Head lice continue to be a problem in homes, day care centers, elementary and preschools in California and elsewhere. Head-to-head contact or, less frequently, an exchange of hats, clothing, combs, brushes, barrettes, helmets, scarves, head phones, and other personal items can transmit lice from an infested child to others. Most schools have a "no-nit" policy, so treatment and use of a nit comb are needed before an infested child can return to school.

Daily removal of lice and their eggs ("nits") from a child’s hair with a metal nit or flea comb is the most important lice control measure. It is important to inspect the child’s and sibling’s hair thoroughly, especially close to the scalp at the neckline and behind the ears. Complete nit combing of the entire head has to be performed every day until no more lice or nits are found. Several brands of combs are available. The LiceMeister®* metal comb with long teeth is available from the National Pediculosis Association (800-446-4672), is easy to use, and costs about $10. This and other effective devices may also be purchased at your local pharmacy. Any nits (correct identification of actual nits is critical) that cannot be combed out must be removed either by picking them out with the fingernails or snipping the hair between the scalp and where the eggs are attached.

Permethrin or pyrethrin is the active ingredient in most over-the-counter control products. The active ingredient of choice is permethrin, which is currently in Nix®* cream rinse formulation. Follow the label directions carefully, but do not go beyond the recommended time for application without consulting a physician. Do not treat a second time until 7-10 days following the first treatment. Treatment "failures" usually result from thefollowing: 1) incorrect identification (not lice), 2) incomplete combing out or removal of the nits (eggs), 3) not realizing it may take 8-12 hours for the lice to die, 4) lice re-infestation, or 5) not strictly following labeled directions. Resistance could be considered as a possible reason for failure if none of the above apply. If neither permethrin nor pyrethrin products are effective, one alternative is 0.5% malathion (Ovide®*), which requires a prescription. The label of this alcohol-based product states 8-12 hours contact time is needed, then remove nits with a fine-toothed comb.

There is no convincing scientific evidence to support use of products such as vinegar or advertised compounds to dissolve the glue on the nits (to ease their removal) or kill the nits. Also, there is no documented scientific data to support claims that mayonnaise or olive oil on the hair "suffocate" the nits and lice.

Lice die within 1-2 days without a blood meal. Nits take 8-10 days to hatch and then it takes about nine or more days for the lice to become adults and lay eggs. Since it is possible for nits or lice to be on items used by the child prior to treatment, clothing and bedding should be washed in hot water. Dry on hot cycle for at least 20 minutes. Items that are not washable should be dry cleaned or put in a sealed plastic bag for two weeks to prevent hatched lice from getting a blood meal. Soak combs, brushes, hair bands, and barrettes in soapy hot water for one hour (or boil for five minutes). Carpets and furniture can be vacuumed daily. THERE IS NO NEED TO APPLY PESTICIDES

Please contact your local health department if there are additional questions. These guidelines will be posted on the Department of Health Services web site at http://www.dhs.cahwnet.gov/ps/dcdc/html/publicat.htm.

*Use of a product name is for identification purposes only and does not constitute endorsement.

In our community, head lice infestations are a continuing problem and are highly communicable. Head lice infestation can be a frustrating problem, but this information will help you identify head lice and treat your child safely.

HOW DO YOU GET LICE?
Head lice have been a parasite of humans since recorded time. Many people associate lice with unclean people or homes; this is not true. Frequent bathing or shampooing will not prevent lice nor eliminate them once they are established. Lice cannot jump or fly, and are usually transmitted by contact with infested persons, their clothing, or their comb or brush. Warn children against sharing hats, clothing, or grooming aides with others. Household pets do not transmit lice.

WHAT TO LOOK FOR
Lice are small insects about the size of a sesame seed. They are usually light brown but can vary in color. They move quickly and shy away from the light, making them difficult to see. A more obvious sign of infestation is nits (eggs). Nits are tiny, yellowish-white oval eggs attached to the hair shafts. As she deposits her eggs, the female louse cements them to the hairs. Unlike lint or dandruff, they will not wash off or blow away. Nits may be deposited throughout the hair, but are more commonly found at the nape of the neck and behind the ears. Use bright, natural lighting or a lamp without a shade when looking for them.

