A recent letter on the worldwide prevalence of head lice in CDC’s journal Emerging Infectious Diseases made me nostalgic for the good old days when our two kids were in daycare (they are both adults with children of their own in daycare now). In particular, I got to thinking about the days when I was active as an officer in the American Public Health Association (APHA) and many years made the yearly trek to its large annual meeting. While it’s a large meeting, usually over 10,000 with scientific and business sessions spread out over many hotels, there is usually one headquarters venue where the Exhibitor’s Hall is located. This is a huge space with booths rented by businesses, drug companies, device manufacturers, government agencies like CDC and NIOSH, scientific book and journal publishers and most schools of public health. Lots of these places give away little trinkets or free samples to encourage you stop by and chat. Condoms are a perennial favorite (the supply is usually gone before the end of the four days of meetings). The other big free sample draw was head lice shampoo and lotion. I always stocked up.
I had good reasons for hauling the stuff home. The day care center our kids went to would periodically have outbreaks of head lice. It was the kind of cooperative enterprise where parents didn’t just drop the little dears off and then high tail it to work but one where parents also had jobs to do (there were professional teachers, too, of course and unfortunately the enforced parent labor didn’t make it cheaper). There were about 60 kids divided in four age groups, from infants to pre-school. My job was to be the center’s “doctor.” That didn’t mean I provided pediatric care. It meant I dealt with any health issues or problems that came up. Since this was the kind of day care center where even the ice cream had to be made of whole wheat (I’m joking, but not by much), being saddled with the job of medical guru for this group of aging hippie and academic parents was a sign I must have done something very bad in a past lifetime.
There is an idea that head lice are the exclusive province of the poor or unhygienic. It is not supported by the evidence but has stigmatized the condition to the point where it can become a significant stressor for children and their parents, either because they have been found to have head lice or they are afraid of getting head lice. This wasn’t so much a problem at our daycare center but it still freaked out the parents. Unfortunately I soon learned that all the free lice shampoo I was hauling home from the APHA convention was destined for our personal use only. Lotions or shampoos with pesticides like pyrethrins or malathion were not the kind of medical intervention on the agenda for this group. Instead the solution was to set up a security screen at the entrance to the center that the TSA could take lessons from. Each scalp got an inspection and comb with a fine tooth louse comb.
Well it turns out that using a louse comb on conditioned hair to remove nits (nits are louse egg cases that are stuck to hair shafts) and to detect live lice is among the most effective control measures. Lice have started to develop resistance to insecticides and the potential toxic issues in young children also is a disincentive for using them for many people (opinions vary on this). We weren’t quite so strict about our own kids. Of course we participated in the overall program but then shampooed their hair (and sometimes our own, for good measure) with the freebies I picked up in the Exhibitor’s Hall when they got home. Our kids seem normal — which means they periodically have Mrs.R.and me tearing our hair out, but not for lice control.
For those of you now in the head lice business, here’s a good fact sheet from the Department of Public Health in the state of Washington. It tells you how to get rid of lice both with and without the use of insecticide shampoos. And here are a couple of pictures and a video clip for your viewing pleasure:
This clip shows a louse crawling around the scalp of a child. Enjoy: