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How to treat (and prevent) lice

girl scratching her head.

BY SARAH JAYAS
Winnipeg Health Region
Wave, November / December 2016

What are head lice?

Head lice are tiny tan, grayish white, or brown bugs about the size of a sesame seed. They bite through the skin to suck blood and are hard to see.

The bites can cause skin irritation and itching. Scratching may break the skin open and cause infection, but this is not common.

Head lice are not a sign of poor hygiene and do not carry or cause disease. They live in the hair for up to 30 days, but they only live for less than two days if away from the higher temperature of the scalp.

Lice eggs, also called nits, will not hatch away from the higher temperature of the scalp, and they usually die within a week or two. Head lice attach their whitish nits to the hair close to the scalp.

Nits are about the size of a grain of sand and, unlike dandruff, can’t be shaken off. The nits are easier to see than the lice because they are white and there can be a lot of them.

How are they spread?

Head lice are very common and live only on human beings. Anyone can get head lice. They are spread easily, especially where individuals are in close contact.

They are usually spread by direct head-to-head contact with someone who has head lice, and they can also be spread indirectly by sharing things like hats, toques, clothing, combs, brushes, hair accessories, bedding, pillows, towels, and headphones.

Head lice can crawl quickly, but cannot fly, jump, or hop, and they cannot be spread to people from pets or other animals.

How do I know if my child has head lice?

Finding nits doesn’t mean that a person has active head lice. For a person to have active head lice, at least one moving head louse must be found on the head.

One of the first signs of head lice may be an itching or scratching of the scalp. However, itchiness alone doesn’t mean a person has head lice. It is possible to have no symptoms from head lice. If your child has an itchy scalp, look carefully through the hair for lice or nits.

Because lice are so small, good lighting is important. You may just see movement rather than the actual lice. They are usually found very close to the scalp, along the neckline, and behind the ears. To check for nits, you can run a fine-tooth comb through the hair. Look for lice in the comb after each combing.

 You can also part hair in small sections, checking all of the hair carefully and moving from one side of the head to the other. If you only find nits, check again every day for two weeks to make sure you did not miss any live lice.

How can I treat lice?

The best way to treat lice is to use an anti-lice shampoo or rinse. Treatment should be started if there is one live louse found.

Anti-lice shampoos/rinses are available without a prescription and kill both lice and their eggs. Some products may not be safe for use on infants, pregnant women, women who are breastfeeding, or people with certain allergies. Speak with your pharmacist for specific instructions.

Treatments for lice are very strong and should not be used more, or more often,  than recommended. If you have seen your health-care provider or pharmacist, use the product they recommend.

Follow the package directions carefully. Rubber gloves may be used to minimize contact with the product. Don’t leave the shampoo or rinse in the hair longer than directed and avoid use on open or infected skin.

Keep the product out of the eyes. A facecloth may be placed over the face to help prevent the product from getting into the eyes. If the product gets into the eyes, flush the eyes right away with lots of water.

Rinse the hair with cool water after treatment. After treatment, comb out any remaining lice with a fine-tooth nit comb. Comb the hair again with the nit comb 24 hours later. Wet hair can slow down the lice, making them easier to remove. Repeat the treatment in seven to 10 days in case new lice hatched from the nits. These treatments can sometimes make the scalp irritated, itchy, or leave a mild burning feeling. Nit combs should be used with the lice product and not used alone.

Most live lice are killed after the first treatment. The second treatment will kill any lice that hatched from eggs that survived the first treatment.

Nit removal is not absolutely necessary (as nits do not transmit lice and only live lice can cause lice in other children); however, nit removal may make it easier to see new lice and nits, and may prevent other people from thinking your child still has untreated lice.

Pull off individual nits by grasping them between your fingertips and sliding them off the end of the hair strands. Place in a bag and dispose of them. Or, you can comb the hair with a fine-tooth nit comb, one small section at a time. Position the comb as close as possible to the scalp and pull through to the end of the hair. Wipe nits from the comb frequently using tissues and discard the tissues in a sealed plastic bag.

Avoid any products claiming they loosen the nits as they may interfere with the anti-lice medicine. Continue checking for lice and removing nits every day for the next two weeks.

Because lice don’t live long off of the scalp, minimal extra cleaning is needed. Vacuum your child’s room, car seat, bed, the couch, and any pillows your child’s hair may have touched. Soak combs and brushes in hot soapy water for at least 15 minutes. Do not wear the same clothes that were worn before the treatment or sleep in the same bedding until the clothes and bedding are washed.

Try to get rid of lice and nits from items that touched the head in the last 48 hours such as hats, toques, pillowcases, scarves, clothing, combs, brushes, and hair accessories: wash these items in hot, soapy water and dry them in a hot dryer for at least twenty minutes. Items that are difficult to wash and dry (like teddy bears or winter coats) can be dry cleaned or stored in an air and water-tight plastic bag for two weeks. Items can also be placed in a bag in the freezer for at least three days.

Only treat family members who have lice, and treat all people with lice at the same time. Your child can return to daycare or school after the first treatment is complete and toques, hats, headgear, etc. have been cleaned.

What about using home remedies or natural treatments?

Do not use home remedies or “natural treatments” such as mayonnaise, margarine, melted butter, vinegar, tea tree oil, eucalyptus oil, olive oil, or petroleum jelly. These products may make it hard for lice to breathe but it probably won’t kill them. Such products are not recommended until more studies show that they actually work. Never use gasoline or kerosene, as these products can be extremely dangerous.

How long do head lice last?

After you use the anti-lice shampoo or anti-lice rinse twice, all lice and nits should be killed. However, there is no guarantee, as there is about a one per cent failure rate with anti-lice shampoos/rinses. Some forms of head lice can be resistant to usual treatments and may require prescription medication. If the lice come back, it usually means your child has had contact with another infected person or you didn’t use the anti-lice shampoo/rinse exactly as directed.

Can head lice be prevented?

Yes. Teach your child to avoid head-to-head contact with others, and to not share combs, brushes, toques, hats, clothing, pillows, headphones, hair accessories, etc. Have someone check your hair if you have been in contact with someone who has head lice.

When should I call my child’s health-care provider?

Call your health-care provider if any sores, rashes or itching are not gone within one week after treatment, if sores or rashes start to spread or look infected, if the lice or nits return, or if you have other questions or concerns.

Sarah Jayas is a registered nurse and Team Leader with Health Links – Info Santé, a telephone health information service with the Provincial Health Contact Centre at Misericordia Health Centre.

The information for this column is provided by Health Links – Info Santé. It is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a health-care professional. You can access health information from a registered nurse 24 hours a day, seven days a week by calling Health Links – Info Santé.

Call 204-788-8200 or toll-free 1-888-315-9257.

Wave: November / December 2016

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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