It’s hard to imagine that an entire month would be dedicated to head lice but knowing more about this condition can help to prevent it. As your children return to school this year, you can be sure that some students, and maybe even your own child, will be sent home with this dreaded condition! The Miami County Health District and the National Pediculosis Association, Inc., hopes to answer some of your questions by providing the following information.

Known to scientists as Pediculus humanus capitis, head lice are tiny (2-4mm) wingless insects that spend their entire lives on human heads. Adult head lice look like six-legged grains of rice, and vary in color from grayish-white to reddish-brown.

Female lice lay eggs, or nits, by gluing them tightly to hair close to the scalp. A single female produces between 80 and 100 eggs in her lifetime. Over 90% of these nits will hatch within 7-11 days, and mature in another 8-9. The new adults will live for about 22 more days, laying the next generation of nits.

Lice can not fly, hop, or jump, but they can crawl with surprising speed. They may temporarily move onto hats, clothes or other surfaces, but must return to a human head within 50-60 hours to survive.

With the exception of the common cold, head lice affect more school-age children than all other communicable childhood diseases combined. In the U.S., as many as 6 million children are treated for lice each year. Head lice are most frequently found on children between the ages of 3 and 10, and are slightly more likely to affect girls than boys. African-Americans and others with naturally kinky hair are usually spared lice infestations - kinky hair is oval in cross section, and female lice select round hairs for nit-laying. Despite these generalizations, it is important to understand anyone can get lice, including the older siblings, parents and teachers of children who have been infected.

It is a myth that head lice like dirty heads - in fact, there is evidence that lice actually prefer clean hair. And contrary to popular belief, you don't get lice from poor people any more than you get them from rich people. An infestation does not indicate poor hygiene, and is nothing to be ashamed of. Unfortunately, routine bathing and shampooing will neither prevent nor eliminate head lice problems.

Head lice are transmitted by direct contact with an infested person, or by the sharing of brushes, combs, hats, scarves, coats, bedding, towels or upholstered furniture. Since they're specific to human heads, you can't get them from pets or wildlife.

Symptoms of a lice infestation include excessive head scratching; scalp inflammation from bites; red or black gritty fecal specks on the collar, shoulders, back or pillows; adult lice in the hair, eyebrows or eyelashes; and nits attached to the hair.

Before seeking any treatment, however, it is critical to verify that lice are actually present. Spotting attached nits, rather than crawling lice most easily makes a diagnosis.

To perform a proper inspection:

• Work with a second adult for best screening results.
• Use bright natural daylight, or a lamp with an adjustable neck.
• Find a good book or video to keep your child occupied.
• Separate strands of hair at the scalp for close inspection.
• Inspect the entire length of hair thoroughly for lice and nits. Adult lice are most often found around the ears, on the nape of the neck, and the top of the head. They move very quickly away from light, so one person should maneuver the light while the other looks for lice on the run.
• Examine suspected nits under a magnifying glass if you have one. Nits stick tightly to hair and can not be dislodged with your fingers (unlike easily-removed hair casts, dandruff, hair spray residue or other particles). Live nits are oval to tear-drop shaped, and yellowish to grayish white, darkening to a tan or coffee color with maturity. Live nits can be found anywhere on the hair. Contrary to popular opinion, nits located more than ¼" from the scalp are not necessarily dead.
• Double-check your diagnosis if the infestation is chronic. Chemical treatments may produce irritation or desquamated epithelial cell plugs (bright white, irregularly-shaped clumps of dandruff stuck to the hair shaft) which may appear to be symptoms of an infestation, and leading to endless rounds of unnecessary treatment.
• Report any findings of lice or nits to your school nurse, childcare center, summer camp, or parents of your child's playmates. It may seem embarrassing, but early notification can help prevent hundreds of other uncomfortable cases.

Lice attach themselves to the scalp and use needle-like feeding tubes to suck blood. Their bites are painless, but their saliva and feces usually cause an itching allergic reaction. Scratching often leads to broken and inflamed skin, which sometimes enables germs to enter and cause infections like impetigo. Unlike body lice, however, head lice do not appear to be vectors of human disease, and are not life-threatening. This is especially important to keep in mind when evaluating treatments, since many lice-killing pesticides can be dangerous to your child.

Over-the-counter and prescription lotions, shampoos and cream rinses are available that are reasonably effective; however, evidence of increasing resistance to these medications is growing making it increasingly difficult to clear up infections. Bed clothing, combs, brushes, hats and other personal hygiene items must be disinfected (typically washed in hot soapy water) to prevent re-infestation. This should be done at the time the child is treated.
The effective elimination of head lice requires radical eradication. If you kill 99.99% of the lice, for example, but leave 0.01% alive and kicking, you have the makings of yet another unfortunate infestation. In order to achieve control, you must kill the active adults and remove all of the nits. This is crucial no matter what treatment is used.

The National Pediculosis Association recommends a treatment regimen that avoids the use of pesticide-containing shampoos and lotions. According to their regimen to treat head lice safely, you will need:

• coconut-oil or olive-oil-based shampoo (or bar soap or pure oils)
• 2 bath towels
• books or videos
• large-toothed comb
• special metal lice comb
• hair clips
• tweezers or safety scissors
• double-sided scotch tape
• tissue
• bowl of hot water and detergent
• bowl of ammonia water
• nail brush or old toothbrush.

Follow these ten nit-picking steps for head lice success:

Step 1. Wet hair thoroughly with water that is as hot as is safe and tolerable (lice are repelled by heat). Since young children's scalps may be very sensitive to heat, start with lukewarm water and increase the temperature gradually.

