Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Common sense guidelines for children with lice

Roy Benaroch, MD
Conditions
May 25, 2015
Share
Tweet
Share

A new clinical report from the American Academy of Pediatrics is a rare beacon of coherent thought about lice and children.

Rather than humiliating children and driving them away like lepers, the AAP recommends common-sense steps to identify and treat lice. Some facts really shouldn’t be in dispute:

  • Lice is not a serious illness or a significant hazard to health. They don’t make anyone sick, and they do not spread any disease.
  • Lice is not a sign of poor hygiene or parental failure.
  • Lice cannot jump or fly from person to person — they’re only transmitted by close and prolonged personal contact.
  • Transmission via objects — combs, hats, and pillowcases — is uncommon.
  • Most lice transmission occurs in neighborhoods and households, notin schools.

Nonetheless, a case of lice in a school seems to cause hysteria and panic. Children are marched through the “nurse’s office”, examined by a (sometimes) poorly trained parent, and sent home — usually because of a few flecks of dandruff or debris. Most kids sent home because of lice don’t even have them. Parents miss work, kids are humiliated, and households are turned upside down with washing and spraying and vacuuming and combing and worrying. There are whole industries, now, of people who can comb your child’s hair or use special treatments guaranteed to rid them of the pesky varmints.  To treat what is, at most, an itchy scalp.

Here’s what parents should keep in mind when they suspect their child has lice:

  • Lice are not difficult to diagnose. They run around the scalp. Look. If they’re there, you’ll see them. You can also “catch” them on a comb.
  • Lice are not little fluffy bits of fuzz or little flakes of nothing.
  • Lice eggs (nits) look like sesame seeds, and they’re literally glued to individual hairs, down near the scalp. The live ones, ones that will hatch, are within ½ inch of the scalp. Any nits further out are dead or already hatched.
  • OTC lice treatments (like “Nix”) work very well when used as directed. Repeat the treatment in 9 days to kill newly hatched eggs before the little ones have a chance to mature and lay more eggs.
  • Most treatment failures are from improper use, failure to repeat treatment, or from re-infestation. True resistance to OTC products does occur, but it is not common. The people yelling about resistance are usually the same people who are trying to sell you something.
  • Combing can help treatment work (by dislodging viable eggs and removing live lice.)
  • Nit removal is not necessary for effective treatment, but some misguided schools insist that a child be nit-free before returning. That’s stupid, and it’s not recommended by legitimate health authorities. But, hey, I don’t make the rules.
  • It’s prudent to change and wash pillowcases — though even that is probably not necessary, as only 4 percent of pillowcases harbor live lice, even when someone with lice sleeps in the bed. Live lice cannot live off of a warm body for very long.
  • Consider washing items that have recently (within 2 days) come in contact with a child’s head, like hat or hair accessories, but exhaustive and widespread cleaning and vacuuming efforts are not needed. Widespread use of chemical sprays in the house is dangerous and unnecessary.

Most importantly, as the AAP says, it doesn’t make any sense to exclude children with lice or nits from school. That doesn’t decrease transmission, and it doesn’t prevent any important illness. Children with lice should be (correctly) identified and (correctly) treated, but they don’t need to be embarrassed, excluded, or humiliated.

Lice can make you or your child itch, and that’s not pleasant. But, really, they’re just another thing that you shouldn’t worry about. Safe treatment isn’t very difficult, and it usually works. It’s only our own sense of ick that’s turned lice and lice-removal into a big deal.

Now, excuse me while I scratch my head … writing this has made me itchy.

Roy Benaroch is a pediatrician who blogs at the Pediatric Insider. He is also the author of A Guide to Getting the Best Health Care for Your Child and the creator of The Great Courses’ Medical School for Everyone: Grand Rounds Cases.

Prev

Bruce Jenner is evolving the birds and the bees talk

May 25, 2015 Kevin 4
…
Next

This is why it's so hard to rein in mammogram screenings

May 25, 2015 Kevin 16
…

Tagged as: Pediatrics

Post navigation

< Previous Post
Bruce Jenner is evolving the birds and the bees talk
Next Post >
This is why it's so hard to rein in mammogram screenings

ADVERTISEMENT

More by Roy Benaroch, MD

  • Goodbye, Benadryl: It is time for you to retire

    Roy Benaroch, MD
  • Telemedicine overprescribes antibiotics: Are you really receiving the best care over the phone?

