As seen on Better.tv: Head Lice

Head lice - yuck! Amazing how 2 little words can make you so...itchy! (Ever wonder where the term "lousy" came from? Now you know!)
There are many misconceptions about head lice that are simply not true. Head lice know no bounds (neither cultural nor socioeconomic) and are not a reflection of poor hygiene. Common to very popular belief, they do not jump from one head to another (don't look for any lice going for the pole vaulting gold in Beijing this Summer), and though they are incredibly disruptive and annoying, they are not dangerous. Here are a few tips on how to prevent, spot and treat head lice, and even some recommendations for a support team!

Remember...this advice does not constitute care...and the final call is with your pediatrician.

PREVENTION: lice can infest through DIRECT contact – so sharing hats, hair ornaments, caps, scarves and other adornments with others should be prevented. Lice can live on inanimate objects for a few hours, so even surfaces like movie theater seats/airline seats/car seats can be vehicles for spread – wearing a CAP to the movies (hair tucked under) might be a good strategy.

HOW TO RECOGNIZE: active lice are obvious – they are tiny, crawl, and hang out at the hairline under the nape of the neck, behind the ears, and hide in the depths of hair. Their eggs (called NITS) adhere pretty firmly to the hair shaft about 1/4" to 1/2" from the scalp. Nits are often mistaken for dandruff and vice versa. If you have a child with an ITCHY scalp AND see nits or live lice, your kid’s condition is obvious. Lice can also infest eyebrows and beards – anywhere there is a hairy hiding place.

TREATMENT: OTC: Many of the over the counter treatments are ineffective – partially due to some resistance that has developed with the lice themselves, but also because the MOST IMPORTANT STEP OF TREATMENT, which is to PICK OFF ALL THE NITS is hard to do. Lice combs may help, but the most tedious, yet effective way to cure an outbreak is to go through EVERY strand of hair and physically pick out the nits with your fingers. With boys, piece of cake – haircut, buzz ‘em, most don’t mind. With a child with luxurious locks, pin up 1 inch sections of all the hair, round up some magnifying dimestore glasses, a bright light, and a big bucket of patience and go through section by section.

Prescription treatments: there are 2 that we use pretty routinely – Elimite (permethrin – oil of chrysanthemum) and Ovide.

With Elimite, we saturate the dry hair/scalp and leave on for 8-12 hours, shampoo out, NIT PICK – and repeat in a week. Ovide (malathion, an insecticide) always works, but we restrict it’s use to older children.

ALTERNATIVE REMEDIES: From our good friends at DrGreene.com...

Most alternative treatments are untested, but early reports are promising. One method with widespread stories of success is the Vaseline (or mayonnaise) treatment. Cover the infested head liberally in Vaseline. Place a shower cap over the entire head for the night (or an eight-hour period). Then shampoo the Vaseline out of the hair. This treatment is reported to "smother" the lice. The downside of this method is that the Vaseline does not shampoo out of the hair easily -- in fact, it usually takes a week or so to get it all out. The upside is that it is not toxic, and from all reports, it seems to work. Washing the hair with dishwashing liquid, which has a degreasing agent in it, may help. I've smothered my own hair in mayonnaise (loved the smell), and it came out easily with Dove Ultra dishwashing liquid.
The Packard Children's Health Services Pediatric Hotline at Stanford is hailing another popular treatment. It uses regular shampoo and three ingredients that can be found at most health-food stores:
Shampoo (use an inexpensive brand such as Prell -- these seem to mix more easily with the oils).
3 tbsp olive oil.
1 tsp tea tree oil.
1 tsp rosemary or eucalyptus oil.
Add the oils to a small amount of shampoo and mix well. Work into hair and leave on for half an hour with a tight-fitting shower cap. This mixture has a strong smell. The fumes may burn the eyes, so don't lean forward. Wash hair two or three times to get the oil out. Repeat the procedure if necessary.
I'm hearing positive reports about this nontoxic treatment, though to my knowledge, no medical studies have been conducted to establish the efficacy or possible side effects of this treatment.
One of our readers suggested using a hot blow-dryer for 15 minutes, morning and evening, in conjunction with thorough nit combing. The heat helps to kill the nits and adult lice, but the combing is essential to the process. This type of treatment should not be combined with the over-the-counter treatment.

ENVIRONMENT: so anything that has touched infested scalps needs to be dealt with – sheets, hats need to be washed in hot water/dried on hot. If seat cushions/pillows/toys have been in contact with the lice, they can just be bagged up in large trash bags for 2 days (lice can’t live that long without a human host) and then tossed in the dryer for a few minutes to remove the nits (or vacuumed). All hair brushes/combs need to be soaked in boiling water.

WHO CAN HELP: There are several services out there that will NIT PICK for you – some come to your home, some are housed in salons. Check for a service in your area, but a few we like are:

Hair Fairies : http://hairfairies.com/

Lousy Nit Pickers : http://www.louseynitpickers.com/

The Hair Whisperers : http://www.liceremovalla.com/

Some will accept a prescription from your doctor, and some insurers will actually pay for delousing!

Good luck!

The Doctors are IN!

Well, here we are, finally joining the blogosphere! If we haven't met, allow us to introduce ourselves...
We're the MD Moms - Dr. Diane Truong and Dr. JJ Levenstein. We are nationally recognized, board-certified pediatricians and moms. We were inspired by the needs of our patients and our own children to create Baby Silk, the first skincare line for babies developed by pediatrician-moms.
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