head lice

The biggest concern with head lice is that children will irritate their scalp from scratching.

When she was first notified that her youngest son might have head lice, Dr. Lisa Lopez went through his hair again and again only to find nothing. But when she checked later, the tiny parasites were impossible to miss.

“Finally, one day I looked and saw a ton,” says Lopez, a pediatrician with the North Charleston office of Sweetgrass Pediatrics. “They went from nothing, hardly visible, to like everywhere.”

For parents who have been through it, the act of combing through a child’s hair hunting for lice and their eggs is a familiar story. For those who haven’t, just the idea of bugs in their children’s hair brings about a serious case of the creeps. And in general, lice is an often-misunderstood condition that can prompt unfounded assumptions about the cleanliness of a child’s home.

“It’s pretty common. And it has nothing to do with how clean you are, or how dirty you are or your spot in life socioeconomically,” Lopez says. “Truly, it just kinds of happens.”

Lice are small, parasitic insects that can live in hair, eyelashes and eyebrows, though they prefer to be near the scalp where they can feed on human blood. If that very sentence has you running for the shower, you’re not alone — the discovery of lice on a child’s head can lead to a freak-out on the part of both parents and kids, something the owners of a lice treatment center in Mount Pleasant have seen too many times.

“The first time a parent has to deal with lice can be extremely overwhelming,” says Emily Linville, who co-owns Lice Beware along with Shelly Klimas. “The most important thing for parents to understand is that there are effective options that are not harmful to their family. We have found that a lot of parents do panic when dealing with their first infestation, and we do our best to calm and educate them on the process and prevention.”

‘A big nuisance’

For parents dealing with lice for the first time, it may help to know that the condition is extremely common. Lice exist worldwide, and in the United States they’re most typically found among children in daycare, kindergarten or elementary school. According to estimates by the Centers for Disease Control and Prevention, there are up to 12 million annual infestations — another term sure to deliver the creeps — among children between the ages of 3 and 11 years old, though lice are much less common among African Americans.

female pediatrician in white lab coat examined little patient for lice

Lice is an often-misunderstood condition that can prompt unfounded assumptions about the cleanliness of a child’s home.

And ultimately, they’re harmless. “It’s a big nuisance,” Lopez says. The biggest concern is that children will irritate their scalp from scratching, or scratch so hard that they create sores on their scalp and open themselves up to possible infection. And that itching caused by — brace yourself — the little critters moving around and laying eggs is the No. 1 symptom that lice are present.

Other signs may be rashes around the ears or on the nape of the neck, Klimas says. But there’s more good news: lice cannot jump or fly, and they can’t survive away from their host for very long. The most common methods of transmission are head-to-head contact or using something like hats or bedding that have been recently used by someone with an infestation. Watch out for those shared sports helmets or slumber parties.

“They don’t really survive off the human host for more than 48 or 72 hours,” Lopez says. “If you’re just sitting at a desk and you have someone in front of you, they’re not going to jump off you onto your neighbor. You have to be right next to each other, or use something the other person has used. You’re not excluded from school anymore if you have them.”

A lice infestation can be embarrassing for parents, given the longstanding misconception that they stem from dirty or unsanitary living conditions. The CDC succinctly shoots down that myth: “Getting head lice is not related to cleanliness of the person or his or her environment,” the agency says on its website. The irony is that lice prefer clean hair, which is easier for them to grab ahold of.

“Usually to make people feel better, I tell them, ‘This nice, beautiful, clean hair is a perfect place for them to grow,’” Lopez says. “Because it kind of scares them a little bit.”

Understandably so, given the literal skin-crawling nature of an infestation. Girls with longer hair can sometimes have a more difficult time dealing with the condition than boys, who can have all their hair shorn off. But children of either gender can feel grossed out by the ordeal, as Lopez knows from personal experience.

“It depends on your personality,” Lopez says. “I think girls tend to get a little more frantic and upset about it. The boys get disgusted, but they kind of move on. When my sister and I had it, both around the same time, I remember crying, ‘I have bugs in my hair!’ But my little one, he’s like, ‘Remember that time I had bugs in my hair?’ ‘Yeah, I remember. Let’s not tell everybody.’”

Emily Linville and Shelly Klimas

Emily Linville, left, co-owns Lice Beware with Shelly Klimas, right. 

‘Tedious’ treatment

So yeah, they’re gross. But they don’t fly, jump or carry diseases. They’re very common, and not a reflection of your household cleanliness. They don’t force kids to miss school. Preventing transmission from one head to another is fairly straightforward. Unfortunately, there’s one hitch — lice can be very difficult to get rid of, because you have to root out not only the living parasites, but also the eggs (called nits) that have been left behind.

For parents, the first step is usually an over-the-counter treatment like Nix or Rid, which are typically applied as cream rinses or shampoos. But some over-the-counter treatments can’t be used on children 2 years old or younger, and may have to be left on overnight or for a long duration such as 12 hours. A prescription lotion containing less-toxic benzyl alcohol is available for children 6 months or older. Treatments typically kill only the live parasites, but do not affect the eggs.

Dr. Lisa Lopez

Dr. Lisa Lopez of Sweetgrass Pediatrics in North Charleston

“They’re all similarly effective. It’s just tedious,” Lopez says. “Once you’ve killed them, you’ll still see the nits there for a long time. What you’re looking for is to make sure anything alive is gone. Their lifecycle is about a week, so if you get everything that’s alive but still have eggs in there, in about a week they’re going to hatch.”

While many lice kits come with fine-toothed combs that are designed to root out the eggs, they often don’t get them all. That leaves parents to go through their child’s hair strand by strand with their fingernails, pulling out the shiny white eggs. If lice are still found a week later, doctors advise treating the head again. And if one child is found with lice, the typical recommendation is to treat everyone in the house.

If over-the-counter medications don’t work, a trip to the pediatrician may follow. Of course, Lopez has also seen patients much earlier in the process — that freak-out factor is a high one, after all. “It depends,” she says, “on the level of parental alarm.”


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