    Roy Benaroch, MD
  • No, phones don’t cause horns to grow on skulls

    Roy Benaroch, MD

More in Conditions

  • Public violence as a health system failure and mental health signal

    Gerald Kuo
  • Understanding factitious disorder imposed on another and child safety

    Timothy Lesaca, MD
  • Joy in medicine: a new culture

    Kelly D. Holder, PhD & Kim Downey, PT & Sarah Hollander, MD
  • AI in prior authorization: the new gatekeeper

    Tiffiny Black, DM, MPA, MBA
  • How to keep the soul of medicine alive in a scaling system

    Gerald Kuo
  • How to handle medical gaslighting

    Alan P. Feren, MD
  • Most Popular

  • Past Week

    • The loss of community pharmacy expertise

      Muhammad Abdullah Khan | Conditions
    • Is primary care becoming a triage station?

      J. Leonard Lichtenfeld, MD | Physician
    • Psychiatrists are physicians: a key distinction

      Farid Sabet-Sharghi, MD | Physician
    • How should kratom be regulated? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Understanding the unseen role of back-to-school diagnostics [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why senior-friendly health materials are essential for access

      Gerald Kuo | Conditions
  • Past 6 Months

    • Direct primary care in low-income markets

      Dana Y. Lujan, MBA | Policy
    • Patient modesty in health care matters

      Misty Roberts | Conditions
    • The U.S. gastroenterologist shortage explained

      Brian Hudes, MD | Physician
    • The Silicon Valley primary care doctor shortage

      George F. Smith, MD | Physician
    • California’s opioid policy hypocrisy

      Kayvan Haddadan, MD | Conditions
    • A lesson in empathy from a young patient

      Dr. Arshad Ashraf | Physician
  • Recent Posts

    • Understanding the unseen role of back-to-school diagnostics [PODCAST]

      The Podcast by KevinMD | Podcast
    • Public violence as a health system failure and mental health signal

      Gerald Kuo | Conditions
    • Physician asset protection: a guide to entity strategy

      Clint Coons, Esq | Finance
    • Understanding factitious disorder imposed on another and child safety

      Timothy Lesaca, MD | Conditions
    • Physician grief and patient loss: Navigating the emotional toll of medicine

      Francisco M. Torres, MD | Physician
    • Joy in medicine: a new culture

      Kelly D. Holder, PhD & Kim Downey, PT & Sarah Hollander, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The loss of community pharmacy expertise

      Muhammad Abdullah Khan | Conditions
    • Is primary care becoming a triage station?

      J. Leonard Lichtenfeld, MD | Physician
    • Psychiatrists are physicians: a key distinction

      Farid Sabet-Sharghi, MD | Physician
    • How should kratom be regulated? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Understanding the unseen role of back-to-school diagnostics [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why senior-friendly health materials are essential for access

      Gerald Kuo | Conditions
  • Past 6 Months

    • Direct primary care in low-income markets

      Dana Y. Lujan, MBA | Policy
    • Patient modesty in health care matters

      Misty Roberts | Conditions
    • The U.S. gastroenterologist shortage explained

      Brian Hudes, MD | Physician
    • The Silicon Valley primary care doctor shortage

      George F. Smith, MD | Physician
    • California’s opioid policy hypocrisy

      Kayvan Haddadan, MD | Conditions
    • A lesson in empathy from a young patient

      Dr. Arshad Ashraf | Physician
  • Recent Posts

    • Understanding the unseen role of back-to-school diagnostics [PODCAST]

      The Podcast by KevinMD | Podcast
    • Public violence as a health system failure and mental health signal

      Gerald Kuo | Conditions
    • Physician asset protection: a guide to entity strategy

      Clint Coons, Esq | Finance
    • Understanding factitious disorder imposed on another and child safety

      Timothy Lesaca, MD | Conditions
    • Physician grief and patient loss: Navigating the emotional toll of medicine

      Francisco M. Torres, MD | Physician
    • Joy in medicine: a new culture

      Kelly D. Holder, PhD & Kim Downey, PT & Sarah Hollander, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Common sense guidelines for children with lice
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...