Have You Ever Gotten the Lice Letter? Here's a Survival Guide

As a Hawthorne parent I cringe when I see the dreaded lice letter from the school staff.  When that note comes out of my kid’s backpack I get a sinking feeling. I had treated kids with lice in clinic, but it wasn’t until my own kids brought those scratchy, nasty bugs into our house that I truly understood their impact.

There is no shame in having lice. It’s as common as getting a cold. Lice are attracted to clean, shiny hair so the assumption that only unclean people having lice is false. Lice do not carry any dangerous diseases and do not typically transmit infections. Lice, however, are more of a nuisance and a big-time inconvenience to already busy moms and dads.  Here are some answers to common questions:

What are lice?

Lice are small insects about the size of a grain of rice. They lay nits, which are small whitish or brownish eggs, that are glued to hair shafts. A louse can lay up to 100 nits which are usually found within an inch or two from the scalp. Nits typically hatch in eight-nine days. And baby lice, or nymphs, take another eight to nine days to grow to maturity before mating.     

Lice need blood in order to survive, so lice that are not attached to humans typically die in two to three days. Symptoms include itchiness (especially behind the ears and the nape of the neck) and bumps on the neck. Sometimes there is a feeling of movement in the scalp.

How do you get lice?

Lice are transmitted from person to person. They can't jump or fly and usually are transmitted through activities like snuggling, hugging and sleeping in the same bed. Other ways lice make their way around are when people share hats, backpacks or other clothes, or use someone else’s brush or comb.

When to check for lice?

It's every parent's responsibility to check their child's hair for lice. This reduces the chance of lice spreading throughout the classroom or school. Check when:

• a note comes home from school regarding lice and continue to check daily for the next two weeks
• after any transitions where your child is around new kids, such as the back-to-school week, coming home from camp or changing activities
• your child complains of any head itchiness, or you notice head scratching
• you notice any bumps behind the ears or neck

Try checking your child's hair once a week. It's inconvenient but it’s far easier to deal with lice early on than after the bugs have been there for a month.

How do you look for lice?

It's not enough to do a quick visual by parting your child's hair. Lice move very quickly and evade your best efforts.

• Purchase a fine-tooth comb from a children's hair salon like Kid Snips, or order one from amazon.com. The combs that come with other over the counter anti-lice solutions are not fine enough to look for lice or nits.
• Get a white towel and sit your child by a sink filled with warm water. If you child has longer hair, part it in sections.
• Spray either water or nit spray (more details later) on a small section of hair, and starting from the roots, pull the comb completely through the strand.
• Rinse the comb out and wipe it off on your towel. Repeat this until you have combed through all the hairs on your child's head. Salons such as Shiny Strands recommend combing hair from four different angles in order to completely cover each hair. While this work is tedious, it is crucial in completely checking hair and removing nits and live lice.

What if I find lice?

If you find evidence of lice, either alive or as nits, treat all members of the household. Lice are tenacious and cannot be killed with a hot shower or strong shampoos.

There are many different types of medications for lice, such as Rid or Nix. There are prescription medications such as benzyl alcohol (Uflesia), permethrin and Pyrethrin. Please remember that all these medicines can kill live lice, but DO NOT kill nits. If you do not remove the nits, the cycle will start all over again. I remember a patient of mine complaining that the lice kept coming back. That was partially true, as they never went away.

Other options are Nit Removal Mousse sprays and Neon Nits (which help highlight nits visually). These are not medications, do not need a prescription and are equally effective in eradicating live lice but not the nits. The benefit of these solutions is that they need to be on the hair only about 10-15 minutes before killing lice and loosening the glue from the nits.

I've seen home remedies such as saturating the hair with olive oil, wrapping the head in saran wrap and a towel, and leaving it in overnight. These methods suffocate live lice, but it may take several shampoos to remove the oil and then you will still have to comb through your child's hair.

How to nit pick?

Here is what I learned from the best at Shiny Strands, which specializes in lice and nit removal.

• Section off hair, if possible, so that you can methodically comb through your child's hair.
• Take a small section of hair. Using a fine-tooth comb start from the scalp and pull the comb all the way through the ends of the hair.
• Comb each strand from four different sides- imagine each strand of hair as a cube and comb each side.
• In between each combing to the end of a hair, rinse off the comb in water and then dry the comb briefly on the white towel. This will allow you to see nits (which look like little white pearls or brown dots) and live lice from the immature lymph stage to the adult louse. Also, cleaning off the brush each time will reduce the possibility of a louse returning to your child's hair.
• You must recheck and retreat your child in one week check again in two weeks. For those children who have many lice and/or nits, you should check his/her hair daily as it is easy to miss lice and nits. This is best way to ensure you eradicate every single nit. It takes just two to tango and produce more lice.

What else should I do if I find lice?

Wash linens and towels on a hot setting of the washing machine. Anything you cannot wash place in a large trash bag, seal it tightly, and let it sit at least 72 hours. Don't forget car seats, booster seats, back packs, hats and jackets. If you have one family member with lice, you are better off washing and bagging everyone's items.

Still need help?   

There are special salons that specialize in lice removal. This can be expensive, but the support might well be worth the cost. It can be overwhelming and just knowing a professional is taking care of it can make the battle easier to handle.

Personally, I found Shiny Strands in Glen Ellyn to be an excellent salon to get treatment. Or if you simply need hair products for lice prevention such as sprays, shampoos, conditioners or that special fine-tooth comb. The staff are extremely friendly and can answer all your questions.

How to prevent future lice?

Lice do not like scents such as mango, rosemary or tea tree oil. Shampoos containing these scents will help deter them. Some parents make their own shampoos or sprays. You also can buy nit and lice repellant sprays that you should be used daily. Spray it at the nape of the neck and behind the ears.  Also, spray backpacks and jackets. For girls, tie hair back in a pony tail or a braid to minimize lice exposure.

Be vigilant! Early discovery will save you a lot of time and energy. And in this instance other parents will be grateful your child didn’t share.

Hannah Chow-Johnson, MD, is an Elmhurst mom and pediatrician at Loyola University Health System.