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Daily Dose

Head Lice & Hollywood

Do not take Hollywood's advice when it comes to treating head lice.Over the weekend, I dragged my family to see The Switch. It was a great escape movie and a perfect “chick flick” with a happy ending. What does this have to do with kids’ health? Well, one of the scenes was related to an elementary school child who had a case of head lice.

I listened intently while Jennifer Aniston instructed her best friend on how to treat her son’s head lice. And guess what? The information was somewhat incorrect! The writers must have missed the 2010 American Academy of Pediatrics abstract on lice and treatment recommendations that not only endorsed banishing the “no nit” policy (which had prevented children from returning to school), but also stated that “no healthy child should be excluded from or allowed to miss school time because of head lice.” By the time a case is diagnosed, the child has probably had the infestation for at least a month, so why keep him home now? Nothing causes more angst and disgust than when parents find that their child has lice, yet it has nothing to do with cleanliness. It’s not unusual for everyone in the family to start scratching their heads and thinking they’re infested, too. The latest recommendations begin with properly diagnosing the infestation; it is thought to be both “misdiagnosed and overtreated,” which may be causing resistance to over-the-counter products. The two most commonly used products are Nix and Rid. It is important to know if your community is believed to be resistant to these two products. Depending on that information, you can start treatment; make sure to repeat the treatment in a week or 10 days to prevent new lice from repeating the life cycle. Current recommendations advise washing all bedding and hair-care items used by the child within the previous 48 hours. In one study, changing the pillowcase alone was enough to minimize head lice transmission — but if you are washing, you might as well throw in all of the bedding. Louse survival off of the scalp beyond 48 hours is extremely unlikely, so it is not necessary to call in the “lice busters” to exterminate your house. Washing, soaking or drying items at 130 degrees will kill stray lice or nits — and simply vacuuming the couch, car seat or other fabrics should be more than sufficient. The perfect lice treatment would be both pediculicidal (killing the louse) and ovicidal (killing the eggs, too). The perfect treatment also would be safe, easy to use, inexpensive and would not have potential for developing resistance. But there currently is not a treatment method that fits this description. Oh, by the way: We all enjoyed the movie, and the little boy is precious (and lice free by the end). That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

Parenting

AAP Says Lice Shouldn’t Keep Kids Out of School

1:30

Typically, when a student has head lice or nits (the eggs of head lice), the school requires that he or she go home and not return until the lice are gone. The American Academy of Pediatrics (AAP) recently proposed new guidelines that say, "No healthy child should be excluded from school or allowed to miss school time because of head lice or nits."

The AAP says that while head lice may be annoying and cause itching, they don’t actually make people sick or spread disease. Many people believe that the insects are easily spread, but experts say that direct head-to-head contact is required.

The AAP notes that most doctors who care for children agree that school policies requiring children to be free from nits before returning to school should be abandoned.

The AAP also reported that screening kids at school for head lice does not reduce the occurrence in classrooms over time. However, pediatricians advise parents to check their children’s heads for lice and school nurses may check children who are showing symptoms such as repeated head scratching.

To treat lice, the AAP recommends parents start with over-the-counter medications that contain 1 percent permethrin or pyrethrins (types of insect-killing chemicals).

Parents should carefully follow the treatment instructions, and when using permethrin or pyrethrin products, should apply the treatment at least twice (about 9 days apart).

Because these medications do not kill 100 percent of the lice eggs, the treatments should be followed by manual removal of the eggs, the guidelines say. This can be a tedious process, but fine-tooth combs called "nit-combs" can make the process easier.

Some head lice have become resistant to OTC treatment, these cases may benefit from prescription medications such as spinosad or topical ivermectin.

Once a person is diagnosed with head lice, everyone in the family should be checked for the condition. Lice are usually transmitted by direct contact, so it's less likely that people will get lice from touching household items, but it is still wise to clean all hair-care items and bedding used by the person who had lice, the guidelines say.

Children should be taught not to share items such as combs, brushes and hats, although such precautions may not prevent all cases of head lice, they can reduce the risk of transmission.

Source: Rachel Rettner, http://www.livescience.com/50629-head-lice-recommendations.html

Your Child

Super-Lice Resistant to OTC Treatment

1:45

Well, this certainly isn’t good news.

The American Chemical Society recently reported a new study shows that certain lice in at least 25 states are now resistant to over-the-counter (OTC) treatments.

