Today was pretty much just relaxing and a little shopping. Just my kind of day. Although I did try to get in touch with Rick's sister in Garland and I found out that she and her husband are BOTH in the hospital with some nasty viral infection. They are both senior citizen retiree types; he is in rather poor health anyway, and she probably got run down just trying to take care of him. I wish we lived closer so I could check on them more regularly; thank goodness their best friends (another older couple) are taking care of them and making sure they've got what they need.
I also found out that my own dear husband has come down with something nasty; I'm glad we're not there, to be honest, because I don't want any of the rest of us to catch it. He's fairly capable of caring for himself, although he sounded terrible on the phone and I called Jeff's wife Linda and asked her if she'd call him tomorrow evening to make sure he had everything he needed.
Tomorrow we're planning to visit my parents' lake cabin at Texoma and meet up with my grandparents. Erica seems to be enjoying her visit so far; she keeps Martha well occupied and out of Isaac & Alice's hair. Speaking of Isaac & Alice's hair, I treated for cooties again today and did the nitpicking routine out in the backyard afterward. Dang bugs. I want the durn things GONE, for Pete's sake! What's a mom gotta DO to get rid of the wretched vermin anyway? Don't answer that; I have no intention of using flamethrowers or Molotov cocktails... but don't think it hasn't crossed my mind.
My readings on the matter of cootie-killin' have surprised me. The American Academy of Pediatrics actually discourages the no-nit policy that I've always seen at schools and daycare facilities. Their head-lice policy statement reads thusly:
Head lice (Pediculosis capitis) infestation is common in the United States among children 3 to 12 years of age; approximately 6 to 12 million have infestations each year. Head lice are not a health hazard or a sign of uncleanliness and are not responsible for the spread of any disease. The most common symptom is itching. Individuals with head lice infestation may scratch the scalp to alleviate itching, and there rarely may be secondary bacterial skin infection. Head lice are the cause of much embarrassment and misunderstanding, many unnecessary days lost from school and work, and millions of dollars spent on remedies.The use of "Nix" brand seems to be the preferred method of OTC head lice treatment. It contains a synthetic pyrethroid, permethrin, which seems to do a little bit better job than just plain pyrethrin products. The prescription stuff like Lindane and Ovide are very effective but are much more toxic to humans.
The adult louse is 2 to 3 mm long (the size of a sesame seed) and usually pale gray, although color may vary. The female lives up to 3 to 4 weeks and lays approximately 10 eggs, or nits, a day. These tiny eggs are firmly attached to the hair shaft close to the scalp with a glue-like substance produced by the louse. Viable nits camouflaged with pigment to match the hair color of the infested person are most easily seen at the posterior hairline. Empty nit casings are easier to see, appearing white against darker hair. The eggs are incubated by body heat and hatch in 10 to 14 days. Once the eggs hatch, nymphs leave the shell casing, grow for about 9 to 12 days, and mate, and then females lay eggs. If not treated, this cycle may repeat itself every 3 weeks. While the louse is living on the head, it feeds by injecting small amounts of saliva and taking tiny amounts of blood from the scalp every few hours. This saliva may create an itchy irritation. With a first case of head lice, itching may not develop for 4 to 6 weeks, because it takes time to develop a sensitivity to louse saliva. Head lice usually survive for less than 1 day away from the scalp at normal room temperature, and their eggs cannot hatch at an ambient temperature lower than that near the scalp.
Head lice, unlike body lice, do not transmit any disease agents. Itching may develop in a sensitized individual. Rarely, an individual may develop impetigo and local adenopathy from scratching.
Head lice are most common in children 3 to 12 years of age. All socioeconomic groups are affected. Infestations in the United States are less common in blacks than in individuals of other races, most likely because blacks have oval-shaped hair shafts that are harder for lice to grasp. Head lice in Africa have adapted claws for grasping this type of hair. Head lice infestation is not significantly influenced by hair length or by frequent brushing or shampooing. However, in the United States, where daily brushing is routine, infested individuals rarely have more than a dozen live lice, whereas individuals in cultures with different grooming practices often have a hundred or more live lice. Lice cannot hop or fly; they crawl. Transmission in most cases occurs by direct contact with the head of another infested individual. Indirect spread through contact with personal belongings of an infested individual (combs, brushes, hats) is much less likely but cannot be excluded. Lice found on combs are likely to be injured or dead, and a healthy louse is not likely to leave a healthy head.
