Close-up of young woman's hair being combed


Just thinking about it makes you itchy: Head lice—the scourge of school nurses near and far. Bristol Elementary School in the Webster Groves School District, like other schools across the country, provides parents with a three-page information packet about the symptoms, transmission, diagnosis and treatment of head lice. Information included notes that the American Academy of Pediatrics recommends that no healthy child be excluded from or allowed to miss school because of head lice and that ‘no nit’ policies for return to school are to be discouraged. Nits are the eggs that can be found on the hair shaft near the scalp. They hatch into nymphs, the immature lice that feed on human blood but cannot yet reproduce. Within 12 days, nymphs develop into adult lice, which can survive for up to a month on the scalp. They are about the size of a sesame seed, and are tan to grayish-white in color.

The Centers for Disease Control and Prevention estimate that 6 million to 12 million infestations occur each year. “It does require medical treatment; however, it is not a serious problem,” says Dr. Colleen Seematter, a pediatrician with Mercy Clinic Pediatrics. “Over-the-counter treatments, such as Nix and Rid, combined with combing the hair carefully to remove nits is often effective. However, some lice are resistant to treatment.”

Physicians prescribe topical medication, such as Ovide and Ulesfia, to treat lice that survive despite OTC treatment. Seematter notes that there are some studies that show the oral antibiotic Septra or an oral anti-infective called Ivermectin also are effective for resistant lice.

Once lice are gone, they don’t come back unless the child is again infested through direct contact, says Dr. Jennifer Foersterling, a pediatrician with SSM Pediatrics and former director of pediatrics at the St. Louis County Health Department. “Head lice do not transmit or cause any diseases, and they are not a health hazard,” she says. “It is possible that the scratching may cause a superficial bacterial infection, but this is rare.”

Most cases of lice infestation are diagnosed when the child complains of a tickling or itching sensation on the head, which may be especially bothersome at night when lice tend to be more active.

“Children should be taught not to share hats, combs or brushes; but these items rarely are what cause the transmission,” Foersterling says. “It is difficult to prevent infection as often the child who is infested is not symptomatic.” Seematter adds that once diagnosed, all towels, sheets, pillowcases, hats and jackets used by the child be washed and dried on the hottest settings. Things that can’t be washed, such as throw pillows or stuffed animals, should be sealed in an air-tight trash bag for two weeks.

The most important message for parents whose child is infested is ‘don’t panic,’ Foersterling says. “Lice are not a health threat— they are a nuisance. There is likely nothing you could have done to prevent it, and it can be treated.”