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Anyone who has children in school or in daycare can identify with the panic that parents feel when that call comes from the school nurse or the note comes home in their child’s backpack that their son or daughter has head lice. Head lice has always been more common in situations where people are grouped together, including schools and summer camps, but lately there has been increasing attention in the media warning about “resistant” head lice, which makes this routine problem seem more serious.
In fact, there are increasing numbers of reports of head lice that have become resistant to some of the first-line, over the counter products that are available to families. The good news, however, is that there are also several prescription products which can circumvent this issue and should still be effective even against resistant head lice.
One of the biggest challenges in the treatment of head lice is distinguishing between an active case and old, fully treated infections where the lice’s empty egg cases, also known as “nits”, remain stuck to the hair shaft but are no longer living or contagious.
The most common route of spread is through direct head-to-head contact; less commonly it can also occur when children share hats, pillows, combs, or hair brushes. The American Academy of Pediatrics does NOT suggest avoiding important head protection like helmets due to concerns of head lice, however.
It may be impractical to believe that lice is 100 percent preventable in young children who play closely with one another, but ways to minimize your child’s chances of contracting lice include teaching your child not to share combs, brushes, or hats with others and checking your child’s scalp regularly to rule out any problems. When cases do occur within a school or camp, prompt treatment can decrease spread to others.
Inspect the “high-yield” areas, which are the scalp at the nape of the neck and behind the ears within 1 or 2 mm of the scalp, to look for white flecks that are moving. Children usually develop itching, especially after several days of infestation, but if it’s the very first case of head lice they may not become allergic to the lice’s saliva for a full 6 weeks, so the absence of itching does NOT fully rule out a live infestation. Beware, because other common skin problems such as dandruff or dried hairspray droplets can appear similar to lice, these do not move.
An easy rule of thumb is that if the nit is much more than 4 mm away from the scalp, it is less likely to be alive. This is because most living head lice lay their eggs within 1 to 2 mm of the scalp, since they depend on both the warmth and the blood supply of the scalp to remain alive.
First, ensure that what you are considering treating is truly an active case of head lice and not dandruff or empty egg casings from a previously successfully treated case of lice. The following is a list of over the counter first-line agents for treating head lice:
No well-done studies have properly evaluated the efficacy of products such as mayonnaise, butter, or olive oil for treating or “suffocating” head lice. The safety and efficacy of herbal products is unknown, as they are not currently regulated by the Food and Drug Administration (FDA), so these agents should be avoided in children due to unknown risks.
If your child does not respond to one of the over the counter products and your doctor determines that an FDA-approved prescription product is indicated, options include:
Lindane 1% is no longer recommended for treating children’s head lice due to concerns of absorption and potential neurotoxicity, including seizures.
Products that we NEVER recommend include gasoline or kerosene.
The first things to consider in a case of head lice that seems like it isn’t getting better is whether there could be another diagnosis, such as dandruff or psoriasis, that could explain the findings. Consult your pediatrician or pediatric dermatologist to help with this consideration.
Make sure if you are treating active head lice that you have used enough of the medication and fully saturated the hair. Also, make sure that your child isn’t getting re-exposed to someone else who may be re-infecting him or her.
Lastly, you can entertain the possibility that the head lice may be resistant to one of the first-line over the counter therapies and may require a prescription therapy from your doctor.
For more information or to schedule an appointment with one of our pediatric dermatologists at UPMC Children's Hospital of Pittsburgh, please visit www.chp.edu/our-services/dermatology.
With our Patient Portals, you can easily manage your child’s health online with 24/7 access to their medical record.
Learn more about UPMC Patient Portals.
By visiting UPMC Children’s Express Care, our after-hours clinic, your child will receive the same specialized pediatric care you’ve come to expect from your UPMC Children's Community Pediatrics pediatrician. Open conveniently on evenings and weekends, your child can receive care for minor injuries and illnesses when your pediatrician’s office is closed for the day.
Learn more about our services or find a location near you.
In the case of a serious emergency, call 911 or go to the emergency room.
Paying your bill has never been easier. UPMC Children’s Community Pediatrics offers you an easy and secure method for paying bills online for well and sick appointments as well as behavioral health visits.
Pay Your Bill Online
For questions regarding your billing statement, please call the UPMC CCP Billing Office at 1-888-857-7646 or email CCPBilling@chp.edu.
Are you passionate about caring for children? UPMC Children's Community Pediatrics offers the opportunity for you to apply your unique skills in pediatric medicine and to make an impact on children’s lives.
We are seeking candidates for full-time, part-time, casual, and temporary positions at our locations throughout 12 counties in western Pennsylvania.
To apply, visit the UPMC Careers website.
UPMC Children’s Community Pediatrics Stonewood Commons II 103 Bradford Road, Suite 200 Wexford, PA 15090
For administrative inquiries, please call 724-933-1100 or 1-888-857-7646.
Should a concern about your experience at UPMC CCP arise, please discuss it with your child’s pediatrician. If the concern remains unresolved, please email your concern to our patient relations specialist at ccpconfidential@chp.edu. We will investigate your concern and provide you with a response. Contacting our patient relations specialist will not negatively affect your care.