The gold standard for diagnosing head lice is finding a live louse on the head. This can be difficult, because the louse can crawl 6 to 30 cm per minute. The tiny eggs, or nits, may be easier to spot, especially at the nape of the neck or behind the ears, within 1 cm of the scalp. It is important not to confuse nits with dandruff, hair casts, or other hair debris; nits are more difficult to remove because they are "glued" on. It is also important not to confuse live nits with dead or empty egg cases. Among presumed "lice" and "nits" submitted by physicians, nurses, teachers, and parents to a laboratory for identification, many were found to be artifacts such as dandruff, hairspray droplets, scabs, dirt, or other insects (eg, aphids blown by the wind and caught in the hair). In general, nits found more than 1 cm from the scalp are unlikely to be viable, but some researchers in warmer climates have found viable nits farther from the scalp. A viable nit will develop an "eye spot" evident on microscopic examination several days after being laid.
It is probably impossible to totally prevent head lice infestations. Young children come into close head-to-head contact with each other frequently. It is prudent for children to be taught not to share personal items such as combs, brushes, and hats. In environments where children are together, adults should be aware of the signs and symptoms of head lice infestation, and affected children should be treated promptly to minimize spread to others.
More from the AAP's head-lice policy:
If an index case is identified, all household members should be checked for head lice, and only those with live lice or nits within 1 cm of the scalp should be treated. It is prudent to treat family members who share a bed with the person with infestation, even if no live lice are found. Fomite transmission is less likely than transmission by head-to-head contact; however, it is prudent to clean hair care items and bedding of the individual with infestation. Only other items, clothing, furniture, or carpeting that have been in contact with the head of the person with infestation in the 24 to 48 hours before treatment should be considered for cleaning, given the fact that louse survival off the scalp beyond 48 hours is extremely unlikely. Washing, soaking, or drying items at temperatures greater than 130°F will kill stray lice or nits. Furniture, carpeting, car seats, and other fabrics or fabric-covered items can be vacuumed. Pediculicide spray should not be used, because exposure cannot be controlled. Nits are unlikely to incubate and hatch at room temperatures; if they did, the nymphs would need to find a source of blood for feeding within hours of hatching. Although it is rarely necessary, items that cannot be washed can be bagged in plastic for 2 weeks, by which time any nits that may have survived would have hatched, and nymphs would die without a source for feeding. Herculean cleaning measures are not beneficial. [emphasis mine! wahoo!]I just knew you'd find all that interesting.
Screening for nits alone is not an accurate way of predicting which children will become infested, and screening for live lice has not been proven to have a significant effect on the incidence of head lice in a school community over time. In addition, such screening has not been shown to be cost-effective. In a prospective study of 1729 school children screened for head lice, only 31% of the 91 children with nits had concomitant lice. Only 18% of those with nits alone converted to an active infestation over 14 days of observation. Although those children having greater than or equal to 5 nits within 1 cm of the scalp were significantly more likely to develop an infestation than those with fewer nits (32% vs 7%), still only 1/3 of these higher-risk children converted. Furthermore, school exclusion of children with nits alone would have resulted in many children missing school unnecessarily in this study population. Several descriptive studies suggest that education of parents in diagnosing and managing head lice may be helpful. Because of the lack of evidence of efficacy, classroom or school-wide screening should be strongly discouraged.
It would be prudent to periodically provide information to families of all children on the diagnosis, treatment, and prevention of head lice. Parents should be encouraged to check their children's heads for lice if the child is symptomatic; school screenings do not take the place of these more careful checks. It may be helpful for the school nurse or other trained persons to check a student's head if he or she is demonstrating symptoms.
