Ruth-Anne Morris Public Health Nurse September 2013

1. Head Lice Prevention and Treatment Ruth-Anne Morris Public Health Nurse September 2013

2. How Is Head Lice Spread? Head lice spread through direct contact among children (head-to-head),or indirectly on items such as : hats, combs, hairbrushes, headbands, helmets, and toques.

3. The cycle of head lice

4. How do I check for head lice? • To confirm a case of head lice, you need to find live lice. • Good lighting is important when you are checking. • Head lice move fast and are hard to see. They are usually found very close to the scalp, at the bottom of the neck and behind the ears. • To look for nits, part hair in small sections, moving from one side of the head to the other. Check carefully, looking close to the scalp.

5. Head lice eggs on hair and head louse on fingernail

6. Description of Lice Eggs (Nits) • oval, white-gray-tan-dark brown • cylinders about 1/16 inch long. • glued to the side of the hair ¼ inch (6mm) from the scalp. • Older nits are found further from the • scalp due to hair growth. • Nits found ½ inch (12mm) • from scalp are considered • nonviable.

7. Nit Removal Expert opinion is that removal of nits is not necessary for adequate treatment, and prevention of the spread of head lice. This opinion is based on knowledge of the life cycle of head lice.

8. Keys to Controlling Head Lice • Two treatments, 9 days apart, for every family member who has lice. • Daily lice combing between treatments. • Careful checking of everyone who has been in close contact with someone who has head lice. Only treat those with lice. • Cleaning personal and household items family members with lice may have used.

9. Treatment Rational • The first treatment will kill most lice and some nits • Daily lice combing will remove adult lice who have survived. • Residual viable nits will hatch into immature lice within 7 -10 days post first treatment. Daily lice combing and the second treatment will remove/kill these immature lice before they are able to lay a second generation of nits. • The time and energies for treatment need to be focused on two adequate treatments 9-10 days apart and daily follow-up in between (rather than on nit removal).

10. How can head lice be treated? • Comb hair with regular comb to remove tangles. • Apply treatment as package describes on dry hair. • Rinse out the treatment over the sink, dry hair with clean towel. • Comb hair with regular comb to remove tangles • Comb for lice daily. • Apply 2nd treatment 9 days post 1st treatment • Continue checking family members regularly for at least 3 weeks post second treatment.

12. Combing for lice • Pick a place to start, top of head or behind ears. • Part hair into thin, narrow sections, comb one section at a time. • Place lice comb against the scalp and pull it to the end of the hair. • Check the teeth of comb after each pull through hair. Rinse off any lice or nits under running water or wipe them away with a tissue, bag tissue. • Repeat combing until head is done several times.

13. Combing con’t • When completed wash the lice comb under the tap, use a nailbrush or toothbrush to get between the teeth of the comb. Any discarded tissue should be placed in a plastic bag, tied and trashed.

14. Household Clean-up • Wash all items used by infected people in the last 3 days (hair accessories, clothing, sheets, towels, pillowcases, stuffed toys etc. • Wash in very hot soapy water for at least 10minutes. • Larger items that can’t be washed can either be placed in a plastic bag for 10 days, put in a hot dryer for 20 minutes, or place in the freezer for 24 hours, or ironed.

15. Do Not Treat Your Home • Lice live their entire life cycle on the human body. • Lice die within 2-3 days after falling off the host. • Treatment of homes with insecticidal sprays is unnecessary and may be hazardous. • Vacuum mattresses, carpets and furniture.

16. How to prevent the spread of Head Lice • . Check your child’s head regularly: • once a week as part of your routine • after every sleepover • every day during lice outbreaks at school • Keep long hair tied back or braided. • Teach your child not to share personal items that are used on their head: things like brushes, combs, barrettes, headbands, elastics, towels, hats, helmets, toques, and scarves. • Teach your child to put their hats and scarves in their coat sleeves or backpacks when they take them off at school. • If your child has been in contact with someone who has lice, you need to check your child’s head carefully to see if they have caught lice. • Head lice spread easily, so if one person in the household has lice, others may have it too. Check on the same day.

17. Web Links • The provincial Head Lice pamphlet ‘How to Find, Treat and Prevent Head Lice’: http://www.goc.ns.ca/hpp.publications/07135headlicepamphleten.pdf. • The Provincial guidelines for Head Lice: http;//www.gov.ns.ca/hpp/publications.headliceguidelinesfor treatment. • HRSB policy: http://www.hrsb.ns.ca/files/downloads/pdf/board/policy/sectionb/b.005-head-lice.pdf.

18. More Great Websites… • The Canadian Pediatric Society: http://www.caringforkids.cps.ca/whensick/headlice.htm. • Pollack, Richard. Harvard School of Public Health: https://identify.us.co./idmybug/head-lice/index.html. • Rick Speare. James Cook University: www.jcu.edu.au/school/phtm/PHTM/hlice/hlinfo1.htm. • Center of Disease Control and Prevention: www.cdc.gov/ncidod/dpd/parasites/headlice/factsht_head_lice.htm.