Study author Kyong S. Yoon, PhD, assistant professor in the Biological Sciences and Environmental Sciences Program at Southern Illinois University, has been researching lice since 2000. His research is still ongoing, but what he’s found so far in 109 samples from 30 states is startling: the vast majority of lice now carry genes that are super-resistant to the OTC treatment used against them.

Permethrin, part of the pyrethroid class of insecticides, is the active ingredient in some OTC treatments. Certain lice have developed a trio of mutations that make it resistant to the pyrethroids. What happens is you end up with a new kind of super-lice that doesn’t respond to typical treatment any longer.

“It’s a really, really serious problem right now in the U.S.,” Yoon says.

Six million to 12 million U.S. children are infested with head lice every year, "with parents spending about $350 million dollars annually on permethrin-laced over-the-counter and prescription treatments," Yoon said. Lice infestations occur in rich neighborhoods as well as poor ones.

Currently, there are 25 states, including Arizona, California, the Carolinas, Connecticut, Florida, Georgia, Illinois, Maine, Massachusetts, Texas and Virginia where lice have what Yoon calls "knock-down resistant mutations". This involves a triple whammy of genetic alterations that render them immune to OTC permethrin treatments.

Lice in four states, New Jersey, New Mexico, New York and Oregon, have developed partial resistance, the researchers found.

Michigan's lice have no resistance as yet. Why that is remains unclear.

Fortunately, there are prescription medications that still work in treating lice. They are more expensive than over-the-counter formulas and do not contain permethrin. These prescriptions may contain benzyl alcohol, ivermectin, malathion and spinosad; all powerful agents or insecticides. Lindane shampoo is another alternative for difficult-to-treat cases.

If your child has head lice and OTC medicines haven’t worked, you can check with your pediatrician or family doctor for a prescription treatment. 

Sources: Mandy Oaklander, http://time.com/4000857/lice-treatment/

Alan Mozes, http://health.usnews.com/health-news/articles/2015/08/18/head-lice-now-resistant-to-common-meds-in-25-states

 

Your Child

Lice Is Going Around

How to treat lice.I keep hearing that there are lice out there! Lice are a part of childhood, albeit the gross part, but it really has nothing to do with where you live or go to school or how often your kids take their baths, its about hair.

Lice are obligate human parasites and require a human scalp to live, they can only live off the host for 6 -25 hours.  Lice most commonly infect children between the ages of 3 – 12 years and there estimated to be between 6 – 12 million cases of lice in children per year. So, if your child has lice, you are not alone!  Transmission of the louse is most commonly from close personal contact especially head to head.

Lice do not have wings so they are not flying around a classroom or on the playground.  The most recent issue with lice is that they are becoming resistant to the over the counter products like Rid and Ni, which have been the gold standard for years. These are still used for first line treatment, as well as removing the nits (egg casings) from the hair with a nit comb. It is often easiest to do this with a dark towel or sheet draped over your child’s shoulders so that you can see the nits as they are coming off of the hair shaft.  It is very hard to see nits in light hair.   Nix and Rid do not kill the eggs, so it is recommended that a second application be used in a week to 10 days. Once you have treated your child appropriately they may return to school, there are no longer “no nit policies”. If you notice that your child still has lice after a couple of days despite appropriate over the counter treatment, call your doctor. Don’t try to smother the lice with mayo, olive oil, Vaseline  or a shower cap, as lice don’t have lungs, so this does not work!  Never think about applying  kerosene to the child’s  hair or even shaving their heads. There are some newer treatments available. I have had success using Ovide, which is only available by prescription in the United States (but is an OTC product in the UK, in case you are traveling).  Another new product, Ulesfia, is also available. It is made of benzyl alcohol and inhibits the louse respiratory spiracles (no lungs remember) and thereby does result in asphyxiation of the louse. The only problem with this product is that it takes quite a few bottles to cover a child with a thick head of hair, and this may make it cost prohibitive. Another product that is being used in Canada (again if you are wanting to pick up some lice treatment while away) is Resultz which is isopropyl myristate, and it is in phase 3 trials in the US.  Other products such as Bactrim and Ivermectin have been used “of label” with some success. At time parent’s are willing to travel to Canada to find “the cure” as they become so frustrated with re-occuring lice problems. Remind your children not to share combs, bows, hats etc with their friends.  Lastly, some people advocate treating all household contacts (even without symptoms of itchy head) to eliminate an outbreak within a family. Now, stop scratching your head.  We'll chat again tomorrow!

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