washington Post. Lice eggs have been found in the petrified hairs of ancient mummies in Egypt and South America. A comb used 3,700 years ago unearthed by archaeologists in 2016 is etched with the first known written words about lice, “May this tusk root out the lie of the hair and the beard.”

Researchers learn a great deal about evolutionary history by studying lice DNA. A compendium of studies, including those published in the peer-reviewed journal Nature and others, have determined that lice survived the evolution from Homo erectus to Homo sapiens, supporting the “out of Africa” theory that the small group of ancestors who left the continent between 150,000 and 50,000 years ago carried lice with them.

Studies have also found that humans crossing the Bering Land Bridge from Asia brought lice to North America around 15,000 to 35,000 years ago.

The study of lice can also help scientists learn more about how hosts and parasites have evolved together. In general, they’ve found that lice evolve faster than their hosts, which make them an effective species to test the theory.

Perhaps the best approach to head lice infestations, Gibson wrote in The Washington Post, is respect for the seed-sized creatures.

“I’ve developed a pretty deep respect for them s creatures that have perfected the ability to continue to be here,” Nancy Pfund, co-founder of the Washington-based lice removal service Lice Happens, told Gibson.

“One way I look at lice, in theory, is as a little gift given to a family that is just a reminder of how precious normal, day-to-day life is, because that’s all you want back after lice,” she said.

And Megan Gray, whose kindergartener brought lice home from school last year around Christmas, told Gibson it was “a reminder that all the things you’re worrying about are tomorrow’s problems.”

“I had been worrying a lot about Christmas, and that mattered less, suddenly, because I had to just take care of what was in front of me. In a way, it was a gift?” She laughs. “A gift of mindfulness, and being present.”

And, she added, “Thank all that is good and holy that it was not bedbugs.”

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