Update, July26,2010
The American Academy of Pediatrics on Monday recommended that healthy children should not miss school because of head lice and that schools should abandon policies requiring students to stay home until they are free of lice and nits.
Head lice spend their entire lives on the human scalp, clinging to the hair while feeding, mating, and laying eggs. They are unrelated to hygiene or living conditions. Lice cannot jump or fly (they have no wings), they crawl. Transmission is after close physical contact-head to head. The transfer of lice from host to an object to a new host is relatively rare. Though it is possible for lice to be transferred from a personal item; pillow, hat, towel, brush, it would have to be used immediately after it was used by an infested person. Lice cannot live off the human body for more than 24 hours.
Diagnosis: The main symptom is itching. Diagnosis is confirmed by the presence of a live, mobile louse. The louse is about the size of a sesame seed and brown in color. Nits (eggs) are deposited on the hair shaft usually within 6mm of the scalp. These eggs will hatch in 7-10 days. Nits can remain stuck on the hair shaft for weeks or months after an infestation has been treated. A positive diagnosis is based on the presence of a live louse. If someone in the family is diagnosed with lice, the entire family should be checked.
Prevention:
It is probably impossible to prevent all head lice infestations. Young children
come into head-to-head contact with each other frequently. It is prudent for
children to be taught not to share personal items such as combs, brushes, and
hats. However, no one should refuse to wear protective headgear because
of fear of head lice. In environments where children are together, adults should
be aware of the signs and symptoms of head lice infestation, and infested
children should be treated promptly to minimize spread.
Treatment: Nits can be removed with a fine tooth comb. Part the hair into small strands and comb through hair. Examine the comb for any lice. If no live lice are found, repeat the procedure in 1-2 days. If live lice are found the first line of therapy is over the counter pediculicides (LiceMD, Rid, Nix, Lice Arrest, for example). One percent permethrin lotion is currently recommended as one of the drugs of choice for head lice (Nix). Follow the package directions closely. Treatment is for external use only. A second treatment should be applied in 7-10 days, because 25-30% of lice eggs survive treatment. In general, these preparations are safe to use. Prescription treatment for lice is used only if infestation has not responded to safer treatment.
Linens, towels, clothes worn 2 days before treatment should be washed in hot water and dried on high heat. The room should be vacuumed or wet mopped. Dry clean items that are not washable or seal in plastic bags for 2 weeks or place plastic bag in the freezer for 3 days. Remember to vacuum furniture and car seats. Soak brushes and combs in dishwashing detergent and hot water for one hour, rinse and dry.
CONTROL MEASURES IN SCHOOLS
Screening for nits alone is not an accurate way of predicting which children are
or will become infested, and screening for live lice has not been
proven to have a significant effect on the incidence of head lice in a school
community over time.2,12,24 In addition, such screening has not been shown to
be cost-effective. In a prospective study of 1729 schoolchildren screened for
head lice, only 31% of the 91 children with nits had concomitant live
lice. Only 18% of those with nits alone converted to having an active
infestation during 14 days of observation.
Criteria for Return to School
A child should not be restricted from school attendance because of lice, because
head lice have low contagion within classrooms.86 Some schools
have had “no-nit” policies under which a child was not allowed to return to
school until all nits were removed. However, most researchers agree that
no-nit policies should be abandoned. International guidelines established in
2007 for the effective control of head lice infestations stated that no-nit
policies
are unjust and should be discontinued, because they are based on misinformation
rather than objective science. The American Academy of Pediatrics
and the National Association of School Nurses discourage no-nit policies.
~AAP
Clinical Report Head Lice
Barbara L. Frankowski, Joseph A. Bocchini, Jr and THE COUNCIL ON SCHOOL HEALTH
AND COMMITTEE ON INFECTIOUS DISEASES Pediatrics published online Jul 26,
2010; DOI: 10.1542/peds.2010-1308