Management on the Day of Diagnosis
Because a child with an active head lice infestation has likely had the infestation for a month or more by the time it is discovered, poses little risk to others, and does not have a resulting health problem, he or she should remain in class but be discouraged from close direct head contact with others. If a child is assessed as having head lice, confidentiality must be maintained so the child is not embarrassed. The child's parent or guardian should be notified that day by telephone or a note sent home with the child at the end of the school day stating that prompt, proper treatment of this condition is in the best interest of the child and his or her classmates. Common sense should prevail when deciding how "contagious" an individual child may be (a child with hundreds versus a child with 2 live lice). It may be prudent to check other children who were most likely to have had direct head-to-head contact with the index child. In an elementary school, often the most efficient way to deal with the problem is to notify the parents or guardians of all children in the index child's classroom, encouraging that all children be checked at home and treated if appropriate before returning to school the next day.
Criteria for Return to School
A child should be allowed to return to school after proper treatment. Some schools have had "no nit" policies under which a child was not allowed to return to school until all nits were removed. The American Academy of Pediatrics and the National Association of School Nurses discourage such policies. However, nit removal at the time of treatment by the parent or guardian may be considered for the following reasons:
--Nit removal may decrease diagnostic confusion.
--Nit removal may decrease the possibility of unnecessary retreatment.
Some experts recommend removal of nits within 1 cm of the scalp to decrease the small risk of self-reinfestation.
The school nurse, if present, can perform a valuable service by rechecking a child's head if requested to do so by a parent. In addition, the school nurse can offer extra help to families of children who are repeatedly or chronically infested. In rare instances, it may be helpful to make home visits or involve public health nurses to ensure that treatment is being conducted effectively. No child should be allowed to miss valuable school time because of head lice. Numerous anecdotal reports exist of children missing weeks of school and even being forced to repeat a grade because of head lice.
Reassurance of Parents, Teachers, and Classmates
The school can be most helpful by making available accurate information on diagnosis, treatment, and prevention of head lice to the entire school community in an understandable form. Information sheets in different languages and visual aids for families with limited language skills should be developed by schools and/or local health departments. If pediatricians and schools take the lead in reacting in a calm manner, parents will be able to focus on appropriate treatment without getting unduly upset.
Child Care and "Sleep Over" Camps
Little information is available on the incidence and control of head lice outside of the school-aged population and outside of school. Because head lice are most readily transmitted by direct head-to-head contact, child care centers and camps where children share sleeping quarters may allow for easier spread. Therefore, it may be prudent to establish stricter criteria than in the school-based setting for identifying and treating others in these special settings once an index case is identified.
SUMMARY POINTS
1. Pediatricians should be knowledgeable about head lice infestations and treatments and should be available as information resources for families, schools, and other community agencies.
2. School personnel involved in detection of head lice infestation should be appropriately trained. The importance and difficulty of correctly diagnosing an active head lice infestation should be acknowledged. Schools should examine any lice related policies they may have with this in mind.
3. Permethrin 1% (Nix) is currently the recommended treatment for head lice, with retreatment in 7 to 10 days if live lice are seen. Instructions on proper use of products should be carefully relayed. Safety and efficacy should be taken into account when recommending any product for treatment of head lice infestation.
4. None of the currently available pediculicides are 100% ovicidal and resistance has been reported with lindane, pyrethrins, and permethrin. Treatment failure does not equate with resistance, and most instances of such failure represent misdiagnosis/misidentification or noncompliance with the treatment regimen.
5. Head lice screening programs have not been proven to have a significant effect on the incidence of head lice in the school setting over time and are not cost-effective. Parent education programs may be helpful in the management of head lice in the school setting.
6. Manual removal of nits after treatment with a pediculicide is not necessary to prevent spread. In the school setting, removal may be considered to decrease diagnostic confusion.
7. No healthy child should be excluded from or allowed to miss school time because of head lice. "No nit" policies for return to school should be discouraged.
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