ASK THE DOCTOR: Head lice are a common nuisance in children
By DR. JIM MITTERANDO
The Patriot LedgerQ. I am at wit's end with my two children getting lice again! They still have nits in their hair. Do I need to worry about that? Do I have to worry about the dog passing it around? Do lice jump or fly? Should I spray the house? What do you recommend to treat lice? I am embarrassed that this has occurred twice.
A. Head lice are a common nuisance. They affect more than 10 million kids a year. Parents are often embarrassed as well as horrified by lice.
They are not caused by poor hygiene or negligent parenting. Head lice are different than pubic lice and body lice, which are less common.
Lice are not life-threatening and do not spread disease. They cause itching of the scalp from small insect bites.
Being the size of sesame seeds, these insects have no wings and do not jump or fly. Head lice can be spread whenever there is direct contact of the head or hair with an infested person.
Lice can also be spread through the sharing of personal articles like hats, brushes and helmets and may spread by contact with a recently used pillow or headrest.
Lice live only on humans and are not carried by other animals - so you do not need to worry about the dog. Lice need blood to live and can only survive 24 hours off the human body. That is why you do not need to treat the house other than by vacuuming carpets and upholstery. Avoid potentially dangerous insectide sprays in the home.
Wash your children's clothes and bedding in hot water and use a clothes dryer. Any items that cannot be washed such as coats, teddy bears, down comforters can be placed in a plastic bag for one week. Soak combs and brushes in soapy, hot water for one hour.
Nits are head lice eggs that are quite small and often mistaken for dandruff. They are oval and usually yellow to white. Unlike simple scalp flakes, nits are firmly attached to the hair shaft. Nits take about one week to hatch.
If when checking your child you happen to find nits more than a quarter inch from the scalp, they are probably old since the hair has grown out and you do not need to treat your child unless you see lice crawling.
All lice treatments involve using pesticides that are fairly safe but still have potential side effects. I recommend treating with over-the-counter Nix shampoo. Nix is probably the safest and one of the most effective.
Do not use any other shampoo or conditioner before using the lice medicine and do not rewash hair for one to two days after treatment. Leave Nix on for 10 minutes and then rinse; repeat application of Nix in one week to kill any newly hatched lice from the nits. Fortunately, most lice shampoos kill 90 percent of the nits. Another commonly used over-the-counter shampoo is RID, which does not kill nits and also needs to be reapplied one week later.
After treatment, check hair and comb wet hair with a "nit comb" to remove nits and lice every two to three days. Continue to check for two to three weeks until you are sure all lice and nits are gone. If the nits are difficult to remove or you have persistent lice problems, then consider rinsing the hair with white vinegar and water solution to loosen the nits before combing.
If your child continues to have lice after three treatments, follow up with your doctor. Recurrence is common mostly due to reinfection from other kids or due to failure to follow the treatment plan.
Unfortunately, some lice can be resistant to these medications and may require several types of treatment before being eliminated.
Avoid Vaseline, mayonnaise and kerosene, which do not work well and create their own messy problems.
Wet-combing the hair without lice medication treatment is not effective and not recommended. Do not shave your child's head; this is a drastic measure that is rarely needed. Do not treat yourself unless you are infested as well.
Consult your physician before using these medications in a child younger than 2 months or if you are pregnant. Good luck and be patient.
Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.
Copyright 2001 The Patriot Ledger
Transmitted October 30, 2001