A Real Head Scratcher
Schools are struggling with how best to handle lice
"A lot of kids are missing a lot of school," says Barbara Frankowski, chair of the AAP Council on School Health and coauthor of the AAP guidelines; some, the guidelines note, are forced to repeat a grade. Even those who have adopted the AAP position say that what's best for the school population might not be best for an individual child. To keep a child lice free, parents should remove all nits within one-fourth inch of the scalp, cautions Stan Husted, the California Department of Health Services official who wrote guidelines this year advising districts in the state to drop their no-nit policies in favor of "no lice" rules. Nits farther away from the scalp are dead or already hatched.
Partly, what prompts administrators to be more lenient is the realization that outlawing every nit often leads to overdiagnosis and overtreatment. One influential study by researchers at the Harvard School of Public Health analyzed 614 suspected lice samples provided by head-checkers in schools and elsewhere and found that only 364 contained a louse or nit. The rest were other bugs, dandruff, scabs, or dirt. "We found that lice aren't as prevalent as we once thought. Maybe 1 in 100 kids has it at any given time," says lead study author Richard Pollack.
The surest way to stay out of that select group is to avoid any head-to-head contact. (Not sharing hats, combs, and jackets is also a smart idea, although lice that are shed onto a surface other than a human head won't live for more than a day or two.) Treatment, should the worst happen, can be downright aggravating. Over-the-counter products like the cream rinse Nix and the shampoo Rid were highly effective against lice and nits 20 years ago. Numerous experiments have shown that their active ingredients have lost power as lice have adapted, according to a 2004 literature review published in the Mayo Clinic Proceedings. Still, the AAP recommends using a cream rinse containing 1 percent permethrin (Nix and generic versions) as the first line of treatment. For the moment, lice seem to be more resistant to the pyrethrin products (Rid and generic versions), says Frankowski.
Aftermath. After drenching hair with either product, purists spend hours scouring the child's hair for every remaining nit, checking and rechecking for days. Instead, says the AAP, you can repeat the treatment in a week. If the product is effective, it should kill any new baby lice before they lay eggs. Most experts agree that a top-to-bottom house cleaning is unnecessary. But it's smart to wash the child's bedding, towels, and clothes worn in the previous 24 hours and to vacuum areas his or her head has touched.
If any bugs survive the initial treatment, a more powerful nuking may be called for. Ovide, a prescription lotion containing malathion, is the strongest weapon in the arsenal, shown to kill 100 percent of lice and 98 percent of nits. But it has disadvantages: Its odor can cause headaches and nausea, and it is flammable. Ovide stays on the head for eight to 12 hours, and the child needs to steer clear of space heaters, grills, cigarettes, and anything else that could ignite a flame.