Lice Are Lousy, But Not Unhealthy

Lice are Lousy but not Unhealthy

Head lice are not popular topics of conversation or research, but maybe they should be -- 6 to 12 million children (mostly ages 3-12) have them every year. A report from the American Academy of Pediatrics sets the record straight and makes clear recommendations that may surprise many parents, teachers, school administrators, and youth workers at residential treatment centers and other centers where lice are a potential problem.

The report starts with the statement that "Head lice are not a health hazard or a sign of uncleanliness and are not responsible for the spread of any disease." It explains that lice affect all socio-economic groups, but are less common among blacks, apparently because their oval-shaped hair shafts are harder for a louse (that's the singular of lice!) to grasp.

It is "probably impossible" to totally prevent head lice infestations, but it helps to teach children not to share combs, brushes and hats. And although schools and day care centers usually require children with lice to go home, the report points out that a child with live lice has probably had the lice for a month or more by the time they are discovered, and the child poses little risk to others, and should therefore remain in school. However, they should be discouraged from having "close head contact" with others. The report recommends that the information about a child's lice be confidential rather than public, with a call to the parent or guardian stating that prompt treatment is in the child's best interest. Exceptions might be necessary if a child has hundreds of live lice.

The American Academy of Pediatrics and the National Association of School Nurses discourage the "no nits" policy that many schools have established. Nits are the tiny lice eggs, which can be easier to spot than live lice, since lice crawl up to 30 cm per minute. "No nits" policies are especially problematic because empty lice egg cases, dandruff, or even dirt can be mistaken for nits.

Treatments include a variety of toxic and not-so-toxic shampoos and creams. The report describes Nix as a cream rinse that is the "recommended treatment of choice" because it is less toxic to humans that other products and does not cause allergic reactions to children with plant allergies. It describes Lindane as a prescription product that must be used extremely carefully, can cause severe seizures in children, and is not very effective. Malathion is also a prescription lotion; although it is also a neurotoxin, its greater danger is that it is highly flammable and very dangerous if ingested. Several lice shampoos are made from extracts from chrysanthemums -- RID, A-200, R & C, Pronto, and Clear Lice System. These are neurotoxic to lice but not very dangerous to humans. However, some children and adults have allergic reactions, especially those who are sensitive to ragweed.

The report also lists several products that are sometimes used but not proven safe or effective for lice: creams such as Elimite and Eurax, pills such as Septra, Bactrim, and Stromectal, natural products such as HairClean 1-2-3, and "petrolatum shampoo." Old-fashioned treatments such as gasoline, kerosene, and other flammable substances "should never be used" according to the report.

The report summary emphasizes that head lice screening programs are not cost-effective and often are not effective at all, and that healthy children with lice should not be excluded from school nor even allowed to miss school because of lice.

Reference:
Head Lice
American Academy of Pediatrics Clinical Report
Pediatrics, Vol 110 No 3, September 2002, Available online at http://www.aap.org/policy/0203.html

This article is based on Diana Zuckerman's Research Watch columns that appeared in Youth Today in January 2003 and was reprinted with permission. Youth Today is a publication of the American Youth Work Center, 1200 17th St., NW, Washington, D.C. 20036. (800) 599-2455. E-mail: youthtoday@aol.com