March 28th, 2022
Lice outbreaks come and go as a problem in the United States. With summer camps, sleep overs and various close contact events coming up this summer, we need to be prepared for the inevitable lice events that follow.
First, a lice infestation has nothing to do with one's cleanliness or socioeconomic status. It has everything to do with close contact children's activities where the scalp of one child is near another. This tends to happen often in daycare and elementary school settings. The classic ages of infestation are between 3 and 11 years of age.
A louse is roughly the size of a small sesame seed. It cannot fly, but is a fast runner. Lice cannot be transmitted by animals to us as humans are their only source of food. From the CDC, "Spread by contact with clothing (such as hats, scarves, coats) or other personal items (such as combs, brushes, or towels) used by an infested person is uncommon". Survival off of a human for 1 to 2 days can occur without a blood meal, however, it is believed that they stop their ability to propagate within hours. Active lice lay eggs called nits within a quarter inch of the scalp. Nits found farther away from the scalp are usually empty casings and not viable. Nits are not indicative of active disease unless they are close to the scalp.
Lice are no more than a nuisance. They cause itching of the scalp and a nasty appearance with the critters being visible. That is really it. No risk of developing disease. The psychological stress of families is related to the self judgement of cleanliness. My family has battled lice issues and while it is a hassle, it is not a long term problem.
Many of these infestations can be safely treated with over the counter treatments, alternative thaerapies and aggressive nit combing. The latter is very important for a few weeks to prevent the lice from rehatching and starting the process all over again. If the infestation recurs, then you are dealing with either a missed nit that hatched, a reinfection from a poorly treated contact or a treatment resistant louse.
Resistance to medication has been increasing over the past decade do to overuse of first line agents. Effective management should include topical treatment application two times over 1 week, nit combing daily for 10 days and avoiding close contact with other children's scalps during the treatment period.
If you are interested in alternative and non toxic therapies, the AAP Lice statement has great information about your options. LiceMD, Cetaphil, mayonnaise and olive oil are options that are very safe but have unstudied efficacy. Review the AAP statement for details of all possible options.
We personally used LiceMD with good results. Using alternative methods or first line OTC medicines should be preferable to preserve the action of prescription medicines for difficult to treat resistant cases.
Most importantly - Lice are not a medical emergency. Do not panic. Children should stay in school and receive treatment the day the lice are noted. Once treatment has occurred, send your kids back to school to fill their brains with knowledge. Retreat in a week and nit comb often for the best success.
Nasty nuisance critters,
Dr. M
AAP Lice Statement
CDC Lice Information
AAP Lice Update
Seattle Children's Hospital Lice and Cetaphil Treatment Information
