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Updates Head lice Treatments

AAP Updates Treatments for Head Lice


It’s probably making you squirm just thinking about it – your child comes home from school scratching his head. He has lice. It’s every parent’s nightmare, but it is important to remember that head lice is a nuisance, not a serious disease or a sign of poor hygiene. 
An updated clinical report by the American Academy of Pediatrics (AAP) “Head Lice,” in the May 2015 issue of Pediatrics (published online April 27), provides information to pediatricians and other health practitioners on safe and effective methods for treating head lice, including new products and medications.
Most cases of head lice are acquired outside of school. In the report, the AAP continues to recommend that a healthy child should not be restricted from attending school because of head lice or nits (eggs). Pediatricians are encouraged to educate schools and communities that no-nit policies are unjust and should be abandoned. Children can finish the school day, be treated, and return to school. 
Unless resistance has been seen in the community, pediatricians and parents should consider using over-the-counter medications containing 1 percent permethrin or pyrethrins as a first choice of treatment for active lice infestations. The best way to interrupt a chronic lice problem is with regular checks by parents and early treatment with a safe, affordable, over-the-counter pediculicide. After applying the product according to the manufacturer’s instructions, parents should follow with nit removal and wet combing. The treatment should be reapplied at day 9, and if needed, at day 18. 
In areas with known resistance to an over-the-counter pediculicide, or when parents' efforts on their own do not work, parents should involve their pediatrician for treatment with a prescription medication such as spinosad or topical ivermectin. These are new medications that were introduced since the last time the AAP published recommendations on head lice in 2010.
Once a family member is identified with head lice, all household members should be checked. The AAP does not recommend excessive environmental cleaning, such as home pesticides. However, washing pillow cases and treating natural bristle hair care items that may have been in contact with the hair of anyone found to have head lice are reasonable measures. 

While it is unlikely to prevent all cases of head lice, children should be taught not to share personal items such as combs, brushes, and hats. Regular observation by parents can also be an effective way to detect and quickly treat head lice infestations.

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The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.
- See more at: https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Updates-Treatments-for-Head-Lice.aspx#sthash.jqTsjEAs.dpuf

Vermont Department of Health Website information as of 1/25/16

What are head lice?

Head lice are small, wingless insects about the size of a sesame seed. They live on the human scalp and in the hair. They have six legs and move very quickly. Head lice are parasites - they live by feeding on the blood from the human scalp. They cannot stay alive for more than two days off the human body.

Lice do not spread diseases, and so they are not a major health problem.

What are nits?

Nits are the small, oval-shaped eggs of head lice. Lice lay their eggs very close to the scalp, and the eggs hatch within a week. Nits may be tan or coffee-colored. They are hard to see until they hatch. Once they hatch, the casing (outside) of the nits is white and easier to see. Lice are harder to see than nits because they are tiny, fewer in number, and crawl quickly away from light.

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Who gets head lice?

Lice are a common problem for children, and less often for adults. Children are most likely to get lice because of the close physical contact they have with playmates in school and day care centers. Head lice are not caused by poor hygiene. Anyone can get head lice.

How are head lice spread?

Lice are spread from person to person by direct head-to-head contact, for as long as the lice are alive on the infected person. Head lice can also be spread by sharing combs, hats and other objects such as carpet, car seats and bedding. Although head lice do move quickly, they cannot fly or hop off to another person.

Unhatched eggs cannot be spread from person to person. Pets do not spread head lice.

How can you tell if someone has head lice?

One of the first signs that a person may have head lice is itching and scratching at the back of the head and around the ears. Lice and nits are hard to find unless you look closely at the hair and scalp. Unlike dandruff, the nits are firmly attached to a strand of hair.

If nits are found within half an inch of the scalp, the scalp should be treated. Nits found more than a half inch from the scalp have already hatched or been killed by treatment, and removal is not necessary.

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What if a child is sent home from school with head lice?

Schools may have a variety of policies on head lice. However, a child with active head lice is of little risk to others. If a child is found to have head lice it is recommended that he or she be allowed to stay in school until the end of the school day – but should be discouraged from having direct contact with others.

The child should be allowed to return to school after the first recommended treatment. There may still be nits left in the hair that were killed by the treatment. Re-treatment is usually recommended in 7 to 10 days.

Can you get other diseases from head lice?

Head lice do not spread diseases. Lice can, however, cause physical discomfort, anxiety, embarrassment and the cost of treatment may be a hardship. Toxic or caustic substances should not be used to treat lice.

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What is the treatment for head lice?

An over-the-counter medication such as Nix (Permethrin) or RID (Pyrethin) is recommended. Follow the directions carefully. Lice are usually killed in one treatment. However, a second treatment 7 to 10 days later is also recommended to make sure all nits are killed. Dead nits do not fall off the hair after treatment. Prescription medications are available only if your health provider recommends that one is necessary. Check everyone in the household for lice and nits. Pay special attention to the nape of the neck, behind the ears and within one inch of the scalp. Nits can be removed after treatment with a “nit comb” or with fingernails. Treat only those people in the household who have live lice or nits within half an inch of the scalp. Because over-the-counter treatments may have side effects, do not use lice treatments to try to prevent lice. Do not use the prescription medication, Kwell (Lindane) with infants, young children or pregnant or breastfeeding women.

How can you prevent the spread of head lice in your home?

To help prevent the spread of head lice, teach children not to share combs, brushes and hats. Treat anyone with active lice or unhatched eggs right away. Lice can live for less than two days off the head. Head lice do not reproduce off the body. They do not live on pets. Any nits that fall off the head will not hatch or reattach.

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Other ways to prevent lice from returning

  • Wash clothes, hats, and bedding that has been recently used in very hot water for at least 20 minutes and then dry in a hot dryer.
  • Objects that cannot be washed can be bagged in plastic and put away for 10 days, or dry cleaned.
  • Wash all combs in very hot (130° F) water every day.
  • Put stuffed toys in the dryer at a high setting.
  • In freezing weather (32° F or below), put items outside for 72 hours to kill lice and nits. Small items can go in the freezer.
  • Thoroughly vacuum car seats, the family couch, carpets, and floors.
  • Make sure that each person in the household uses their own comb, brush, towels, and bedding.
  • Store hats and scarves in coat sleeves.
  • DO NOT use insecticide sprays

For more information

Contact your child’s primary care provider, the school nurse, or your Department of Health district office.


Sally Beayon,
Jan 8, 2016, 5:43 AM