When the title character in Judy Blume's novel Starring Sally J. Freedman as Herself gets head lice, the school nurse says this to her mom: "Look, Mrs. Freedman, don't take this personally."
This advice still applies -- and it's not just a fictional nurse offering it.
Head lice don't reflect poor hygiene, are far more benign than the common cold and, in most cases, can be easily eradicated. Kids shouldn't be kept home from school, and "no nit" policies should end, the American Academy of Pediatrics emphasized in a recent report.
"It's just the ick factor that there are bugs on your kid's head," said Dr. Barbara Frankowski, professor of pediatrics at the University of Vermont and lead author of the AAP report. Head lice, she said, can be passed from head to head "anytime kids get close to each other."
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Regular hair washing and brushing disrupt lice. To detect lice early, check your kids about once a week: Use a light and a magnifying glass to check at the nape of the neck and behind the ears. Go online to familiarize yourself with pictures of live lice and nits, their eggs. (A good site: cdc.gov/lice.) Live lice are the size of a sesame seed and can be white, tan or brown. Nits are even tinier and firmly cement themselves to the hair shaft.
Don't treat your child until you are sure he has lice. Eggs more than a thumb's width from the scalp are already hatched or dead and don't indicate an active case, Frankowski said. For confirmation, see a school nurse or your doctor.
Here's the nitty-gritty on treatments:
If your child has lice, the AAP recommends first using an over-the-counter lice shampoo with permethrin or pyrethrins. Pyrethrins, in products such as Rid and A-200, are derived from chrysanthemums and should not be used on children with allergies to the flowers. Permethrin, found in Nix, is a synthetic pyrethrin with "a long track record of safety," Frankowski said. Both require two treatments about nine days apart.
For cases that don't respond to these treatments, see a doctor, who may recommend a prescription hair lotion. Ulesfia, a nonpesticidal treatment containing benzyl alcohol, was approved last year by the FDA. It's odorless and very safe but may not be covered by some insurance plans, Frankowski said.
Malathion, marketed as Ovide, is effective but flammable. This makes it riskier than other treatments, Frankowski said, and dangerous in households with a smoker. Never use it with a blow-dryer.
For persistent cases, doctors may prescribe oral ivermectin, which is approved by the FDA to treat some parasitic worms but not lice. An ivermectin hair lotion for lice is in clinical trials.
A method using the cleanser Cetaphil eradicated 96 percent of lice cases in a 2004 Pediatrics study. (The study recommended covering a child's head with the lotion, combing it through to remove excess, then drying it on with a blow dryer. Leave it on eight hours, then rinse. Do this three times, on a weekly basis.)
Combing lice and nits out of wet hair, with or without conditioner, is effective, but can take hours and needs to be repeated several times.
Home remedies like covering a child's head with Vaseline, mayonnaise or olive oil are not always effective, because lice can play dead and then re-emerge, said Dr. Craig Burkhart, a dermatologist and head-lice researcher in Sylvania, Ohio. Never use kerosene or products made to remove lice in pets, which are toxic to children.
Most doctors don't recommend using essential oils, like tea tree, because they haven't been required to be tested by the FDA for safety or efficacy. A coconut oil-based product, Schooltime Shampoo, was found safe and effective in clearing out lice and preventing recurring cases in recent clinical trials funded by BioSafe Technologies, the shampoo's manufacturer. (It's sold online at biosafetech.com.)