THURSDAY, Sept. 4, 2003 (HealthDayNews) -- As millions of kids head back to school, the annual hair-pulling over what to do about the dreaded pediculosis capitis -- the head louse -- begins anew.
This year 6 million to 12 million people, mostly children, will get head lice. In many cases, because of "no-nit" policies, they will be suspended from school, according to an article in the September issue of the American Journal of Nursing.
The controversies tied to head lice concern selecting the best treatment and implementing the best school policy.
Barbara Frankowski, chairwoman of the American Academy of Pediatrics Committee on School Health and a professor of pediatrics at Vermont Children's Hospital, says the first thing parents should do is not panic.
The best treatment is using a product such as Nix or Rid A-200. These are the best and the safest treatments, she says. Frankowski cautions that for these products to be effective, you have to the follow the directions carefully.
Frankowski adds that combing alone can be effective, but it's time-consuming and may not get rid of a persistent head lice problem, since live lice will move from one area of the head to another to avoid the comb, she notes.
As for prescription treatments such as malathion and lindane, Frankowski feels that while they are effective, they are dangerous. "As a pediatrician, I wouldn't want my patients using them and I don't prescribe them."
She notes that malathion is highly flammable and lindane is associated with seizures. "No one ever died of head lice, so using a product that you may die from makes no sense," Frankowski says.
The most reasonable school policy for head lice is to have the school nurse check children suspected of having them. If any live lice are found, the parent should be notified so the child can be treated before returning to school the next day.
"There is really no need to send the child home the exact minute head lice are found. That makes no sense, because by the time a child is scratching, the lice have been there for at least a month. It's just silly to send the child home," Frankowski says.
The American Academy of Pediatrics discourages no-nit policies in schools because they have not been found to be helpful. Nits are cemented to the child's head and hair and there is only a small chance that the nits will migrate to other children, she notes.
The problem is more prevalent in elementary school, where kids can come into head-to-head contact with each other. It's hardly a problem in middle school and high school, Frankowski says. Ideally, parents should check their kids weekly for head lice, she advises.
To parents, Frankowski says, "Stay calm. This isn't the worst thing in the world that can happen to your child. If you stay calm, then your child will stay calm and won't get embarrassed."
Deborah Altschuler, president of National Pediculosis Association, disagrees with Frankowski. Altschuler says that none of the chemical products approved for treating head lice is 100 percent effective and may have serious side effects, especially in children who have medical problems such as asthma.
"We recommend the path of least risk and greatest benefit, which is early detection and manual removal," Altschuler says. Her group recommends combing the nits out with a quality comb such as the LiceMeister comb, a product the association endorses.
Like Frankowski, Altschuler believes in regular screening to find lice before the problem becomes serious. Only as a last resort, for children with persistent head lice, should a child be excluded from school, Altschuler says.
"Head lice are just a part of growing up," Altschuler says. "They're just a part of living on the planet."
Marion Moses, director of the Pesticide Education Center in San Francisco, recommends a product called Lice B Gone. This product is a nontoxic shampoo made of enzymes from natural vegetable extracts. According to Moses, the shampoo dissolves the "glue" that holds the nits to the hair shaft.
"Not only is Lice B Gone safer than chemical products, it's cheaper," she says. Moses adds that products such as Rid A-200 and Nix have been linked to adverse side effects.
"All of the anguish and maladaptive behavior around lice is because people don't see that controlling head lice is just matter of a simple act of grooming," Moses says.
"Head lice is an easily solvable problem, and there is a safe product that is inexpensive and works," she says. "Relax, calm down and don't reach for anything toxic."
More information
To learn more about the treatment of head lice, visit the Centers for Disease Control and Prevention or the National Pediculosis Association. To read the American Academy of Pediatrics' recommendation, click here.
