An Itchy Scratchy Headache

Lice prevention and control methods to block the spread in children

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

Families across the country are starting to gear up for fall and a new school year. As kids reunite and gather back at school, they may be more likely to come into contact with head lice.

There are ways to prevent lice, as well as to control their further spread if someone in the family does come into contact with these itch-causing bugs.

By understanding how lice are spread, taking measures to prevent the spread and treating infestations properly, head lice can be managed. By learning more, families can help make sure children only return home from school with new textbooks and not some new tag-alongs.

Understanding the Enemy

What exactly are these tiny creatures that can cause such a huge itch?

According to the Centers for Disease Control and Prevention (CDC), head lice, or Pediculus humanus capitis, are parasitic insects that feed on human blood and live close to the scalp. Thankfully, they are not known to spread disease, making them more of a nuisance than a health threat.

It is difficult to know exactly how many people get lice annually. The CDC estimates that between 6 and 12 million infestations occur each year in the US among children between the ages of 3 and 11 — making it a fairly common problem.

The main sign of head lice is intense itching on the scalp, followed by finding adult lice (the eggs, or nits, are harder to spot). The insects tend to gather behind the ears and along the neckline. Some people may also experience the sensation of something moving in their hair. Some people have no symptoms.

"In the United States, infestation with head lice is most common among pre-school children attending child care, elementary schoolchildren, and the household members of infested children," the CDC reports.

Head lice are wingless and do not hop. So they spread through direct contact with the hair of someone infested with lice.

"Head-to-head contact is common during play at school, at home, and elsewhere (sports activities, playground, slumber parties, camp)," explains the CDC.

"Spread by contact with clothing (such as hats, scarves, coats) or other personal items (such as combs, brushes, or towels) used by an infested person is uncommon," reports the CDC. However, this type of transmission can occur, though it is less common.

It is important to remember that the presence of these insects has nothing to do with cleanliness or personal care. "Getting head lice isn't a sign of bad personal hygiene or an unclean living environment," the Mayo Clinic stresses.

Preventing the Itch

According to the CDC, there are steps you can take to prevent to spread of lice, including avoiding head-to-head contact and the sharing of items like hats, barrettes, combs and towels.

If an infestation has occurred, families can take steps to prevent further spread of the insects. One simple step: soak any combs and brushes used by a person with head lice in water heated to 130 degrees for five to ten minutes.

Any bed linens, clothing or similar materials that were used by the infested person in the prior two days should be washed in a machine on the hot water setting and dried using high heat.

"Vacuum the floor and furniture, particularly where the infested person sat or lay," the CDC suggests. "However, spending much time and money on housecleaning activities is not necessary to avoid reinfestation by lice or nits that may have fallen off the head or crawled onto furniture or clothing."

The Mayo Clinic notes how difficult it can be to block the spread of lice among children.

"There's so much close contact among children and their belongings that lice can spread easily," the Mayo Clinic reports. "The best approach to head lice prevention is simply to take thorough steps to get rid of the lice — and their eggs — so that you don't have more lice to deal with."

Treating the Infestation

According to the Mayo Clinic, over-the-counter (OTC) shampoos are often the first line of treatment against lice. These contain either pyrethrin (like Rid) or permethrin (like Nix) and the instructions should be followed carefully. 

Steve Leuck, PharmD, founder of AudibleRx, told dailyRx News that these shampoos are quiet effective when used correctly.

"It is very important to use enough of the product to saturate the hair and the scalp, while paying attention to not leave on for more than 10 minutes. After the scalp and hair has been thoroughly rinsed, towel dry and remove any nits with the comb that is provided," said Dr. Leuck. "It is important to check for lice or nits every couple of days and after seven days if lice are observed, repeat the application and comb process."

Dr. Leuck also noted the availability of pharmacists to help people as they search for an OTC lice treatment product.

"If a patient has any doubt as to which OTC product would be best for them, please walk up to the pharmacy counter and ask the pharmacist for a recommendation," said Dr. Leuck. "Community pharmacists are a valuable resource and readily available for consultations in situations like these."

In some cases, these products may not be able to solve the problem.

"If, after a thorough treatment with OTC product and a follow up treatment seven days later, combined with a diligent effort at eradicating the lice from the household, an infestation still persists, please contact your physician," said Dr. Leuck.

According to the Mayo Clinic, in some regions, lice have become resistant to OTC treatments, requiring the use of stronger products. In these cases, a doctor may suggest prescription-strength medication.

Some common prescription lice medications, in the form of shampoos, lotions and creams are malathion (Ovide), lindane (Kwell), and benzyl alcohol lotion (Ulesfia). Again, it is very important that all directions for these medications be followed carefully. These products are insecticides and can cause harm if used incorrectly.

Dr. Leuck stressed that these products have varying levels of toxicity and require evaluation from a physician before use. "If any of these prescription products are prescribed, be certain to discuss their use with your pharmacist prior to administration," said Dr. Leuck.

In some cases, people may decide to try to avoid use of insecticides altogether.

"If you don't want to employ insecticides, a fine-toothed or nit comb can physically remove the lice from wet hair," says the Mayo Clinic. "This method is recommended as the first line treatment for children under age 2."

If using this method, it is important to repeat the process every couple of days for no less than two weeks.

By treating all lice infestations thoroughly and carefully, their spread can be controlled and further infestations prevented.

It can also be helpful to educate children about how lice are spread, especially in the face of an outbreak in the community or in their school.

Though these bugs might be annoying and uncomfortable, it is important to remember they are not known to spread disease and are not related to cleanliness. With persistence and attention to detail, families can rid lice from the home when they do appear and help prevent their further spread.

Review Date: 
August 7, 2013