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ASK THE DOCTOR: Head lice are a common nuisance in children
By Dr. JIM MITTERANDO
For The Patriot Ledger

Q. My two children have contracted head lice for the second time. What do you recommend?

A. Over-the-counter lice medications are safe pesticides. Nix shampoo is most effective.

It can take two to three weeks to get rid of lice. Treatments often fail because not all the steps are followed or kids become reinfected in school or at home. Lice can also develop resistance to medications. Success depends upon vigilance and repeating treatments.

When using Nix or other treatments:

  • Do not use any conditioner before using the lice medicine.
  • Towel dry hair so it is damp but not too wet to avoid diluting the medication.
  • Leave Nix on for at least 10 minutes and then rinse.
  • Do not rewash hair for two days after treatment since Nix leaves a residue that keeps on killing lice and nits (eggs) for several days.
  • Repeat application of Nix in one week to kill any newly hatched lice from the nits since it kills most, but not all, nits.
  • After rinsing Nix, use a regular comb to detangle hair and then comb with a long, metal ‘‘nit comb’’ (Licemeister or Bug Buster) to remove nits and lice and repeat every four days as needed.
  • Continue to check for two to three weeks until you are sure all lice and most nits are gone. Removing all the nits is not necessary unless the school has a ‘‘no-nits’’ policy. If the nits are difficult to remove and you have persistent lice problems, then consider rinsing the hair with white vinegar and water to loosen the nits before combing.
  • It is common to have continued itching of the scalp up to a week after treatment. This does not mean your child is still infested. Use an antihistamine for itching.
  • Follow up with your doctor if your child continues to have lice after three treatments. Unfortunately, some lice develop resistance to these medications and may require several types of treatment before being eliminated.
  • Combing or ‘‘Bug Busting’’ has become a popular alternative. It can be worthwhile if you are highly motivated. Live lice are removed with a nit comb after applying generous amounts of conditioner that stun the lice. Nit combing is repeated after rinsing. This process is repeated every four days for 12 days.
  • A recent, popular non-medicated treatment called the ‘‘shrink-wrap’’ method involves applying Cetaphil Gentle Skin Cleanser to the scalp and using a hair drier to dry it in place; this ‘‘shrink wraps’’ and suffocates the lice. You leave the dried lotion on the hair for at least eight hours overnight and rinse it out in the morning. You repeat this weekly for three weeks. Refer to nuvoforheadlice.com for more information.
  • Avoid Vaseline, mayonnaise and kerosene, which do not work well and create their own messy problems.

Common myths about lice

  • Lice 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.
  • These small insects have no wings and do not jump or fly.
  • Head lice is spread by direct contact of the head or hair with an infested person. Lice can also spread by sharing hats, brushes and helmets.
  • Lice live only on humans and are not carried by other animals - so you do not need to worry about your pets.
  • Lice need blood to live and can survive no more than 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 insecticide sprays in the home.

Other lice tips

  • Wash your children’s clothes and bedding in hot water and use a clothes dryer. Any items that cannot be washed or dry cleaned can be placed in a plastic bag for two weeks since lice cannot survive that long.
  • Soak combs and brushes in soapy, hot water or rubbing alcohol 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.
  • If problems with lice continue, consider treating family members if they share beds or pillows.

Dr. Jim Mitterando is a family doctor at 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 2005 The Patriot Ledger
Transmitted Tuesday, December 27, 2005