Head lice are among the most dreaded childhood maladies from the perspectives of parents and childcare providers. This loathing of lice is often based on misinformation passed down through the generations.

It is further supported by frequent and exaggerated “outbreaks” reported in the news media. Almost all stories describe the supposed ease of spreading head lice, the risks of these insects to the health and welfare of children, and the danger posed by anti-lice products.

As a child caregiver, you are particularly caught between the proverbial “rock and hard place” as you struggle to reconcile information from medical authorities and the emotionally driven desires and expectations of parents. Knowing what you can and should do to prevent and manage head lice will help you in your work with children and their parents.

What are head lice and how are they spread?

Head lice are tiny insects that feed only on the blood of people. They grasp the hair of the scalp and insert their tiny mouthparts into the skin for just a minute or so to painlessly drink a tiny drop of blood.

Head lice do not burrow into the skin nor do they transmit disease; however, an allergy to their saliva can cause some irritation and itchiness. Thus, head lice are rarely anything more than a nuisance.

They are most common on young children through early elementary school ages. On average, head lice should be expected on about one in every 100 young children in the U.S.

Fortunately, most children will never encounter a head louse. Even if not treated, a child with lice presents far less risk to others compared to a child with a cold, influenza, pinworms, or many other childhood infections.

These insects spread most readily between siblings in the home, but they can certainly spread among children in the childcare setting. Lice cannot fly or jump but they can crawl and are shared mainly by direct head-to-head contact. Activities such as hugging and playful contact offer opportunities for lice to spread between friends and family.

Despite common beliefs, inanimate objects such as combs, brushes, hats, helmets, coats, and sofas are not the primary culprits to transmit head lice.  Because lice need blood to feed on, they will not survive long on these objects. However, Caring for our Children recommends that childcare programs take care to clean or wipe out shared helmets or other head coverings during outbreaks of head lice in the facility.

Adult female lice glue their eggs (nits) directly on scalp hairs very close to the skin. Because they are firmly glued to the hair, louse eggs are not transmissible.

Managing head lice in childcare

Head lice infest people—not homes, cars, furniture, or toys. A louse that falls from the hair will very likely die from starvation and water loss within hours. Do not apply insecticides within the childcare facility to control or prevent head lice; as this action would be unnecessary, wasteful, and may also be prohibited by law. It is not necessary to clean or decontaminate beyond your normal daily routine.

Because of your close contact with children, you may be the first to notice signs of head lice on a child. Before you assume that a child may be infested, and certainly before considering any kind of treatment, it is critical to find a live (crawling) insect and make sure it is a louse.

When children play outdoors, it is possible for other kinds of insects (e.g., aphids, thrips) to become lodged in hair. If you are unsure about how to identify a louse, contact your child care health consultant, a pediatrician, or your local health department.

If a child has lice, it is not necessary to exclude or isolate the child. Gently notify the parent or guardian at the end of the day and offer sound medical information on how to manage the problem. If lice are found on one family member, then other children and adults in the child’s home should also be checked.

Do not divulge the child’s medical condition to other children and their parents. However, if multiple cases are suspected within a specific group of children, it can be helpful to alert parents and provide information regarding appropriate means to manage the problem at home.

Treatment of Head Lice

If a child in your childcare setting has head lice, there are steps you can do to minimize the spread to other children. Clean the environment just as you would for any communicable illness; wash hard surfaces with a cleaner, clean washable toys, and launder stuffed toys and bedding in hot water.

For parents, mechanically removing lice and nits through combing can be effective, but it is time-consuming and often fails to eliminate an infestation. If the child’s hair is fairly fine and straight, then a louse or nit comb can be useful at home to detect and remove these insects and their eggs.

If combing is difficult, impractical, or has been unsuccessful, then pediculicides—special insecticide products registered by the Food and Drug Administration (FDA)—can be helpful. Most over-the-counter (OTC) pediculicides contain pyrethrins (products of chrysanthemum flowers) or their synthetic equivalent. Used as directed on the package, these products can be effective at killing lice. A repeat treatment, about 10 days after the first, is often needed.

However, some lice are resistant to OTC products. If live lice are seen the day after the second treatment, parents should call a pediatrician to discuss other kinds of treatments that are available only by prescription.

When used as directed, pediculicides offer very little risk to children or adults. The main risks from pediculicides (and any medicine) come from gross overuse of the product. Advise parents to read the labels carefully and follow the directions. Avoid treatments that are not approved by the FDA; some other products are promoted based on incredible testimonials rather than objective testing of their effectiveness and safety.

Children in Childcare

If a child has an actual or suspected case of head lice it is important to reassure the child that he or she is not sick or dirty. It is not necessary or appropriate to exclude or isolate the child.

The American Academy of Pediatrics recommends that children with head lice stay in childcare or school. Exclusion is not recommended.

Then provide the parents with accurate information so they might do enough—but not too much—to eliminate the problem.

Richard J. Pollack, Ph.D.
President & Chief Scientific Officer, IdentifyUS LLC; Research Associate Professor, Boston University; Research Associate, Harvard School of Public Health

Resources

American Academy of Pediatrics, www.aap.org/advocacy/releases/july2610studies.htm

Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, 2nd Edition, National Resource Center for Health and Safety in Child Care and Early Education, nrckids.org/CFOC/index.html

Identify U.S., www.identify.us.com

Radio Show, www.childhealthonline.org/radio.htm