Head Lice

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Head Lice A Lousy Problem
Developed by
Updated 9/15
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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

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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.

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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)
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Life Cycle

• Eggs
• Nymphs
• Adults

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Transmission

• Person-to-person transmission (direct contact)

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Transmission

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

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Transmission

• Head lice may be brought into the home by a
  persons 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.

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Transmission
It is a myth that head lice infest dirty hair
over clean hair.

• Head lice can infest all people, regardless of
  age, race, social-economic status or hygiene
  practices.

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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

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Detecting Head Lice

• The most obvious sign that someone is infested
  is the presence of nits or lice.

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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

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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)

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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.

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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.

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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
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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.

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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.

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Pediculicidal Products

• Products that contain permethrin or pyrethrin,
  such as Nix or Rid
• Treatment failures may occur due to
• Misdiagnosis
• Noncompliance
• Repeat infestation
• Resistance

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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.

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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

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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

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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
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Alternative Therapies

• Remember, natural doesnt always mean safe.
• FDA approval recommended
• Products should provide toll-free numbers and a
  list of product ingredients.

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Home Remedies

• Examples include
• Olive oil
• Mineral oil
• Vaseline
• Mayonnaise
• Vinegar
• Listerine
• Cetaphil

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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.

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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.

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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.

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What About Head Shaving or Cutting Hair?

• Cutting or shaving a childs 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.

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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.

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Manual Removal of Nits

• Comb hair one section at a time, removing all the
  lice and nits.

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Manual Removal of Nits

• Removing nits is a very time-consuming but
  important process!

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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.

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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.

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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.

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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.

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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
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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.

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Recommendations for Schools and Child Care

• There is no state law that governs the management
  of head lice control in school or child care.

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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

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The No-Nit Standard/Policy

• Controversy exists in the medical literature
  regarding the no-nit standard.

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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.

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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.

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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.

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Routine Screening and Early Detection
For
Against

• 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.

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Inform All Parents of a Case of Head Lice
For
Against

• 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.

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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.

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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.

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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.

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Head Lice A Lousy Problem

• Remember to keep things in perspective. Although
  head lice are a nuisance, they do not carry
  disease.

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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.

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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/

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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

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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