SYMPTOMS OF INFESTATION
The itching that occurs when the lice bite and suck blood from the scalp is a primary symptom of infestation, although not everyone will experience itching. Children seen scratching their heads should be examined.

TREATMENT OF THE INDIVIDUAL
No treatment is 100% guaranteed effective. A variety of strategies may be necessary to eliminate lice. You may choose to use a chemical pesticide. Please note that pesticides are not 100% effective or 100% safe. Safety must come first when using pesticides. Before treating one family member, all should be examined. Only those showing evidence of infestation should be treated. Treat them at the same time to prevent re-infestation from one family member to another.

A. WHAT YOU NEED TO GET STARTED

1. INNOMED Nit Comb. Do not use the nit combs that come with the Nix treatment kits. You need a hard metal comb with very fine teeth to remove the nits from the hair shaft. All the nits must be removed! Manual removal is the most critical strategy in eliminating lice.

2. PRELL SHAMPOO (Original Formula or Normal to Oily Formula). Do not use Prell shampoo that has conditioner added to it!!

3. If you choose to use a pesticide, you should use NIX, a cream rinse available in most pharmacies. You do not need a prescription. It is currently the best product on the market because it contains Permethrin. Consult your physician if you are pregnant or nursing, have an infant, have allergies, asthma or other medical conditions, or if you see lice/nits in the eyebrows or eyelashes.

    

B. PROCEDURE

1. Shampoo the hair first. Use a stripping type of shampoo like Prell. A shampoo with conditioner will actually coat the louse and nit, and protect them from the Nix treatment. After shampooing, towel dry the hair so that it is damp, but not wet. If the hair is dripping wet, you will dilute the Nix - thus making it less effective.

2. Use the Nix cream rinse. Skip this step if you chose not to use a pesticide and go to step 4. [Avoid applying pesticides when there are open wounds on the scalp of the person being treated or on the hands of the person who will apply the product.] Have the child lean over the sink, working it in thoroughly with the head held forward and a towel to protect the eyes. Do not treat in the bathtub or shower (in order to confine the lice product to the scalp/neck). Leave it on only for the prescribed 10 minutes. Then rinse the hair well with water. Do not use vinegar or any nit loosening product.

3. Towel dry the hair, but do not use a hair dryer. The heat from a hair dryer may affect the residual properties of Nix.

4. Comb out nits with the Innomed comb. Combing out nits works best when the hair is damp. Nit picking can be done with the fingernails or they can be cut out with small safety scissors. Methodically go through every section of the hair, and rinse the Innomed comb periodically with soapy water. After combing, let the hair air dry. Do not blow dry the hair for the next 7 - 10 days! During this time period, do not use conditioners or conditioning shampoo, mousse or hair sprays. Following nit removal, have child/adult put on clean clothing. After treatment and nit removal, children can safely return to school. School districts have adopted a "no nit" policy.

5. A daily nit check is advisable for at least 10 days following treatment and then checking should become part of routine hygiene. You may have to retreat in 7-10 days if there is evidence of new nits or newly hatched lice. Treatment itself can cause itching; do not retreat on the basis of itchiness alone. If you continually see live lice after pesticide treatment do not continue to treat. The lice may be resistant.

    

C. ENVIRONMENT

1. Remove any bedding, infested clothing, and launder on hot cycle and hot dry cycle. This kills lice and nits. Vacuum daily all possibly infested areas, cars and car seats, bed areas, sofas, chairs, any stuffed animals or toys, or any other item to which hair or lice may cling.

2. One of the old environmental solutions was to bag (plastic) toys or other possibly infested items for a few weeks. This works, but may pose a safety risk of suffocation to young children who want their Teddy Bear back.

3. Do not use surface sprays (insecticides sold to spray on furniture and rugs). They pose a risk of their own. You do not need them if you vacuum carefully.

D. REPORTING CASES
Notify your child's school, camp or child care provider, as soon as possible, so they can alert other parents. Also notify your child's playmate's parents.

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