You receive a note or a call from school stating your child has headlice. You wonder how to approach this. Well, feel free to use this article to guide your next step, as well as to know where the AAP stands as far as return to school criteria.
First let’s talk about head lice… Adult head louse is typically the size of a sesame seed and usually tan to grayish-white in color. Tiny eggs tend to be firmly attached to the base of the hair, around 4mm from the scalp. Viable eggs are most often seen in hairline near base of neck. Empty egg casings (nits) are easier to see because they appear white against darker hair VS viable eggs, which tend to be similar color as the hair of the affected individual.
All socioeconomic groups are affected, and head lice infestation is not affected significantly by hair length or by frequent brushing or shampooing.
How does hair lice spread?
Lice cannot hop or jump to a person’s head; they can only crawl. Thus, most cases occur by direct head-to-head contact. Fewer cases occur indirectly, by contact with personal belongings of an affected individual (combs, brushes, hats, pillowcases).
How is it diagnosed?
Simple; by identifying nits, nymphs, or adult lice the diagnosis is made. This may sometimes pose a challenge as lice tend to avoid light and crawl quick. Viable eggs are easier to spot at the nape of the neck or behind the ears, typically 1 cm from the scalp. Eggs found more than 1 cm from the scalp are less likely to be alive.
How to prevent it?
In environments where children are together, infested children should be treated promptly to minimize spread to others. Regular surveillance by parents is one way to detect and treat early infestations, thereby preventing the spread to others.
Never treat unless the diagnosis is clear, which is based on evidence of living lice. Below a list of options. Some over the counter, others requiring prescription.
- OTC options are sold for less than $25, these include: Nix & Rid.
- Options available through Rx are expensive, and typically not covered by insurances unless there is evidence of treatment failure with 1st line agents. These include: Ovide, Ulesﬁa, Natroba and Sklice.
Regardless of treatment chosen, a child should not be excluded from school because of lice. Instead treatment should be applied correctly, and child should be able to return after treatment. The AAP discourage no-nit policies that exclude children from school.
Feel free to contact us if your child is affected by head lice and you need further help with this issue; Remember: WE ARE HERE TO HELP!
Adriana Rosado-Jimenez, MD, FAAP