The mere mention of these little creatures is probably enough to get you scratching, but the chances are that if you’ve got children in nursery or primary school you’ll probably end up with a case of head lice before too long. It’s estimated that nearly one in ten primary school children have head lice at any one time!
Know your enemy
Head lice are tiny wingless insects that grip tightly to the hair and feed on blood from the scalp. They are spread between children by direct contact; they can’t jump or fly and they don’t survive for long away from the scalp so it’s not common for them to be passed on by sharing brushes or towels. They only live on humans so they can’t be caught from other animals, and they like clean hair just as much as dirty hair. Head lice live for about a month with the females laying several eggs each day; once the eggs hatch a baby head louse takes about ten days to mature so that they can reproduce.
“Nits” are the empty egg cases, which stick to the hair and remain after the eggs have hatched – these may be easier to spot than the lice which are fast moving, camouflaged, and may be smaller than a full stop.
Check for lice regularly
If you have small children then it’s wise to invest in a nit comb and check your children’s heads on a weekly basis. Only about 30% of children with head lice will have noticeable itching, and this may take a while to develop, so checking often to identify any lice early will help to prevent lice spreading. The best way to check is with a specially designed nit comb. This is almost four times more effective than just looking at the scalp.
Comb through all of the hair, in sections, wiping the comb with a tissue regularly and inspecting any debris that may have come from the comb. Pay particular attention to the back of the neck, behind the ears and under the fringe. Combing through wet hair, or hair with conditioner applied to it, can make it harder for the lice to grip on and may improve your results.
If you find live lice then you must check the whole family and treat anyone who has head lice at the same time. It’s not necessary to treat members of the family who don’t have head lice.
There are a few options for treating head lice.
Non-pesticide treatments (including dimeticone) physically smother the lice and kill them. The treatment usually needs to be repeated after seven days as it only gets rid of live lice, not the eggs.
Pesticide treatments work by poisoning the lice and killing them. They have been used for many years but head lice are developing resistance to these treatments.
Wet combing alone can be effective but it needs to be repeated frequently (twice a week for two weeks) and can be challenging to do reliably. It’s very easy to miss a few tiny lice!
Alternative remedies and herbal options are available but these are not always subject to rigorous testing and so their effectiveness may vary.
Once you’ve completed the treatment (and any follow up treatments) it’s important to keep checking regularly for lice. If you find live head lice again then it’s possible the treatment has failed, or in some cases you may be dealing with a re-infestation. If the treatment has failed then expect to see lice of varying ages, in contrast to a re-infestation, which is likely to be just a few adult lice. Treat live lice as above, paying close attention to the instructions – if you used a pesticide then consider trying an alternative treatment in case the lice have developed resistance.
Don’t lose heart – with frequent, effective checking and appropriate treatment you can get rid of head lice!
Dr Emma Scott (MBChB, MRCGP) is a qualified GP and mummy to two young children. She works in a GP practice in Edinburgh and in the out of hours GP service in Livingston and she has experience in both obstetrics & gynaecology and paediatrics.
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