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Parents
and teachers often panic when a child is infested with head
lice ("Pediculosis humanus capitis"). Help them with these
tips:
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Head lice are transmitted among children when they share their hats and
combs (Levin, 1998; Merck Manual Online, 2002). Teach children to
never use anyone else's hat or comb. Head lice are also
transmitted through bedding. The lice crawl but do not jump directly
from one child to another.
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A lice infestation is not a sign of poor hygiene. Children from every
socioeconomic level get head lice. They are most common in girls
and least common in African-Americans. When you become aware
that children have head lice, do not embarrass them by making much
ado about the problem.
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When screening for head lice infestations, remember that female lice lay
their eggs, or "nits," in the hair. The nits adhere
to the base of the hair shaft and hatch within three days to two weeks.
Look for the nits along the nape of the neck and in the hairline
behind the ears. You will occasionally also find them in the eyelids or eyelashes.
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To distinguish between nits and dandruff, remember that nits are oval in
shape, have smooth edges, and are gray in color. They are
obvious to the naked eye but get no larger than a sesame seed.
Dandruff is irregular in shape and does not adhere to the base of the
hair.
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Head lice feed off of human blood. Their activities cause intense
itching. Teach children not to scratch to prevent a secondary
bacterial skin infection.
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When you suspect that a child has head lice, inspect the hair.
Parents should take responsibility for removing the
nits and lice. The best technique is to:
~ Brush the hair and divide it into sections.
~ Go through the hair, section by section, with a fine
tooth "lice" comb, which is available at the drugstore.
Use a strong light.
~ Look for the nits at the nape of the neck and behind
the ears. They adhere to the shaft of the hair.
Comb
out the nits and lice and discard them by wrapping them
tightly in several layers of newspaper or in a plastic bag
that can be closed tightly.
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Lice live about 30 days on the human body and lay about 100 eggs in a
lifetime. By the time a parent finds lice on a child's head, the lice
are probably also in pillows and carpets in the child's environment.
Vacuum all pillows and carpets with which the child has contact. Wash all bedding
with detergent and hot water. Set your dryer on "hot."
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Prevent further lice infestation by:
~ Regular inspections of children's heads for nits.
~ Preventing children from sharing hats and combs.
~ Keeping children's hair brushes and combs clean.
~ Hanging each child's coat separate from the others
with hats tucked down into sleeves.
The
"medicate or remove with a comb" debate
The use of chemical preparations to kill the nits and lice
("pediculicides") is controversial. The most common
preparation, lindane, kills the lice by destroying their
nervous systems. However, the FDA recommends that it not be used on children or adults
weighing less than 119 pounds. The National Pediculosis Association (NPA) recommends removal
of lice with a fine-toothed comb rather than with chemical preparations.
Consult their website, http://www.headlice.org,
for further information. Consult your pediatrician or pediatric
nurse practitioner for advice on whether to use chemical removal. The UK
Department of Health recommends applying a hair conditioner to the
infested area, then using fine-toothed comb for handling lice. For
more information, check their "Bug Busting" website, http://www.nits.net/bugbusting/.
The following preparations are compounds used to kill lice and nits
(pediculocides):
Permethrin cream 5% (Elimite) or or Permethrin cream 1%
(Nix). Permethrin is left on the hair for 6-12 hours,
then rinsed off.
Lindane (Kwell) shampoo
Pyrethrin/piperonyl butoxide (RID) shampoo
However,
they are neurotoxins and their use is controversial. The National
Pediculosis Association recommends using a lice combing tool to
remove lice and nits because the compounds used to kill them are
neurotoxins and because the compounds contain inert substances whose
actual effects are unknown.
There
is some evidence that lice are becoming resistant to the pediculocides (Pollina,
2002). The FDA currently requires new labels on the products
that are easier to read.
Parents
need to make the decision whether to use pediculocides. Your role is to
provide them with information.
References
:
Levin,
M.B. (1998). Treatment of pediculosis capitis (Head
lice).
Retrieved August 26, 2002.
http://princetonol.com/family/columns/pedgroup20.html.
Merck
Manual Online. (2002). Pediculosis. Retrieved
August
26, 2002.
http://www.merck.com/pubs/mmanual/
section10/chapter114/114c.htm.
Websites
Related to Head Lice
National
Pediculosis Association, http://www.headlice.org
For
pictures of lice, see "Lousology 101," at
http://www.headlice.org/faq/lousology.htm.
Head
lice information from the Harvard School of Public Health:
http://www.hsph.harvard.edu/headlice.html
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