Head Lice

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Head Lice

• James R. Ginder, MS, WEMT,PI, CHES
• Health Education Specialist
• Hamilton County Health Department
• www.co.hamilton.in.us

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The student will be able to..

• identify the various stages of head lice
• recall the signs and symptoms of head lice
• describe how head lice are transmitted
• list various treatment opportunities

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Health Problem

• Lice are not a Public Health Problem
• Source Harvard School of Public Health

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What are head lice ?

• Head lice (Pediculus capitis) are small insects
  that can live on
• the scalp and neck hair of a human host
• Approximately 6 to 12 million children are
  infected with Head Lice per year (AAP)
• Head lice are not a health hazard or a sign of
  uncleanliness and are NOT responsible for the
  spread of ANY diseases
• All groups of people can develop Head lice

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• Preschool and elementary age children (age 3-11)
  and their families are infested most often (CDC)
• African Americans have fewer cases of head lice
  due to oval-shaped hair shafts which are harder
  for lice to grasp
• Lice seem to prefer red or brown hair over blonde
  or black hair (Vessey)
• Lice development has no connection with the
  length of hair or the frequency of brushing or
  shampooing

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• Lice need blood to feed each day
• They cannot survive for more than a day or so at
  room temperature without access to a persons
  blood (Pollack)
• Lice CAN NOT jump or fly, BUT they can crawl from
  head to head
• Transmission of lice is by direct contact with a
  persons hair
• Indirect transmission can occur. (combs, brushes,
  hats)

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• Nits
• Tiny eggs that are attached
• to the hair shaft by a glue- like
• substance made by the louse
• They incubate by body heat
• and hatch 10-14 days
• Nits are camouflaged with the
• pigment of the hair.

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Life Cycle

• Adult Louse
• 2 to 3 mm long
• Color can vary
• Female can live up to
• 3-4 weeks and deposit
• more than 100 eggs at a
• rate of six eggs each day
• Feeds by injecting a small amount of saliva
• and taking a tiny amount of blood from
  the
• scalp every few hours. This saliva may
  create
• the itchy irritation

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• Nymphs
• Nymphs leave the shell casing
• which can be seen easily at the
• posterior hairline
• They grow for about 9-12 days,
• mate, and the female lays eggs
• If not treated, this process will
• repeat every three weeks

Nymph
Adult
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Signs and Symptoms

• Tickling feeling or something moving in the hair
• Itching, caused by an allergic reaction to the
  bite
• Irritability
• Sores on the head caused by scratching

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Diagnosis

• Diagnosing lice is done by finding a live louse
  on the head
• Eggs, or nits, may be easier to spot at the nap
  of the neck or behind the ears, within 1 cm of
  the scalp
• If nits are seen farther than 6 mm from the scalp
  and no nymphs or adult lice are seen, the
  infestation is a past infestation and DOES NOT
  require treatment (Hansen)
• It is important not to confuse live nits with
  dead or empty egg cases

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• DO not confuse nits with
• dandruff
• hair casts
• hair debris

Egg Cases
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Treatment

• Various treatments for lice include
• ? Insecticides
• ? Mechanical Removal
• ? Enzyme Treatments
• ? Antibiotics
• ? Suffocating Agents
• ? Heat/Cold
• ? Haircuts
• Before ANY treatment contact a pharmacist or
  your healthcare provider

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At Home

• Washing and drying (with heat) pillowcases,
  sheets, nightclothes,
• towels and stuffed animals to prevent
  reinfestation
• Combs, brushes, hats and other hair accessories
  that are in contact with an infected person
  should be washed in Hot water EACH day to
  dislodge any lice and nits
• Furniture and carpeting that have been in contact
  with the head of an infected person within 24 to
  48 hours before treatment should be considered
  for cleaning. Lice can not live off the scalp
  longer than 48 hours

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• Pets can NOT transmit lice and SHOULD NOT be
  treated
• If items cannot be washed, place them in a
  plastic bag for two weeks, by which time any nits
  that may have survived would have hatched, and
  nymphs would die without a source to feed on
• ALL household members should be checked for live
  lice
• Check household contacts for lice and nits every
  two-three days. TREAT only if crawling lice or
  nits within a ¼ inch of the scalp are found (CDC)

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Prevention

• AVOID head-to-head contact during play at school
  and at home
• DO NOT share clothing, such as hats, scarves,
  coats, sports uniforms and hair ribbons
• DO NOT share infested combs, brushes or towels
• DO NOT lie on beds, couches, pillows, carpets or
  stuffed animals that have been in contact with an
  infected person
• Talk with your child about not sharing clothing
  with anyone

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• It is the position of the National Association of
  School Nurses that the management of pediculosis
  should not disrupt the education process.

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Schools Lice

• No-nit policies developed by school systems were
  established in response to the stigma and unclear
  transmission of lice
• Attendance records indicate that 12-24 million
  school days are lost annually in the U.S. due to
  students with nits (Scott)
• The National Association of School Nurses (NASN)
  states that children who have been treated for
  lice SHOULD NOT be excluded from school because
  of the existence of residual nits (NASN)
• According to the American Academy of Pediatrics,
  no-nit policies in schools are a detrimental
  cause of lost time in the classroom.

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• Children with an active head lice infestation are
  likely to have had the infestation for at lease a
  month by the time it is discovered (Frankowski)
• A child with active head lice have NO immediate
  risk to others and SHOULD be allowed to remain in
  school for the day.
• Lice transmission in school is low, due to close
  head-to-head contact which is low and generally
  does not happen in the school setting

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• Screening entire classrooms is an unjustified
  response (Plooack)
• Parents of students found to have LIVE lice
  should be contacted by the school nurse and
  advised of treatment options
• Children SHOULD NOT be sent home for head lice
• Students CAN RETURN to school if they have
  DOCUMENTATION of at least ONE treatment
• Teachers SHOULD reinforce not sharing hats or
  other objects that comes in contact with hair

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• If younger children nap on carpet area, these
  areas should be vacuumed daily
• NO, notification needs to be sent home to
  classmates parents
• Insecticides in the school are not warranted and
  provide unnecessary chemical exposure
• Call your school nurse and see what head lice
  policies the school district has in place

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Care Plans
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Cost

• Parents must take off work to care for children
  who are excluded from school due to no-nit
  policies
• Cost associated with treatment, including the
  cost of doctors visits, medication and
  nit-removal utensils
• Parents must arrange alternate child care to
  prevent lost days at work

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More Information on Lice

• HeadLice.org http//www.headlice.org
• CDC http//www.cdc.gov
• Harvard School of Public Health
  http//hsp.harvard.edu
• Medline Plus http//www.nlm.nih.gov/medlineplus/he
  adlice.html
• Hamilton County Health Department
  www.co.hamilton.in.us

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References

• Centers for Disease Control and Prevention
• Frankowski, B.L. (2004) . American Academy of
  Pediatrics Guidelines for the Prevention and
  Treatment of Head Lice infestation. American
  Journal of Managed Care 10 S269-S272
• Hansen, R.C. (20004). Overview The State of Head
  Lice Management and Control. The American Journal
  of Managed Care, 10, S260-S263
• Pollaxk, R.J. (2000). Head Lice Information.
  February 2007, form The Harvard School of Public
  Health Website http//hsph.harvard.edu/headlice.h
  tml

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References

• Sciscione,.,Krause-Parello, C. (2007) No-Nit
  Policies in Schools Time for Change. The Journal
  of School Nursing 23, 13-20
• Vessey, J.A. (2000). Current Concepts in
  Pediculosis Management. Scarborough, MeNASN