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By Scott Hamilton, MD
September 22, 2021
Hamilton Blog Headshot Updated 12.21.21

This week’s guest columnists are Shalini Choudhary, MD and Yanling Zheng, MD, Family Practice Residents at Ochsner University Hospital & Clinics.

Sally had long black hair down to her waist. She loved doing it up in different designs and when her mom would massage her head and tie it into ponytails. Until the day she came home from school, embarrassed and in tears, clutching the letter from school: Sally had lice. Mom thought about shaving Sally’s hair, but knowing how devastating that would be, brought her to the Pediatric Emergency Department instead.

Schools sometimes overreact to lice, banning kids until they have proof of treatment from a doctor. But they are gross, so you can’t judge schools too harshly. Lice are insects as big as this i on the page. They don’t jump or fly, so they aren’t as contagious as people think. They can only crawl, and the only way they pass is when children touch heads for some time. They feed on blood from scalps, like mosquitoes, and their bites cause the scalp itching that everyone associates with an infestation. They attach their eggs to the base of hairs, hatch in eight days and then grow to the little grey-white beasts we hate. Their legs are made for clinging to hair; their mouthparts contain the bloodsuckers.

Many are embarrassed because they associate lice with uncleanliness, poor hygiene and poverty. However, lice are worldwide, and affect kids from all backgrounds and income levels. Many parents and schools, freaked out by the possibility of infestation, mistake dandruff or hair product residue for bugs. The best way to detect them is to sit children in a well-lit spot, wet their hair and comb with a fine-toothed comb. If you see white egg cases clinging to hair roots, or bugs themselves, time to treat!

Many parents, like our mom above, freak out when the lice letter comes home. Social media is full of these laments: “Kids, I'll always be there for you. Unless you get lice; then find your own way to school!” On the brighter side: “Great excuse to dump the week's commitments, 'my kids have lice.'” Or worse: “Should have gotten a dog instead.”

While parents and schools often panic when finding lice, shaving everyone bald and burning your house to the ground are extreme. Buzzcuts and obsessive house-cleaning are usually unnecessary. Lice only live on scalps; seldom hiding in pillows or hats. They don't jump or fly. Lice only crawl, and thus only go from one head to another by prolonged head contact.

Wiping out lice requires patience, a fine-toothed metal comb and anti-lice lotion like permethrin (available over the counter). First, massage the lotion into the hair, starting with the back of the neck and behind the ears (where lice hide the most). Coat all the hair and leave it on for 10 minutes. Then rinse hair in a sink with warm water. Don't wash medication off in the shower or bath, because if any lingers on skin, it can irritate.

Then while hair is wet, comb it carefully out in good light to remove eggs and dead bugs. Conditioner can lubricate thick, tangled hair to make combing easier. As eggs are often resistant to medicated lotions, you may need to repeat this process once a week for a time or two if you miss some. Though bugs hiding in bedclothes and hats is unusual, washing them in hot water is reasonable. And stay reasonable yourself: no need to call the local orphanage to ask about openings.

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