Each year, parents receive letters from the local school nurse announcing that someone in their child's classroom has head lice. At that point, a slight panic emerges as parents question who the infected child was, how he or she got lice, and how the insects travel from person to person. That fear soon spreads as parents wonder whether their child may have already been exposed to lice or that, soon, their home will be filled with lice and lice-infected children.

Doctors, however, recommend that parents relax.

"Lice themselves are more creepy and irritating than dangerous," says Maya Shetreat-Klein, M.D., who practices in Riverdale, NY, and stresses that, contrary to popular belief, lice are not the result of poor hygiene. "As far as we know, lice do not carry or spread any communicable diseases."

That's good news, and not just for the handful of children parents personally know who have lice. According to the Centers for Disease Control and Prevention, between six to 12 million infestations occur each year in the United States among children 3 to 11 years of age. The children who are most likely to get head lice are preschoolers, elementary-school aged children, and those who attend child care. Those who share a household with an infected child are also particularly vulnerable to infection.

Although each school district has different ways of dealing with children who are found to have nits, the off-white lice eggs that look like dandruff but cling to the child's hair, and the crawling insects themselves, New York City's guidelines are routine. In city schools, any student who is found to have live lice is not allowed to attend school until he or she has received treatment. Following treatment, the child will be allowed back in school when his or her hair is free of lice. Students will be examined when they return to school and will be re-examined again 14 calendar days after they return. If lice are found again, the children will be excluded from school until they are lice free.

Is It Lice?

Although the city guidelines are routine, some health care professionals fear the rules are too strict and keep children who are not a threat to others from attending classes. According to a study in the journal Pediatrics, no-nit school policies, which are just as likely to keep infested and non-infested children out of school, should be abandoned. School personnel should also be trained to correctly diagnose lice, which can be difficult. Currently, children who are infested with lice are as likely to be treated as those who are not. The American Academy of Pediatrics recommends only treating live lice, instead of schools' policy of treating lice and nits, which may cause the likelihood of misdiagnosis to decrease.

Lice are found mostly on the neck and scalp, with most concentrating behind the ears and near the neckline at the back of the head. Each louse holds on tightly to the hair with hook-like claws that are found at the end of each of their six legs. Red dots may appear in these areas. Parents are also likely to notice their child scratching these areas more than usual, says Lice Off, Inc., owner Dale Longworth, whose company is based in Dobbs Ferry, NY. Longworth recommends finding a professional lice technician to diagnose whether someone is infected. Doctors, nurses, and physician's assistants working in an office setting should be able to provide an accurate diagnosis as well. 

In the past, lice treatments focused on various chemical shampoos or sprays. However, because these chemicals, especially those found in the sprays, can be very toxic, and lice are becoming more resistant to the shampoos, treatment recommendations are changing, Dr. Shetreat-Klein says.

Longworth recommends natural shampoos instead. She uses a peppermint oil/enzyme shampoo that kills the lice and loosens the glue of the eggs that are attached to the hair shafts in the head. Once she shampoos the child's hair, she uses a thick conditioner and baking soda, which allow the eggs to be combed out easily. If parents choose to try this procedure themselves, they should purchase a metal lice comb and make sure they comb through the hair thoroughly. Usually, Longworth asks parents to comb out the infected child's hair every other day for 10 days. "The plastic combs that come in the pesticide boxes are useless," Longworth says.

To prevent other children from being exposed to lice, parents should wash or dry the infected child's clothes and bedding at a temperature above 130 degrees Fahrenheit to kill stray lice or remaining nits. Items that cannot be washed can be dry-cleaned or bagged in plastic containers for two weeks. If parents are worried that lice or nits may have gotten into the carpet or other fabric-covered items like couches, they should vacuum the area.

An Ounce of Prevention

Reoccurrence is common, too, which is why Longworth encourages parents to be aware of preventive techniques to keep their children lice-free. Natural products such as sprays that have rosemary, lavender, tea tree, or coconut oil in them have been shown to deter lice from the head, according to Longworth.

Girls should keep their hair up, preferably in a bun, and boys should keep their hair as short as possible. They should also avoid close contact with those who have lice and make sure they don't share clothes or combs with those who have lice. Lice also spread when people sit on infested furniture or bedding.

In case of exposure, Longworth recommends that parents arrange for a 20-minute appointment with a lice-removal specialist who will check for lice. Parents who choose to administer preventive measures themselves should check their child's head for eggs every other day for a week. They should also avoid contact with others for two to three days to avoid spreading lice. Washing clothing and bedding in hot water as well as disinfecting combs can keep infections from spreading.

"Patience and perseverance is the key to eliminating lice," Longworth says.