Step 2. Apply a coconut oil or olive-oil-based shampoo (not one with a conditioner). If you can't find a shampoo, use bar soap with a coconut or olive oil base, or pure coconut or olive oil. Both of these oils are safe, but demonstrate effective, natural insecticide properties. Rather than poisoning the insects, olive oil kills active lice by smothering them - an action they can't develop resistance to. Parents also report that olive oil makes nit removal easier, and re-moisturizes the scalp. Scrub hair and rinse thoroughly.

Step 3. Repeat the shampoo application and scrubbing, but do not rinse the shampoo (or soap or oil) out this time.

Step 4. Wrap a towel around your child's lathered head for 15-20 minutes, and another around shoulders. Find a comfortable spot by a window, outside in full sunlight, or next to a bright, flexible lamp. Seat your child with his or her head just below your eye level, and make sure a good supply of engrossing books or videos is available.

Step 5. Remove the towel (do not rinse shampoo), and use a regular large-toothed comb to remove snarls and excess suds.

Step 6. Separate a 1-inch hank of hair in one hand. With the other, position a special lice comb at a 45-degree angle, with the curved side of the teeth toward the head. Lice combs have specially tooled metal teeth to remove nits. Plastic combs - even the fine-toothed ones sold with lice shampoos - are not adequate.

Step 7. Insert the comb as close to the scalp as possible, and pull it through hair slowly, removing all the nits you can see. Continue with one 1-inch section at a time, checking each section thoroughly for nits or lice. Clip finished sections out of the way. If hair dries during the combing process, rewet it.

Step 8. Use fingernails or tweezers to remove any nits missed by the comb, or use safety scissors to snip out individual nit-bearing hairs. Double-sided scotch tape or tweezers can be used to catch adult lice.

Step 9. Clean the comb periodically with a tissue, placing soiled tissues in a bowl of hot water and detergent. When the bowl is full, flush the contents down the toilet and replace the hot water and detergent.

Step 10. Rinse fully combed hair thoroughly with water as hot as is safe and tolerable. When hair dries, check your child's entire head for stray nits and lice, and remove them individually.

To clean up, soak the comb in hot, soapy ammonia water (1 teaspoon of ammonia in two cups of hot water) for 15 minutes, or boil for 15 minutes. Scrub the teeth of the comb with a nail brush or old toothbrush to remove debris before storing.
Combing should be repeated weekly during the time lice are a problem at school. Normal shampooing with a coconut or olive-oil-based product should be done 2-4 times a week. If re-infestation occurs, combing will have to be repeated more frequently.
During the entire process, make sure your child knows that he or she isn't "dirty," and didn't do anything wrong. As a final note, long hair has not been shown to be more attractive to lice. While cutting it may make combing easier, it is also likely to make an uncomfortable situation more traumatic and won't prevent re-infestation.

Buildings don't get lice - only people do. The National Pediculosis Association and the Centers for Disease Control and Prevention strongly recommend against using insecticide sprays during lice outbreaks. Rather than working as a quick fix, sprays are ineffective and can expose children and pets to potent chemicals. "There is no scientific justification to spray for head lice at home or in the school," says Steve Blum, Director of the National Pest Control Association, "head lice do not qualify for pesticide extermination measures."

If your child requires treatment for head lice, contact the Miami County Health District for more information. Although it is best to avoid the use of pesticides when treating head lice infestations, your physician or clinic may recommend them. If so, you should adhere to the following guidelines:

Always choose the least-toxic product available. Make sure the product you use is approved for use by the FDA.

Never use treatments to prevent lice infestations - they are neither intended for nor effective in this capacity.

Never expose children under 3, pregnant or nursing women, or people with cuts, scratches, inflamed skin, allergies, asthma, epilepsy, immune dysfunction or other pre-existing conditions to chemical lice treatments.

Never deviate from label instructions - read them carefully and follow them precisely. Departing from the instructions can significantly increase risks.

Never re-treat more frequently than the label allows, or use higher doses. Misuse of these products can be lethal.

Never use pesticides for lice in eyelashes or eyebrows. Always keep eyes covered when shampooing.

Never use lice shampoos in a shower or bathtub. Use a basin or sink to minimize body exposure.

Never use shower caps in the application of lice treatments. Always use rubber dishwashing gloves.

Never allow children access to lice shampoos. Store them securely.

Avoid shampoos with conditioners during the treatment period, since they tend to protect nits.

Discontinue product use at earliest sign of failure.

Seek medical attention immediately if any adverse reactions occur, and bring the product with you when the physician sees you.

Lice pesticides don't act as a preventative so sprays and shampoos aren't effective in preventing lice outbreaks. Keeping ahead of lice is possible, though, by taking the following simple steps to limit their transmission through the school environment.

• Teach your children not to share hats, combs, brushes, coats or other personal items.
• In school, each child's coat and hat should be stored in a personal cubby. If these are not available, and there is a lice problem, use heavy-duty plastic bags with identifying stickers, doubled over and tied shut. For safety reasons, bags should only be used with direct adult supervision.
• Vacuum carpets and upholstered surfaces frequently with a high-efficiency or HEPA-filtered vacuum. Clean sleeping pads and tumbling mats regularly with a bleach solution.
• Rethink dress-up areas - if they are an important part of the curriculum, wash costumes between uses, or replace them with disposable items.
• Make sure that there is enough athletic headgear available so that children do not need to share it between cleanings.

For more information about head lice prevention and treatment,

contact the Miami County Health District

by calling (937) 440-5420.