It’s  #HealthyBackToSchool Week which bring us to:  Creepy topic of lice.

They really need no introduction. So we will crack on with what works and what doesn’t and dispel some urban myths that do regular rounds.

Firstly, who gets them? Everyone! In fact, lice love clean hair. It’s not because the child/family is “dirty”.

How are they spread: Lice do not jump, fly, or live on cats/dogs. Head to head contact is a route of transmission. Experts are still out on how well and how long lice can live on objects such as hats or brushes but probably don’t live longer than 48 hours at most. They live by feeding on blood and can’t live more than 2 days without a meal.

The best way to get ahead of them is to wet comb your child’s hair once a week, using a detection comb (these are available in pharmacies quite cheaply; they are finer than your normal styling comb).  Part the hair, go section by section, in bright light Live lice are hard to find  they quickly move away from light.  Nits will look like small white or yellow-brown specks and be firmly attached to the hair near the scalp, usually at the hairline at the back of the neck or behind the ears. Nits are firmly attached to hair, while dandruff, dirt or other particles are not.

This will help to find head lice infection early and can  reduce the number of people who will get infected.

What doesn’t work to prevent them: There is no good evidence that any marketed repellent sprays, alternative preventive products, headbands, or electronic combs work. Do not use treatment products as a preventive measure; they should only be used when infection is present:  when you can actually see a living, moving bug. The treatments are safe, but can make scalp flaky and itchy if over-used.

Itching is not a good way to know if you have them!  Some people do not have the itchy reaction to bites for up to 6 weeks after being infested!  Many people will continue to have some itchiness after treatmetn due to scalp irritation.

How to treat:

Treat everyone in family who is infected at the same time  so that untreated people don’t infect the treated people again. You can discuss with your registered pharmacist for best advice. Read the instructions and follow them – each product is slightly different.  Here are the ones that have been proven to work effectively:

• Isopropyl myristate (Full Marks Solution™)

• Dimethicone 4% (Hedrin™) Hedrin

• Permethrin (Lyclear Dermal Rinse)

• After treating, continue to wet comb every 2 days for next week.  
• Master level tip:  strongly consider repeating one week later – even if the instructions recommend one application only. The reason for this is that no matter what the label claims, no treatment is guaranteed to kill un-hatched eggs and these hatch out over about one week.  Check hair about 2 days after the repeat treatment. Once treatment is complete and has gotten rid of the lice, it is important that you return to your practice of weekly wet combing, to check the hair.  If treatment does not get rid of infection, a second treatment is recommended following check of compliance with treatment. After that, check with your GP if you need a third line.

Does my child have resistent lice?  Resistent lice do exist, but oil based products are now recommended in Ireland. They usually include dimethicone or similar that has a physical “smothering” effect so the lice do not get resistant to active ingredient permethrin. If you are having trouble, your GP can prescribe stronger treatment.

What treatments don’t work:

Mousses, rinses with lower concentrations of permethrin, shampoos or repellents are much less effective as they contain low concentrations of the active ingredient, or don’t allow for sufficient contact time.

30 minute hot air blow drying hasn’t been show to work, and is likely to burn/distress your child.

Never use dangerous products like kerosene or treatments intended for animals!  Also, do not use home remedies, such as petroleum jelly, mayonnaise, tub margarine, essential oils or olive oil, because no studies prove they work.

Never use dangerous products like kerosene or treatments intended for animals!  Also, do not use home remedies, such as

Alternative Products: A number of products containing essential oils such as tea tree and eucalyptus oil are marketed as ‘natural’ treatments for head lice. They have all failed multiple clinical trials.

What about the household?

• Everyone in the house should also be checked and treated if necessary.  You may want to wash your child’s clothes, towels, hats, and bed linens in hot water and/or dry on high heat if they were used within 2 days before head lice were found and treated. You do not need to throw these items away. Items that cannot be washed may be sealed in a plastic bag for 2 weeks or dry-cleaned.  You do not need to spray pesticides in the home.

Alternative/Natural prevention:

Do not use lice treatment shampoos as prevention.  Only use them if you see a living louse or nits.

There has been some early evidence that tea tree oil and lavender oil works at repelling – not killing – lice from inanimate objects (coats, hats, etc) but not on people.  The few trials done on objects – NOT people! – suggest a concentration of 10% tea tree oil and 1% lavender oil. Do NOT put this on your child’s head. Best case, it might reduce potential transmission of lice on the school coat rack. Worst case, your child’s coat just smells amazing. I’ll be honest, I was interested when I read this paper in a pharmaceutical journal back in 2019, so I tried it on my l son’s school outerwear. Love the smell. No lice – but it does not replace weekly wet-coming at bathtime.

Mechanical removal of lice “wet combing”:  To be effective, it is labour intensive and requires a lot of commitment on the part of parents and cooperation from the child. It needs to be done at least every 4 days for at least 2 weeks until there are no lice or nits seen for 3 sessions in a row.  Wet combing, however, is the best treatment for small infants who are too young for chemical first-line treatments.