Texas Parenting News

Get a heads-up on lice treatment

Treating head lice has gotten more complicated. The pesky parasites have become resistant to at least two active ingredients in the leading anti-lice treatments in half the states, and entrepreneurs have seized the opportunity to offer a non-medical treatment. Yet pediatricians and various agencies continue to recommend conventional methods.

If your child’s caregiver or teacher notifies you that head lice has been found at school, the first step is to get informed.

What are head lice?
Head lice are tiny grayish-white insects that attach to the scalp and lay eggs (nits) in the hair. They are most common in preschool and elementary school children as well as family members of infested children.

Lice are spread by head-to-head contact as well as using caps and combs of infested individuals. It’s impossible to pick up an infestation from pets because lice feed only on human blood. Moreover, lice are not the result of poor hygiene; they can infest everyone.

Head lice are not considered a public health hazard and are not known to spread disease. But as many parents and teachers know, they can be extremely annoying because of the itching they cause and the tedious shampooing and combing usually required for eradication.

Increasing resistance
In 25 states, including Texas, lice have become resistant to pyrethroids, the active ingredients in leading over-the-counter products routinely used for treatment. Pyrethroids include pyrethrum, made from ground-up chrysanthemums and found in shampoos such as Rid®, and permethrin, the synthetic version found in cream rinses such as Nix®.

Continual exposure to these lice-killing products over the past two decades has contributed to genetic mutations in lice that render such drugs useless, according to studies reported by WebMD.com, CBS News, and Consumer Reports. And despite what the label says on these products, their ability to kill nits has come under question.

Prescription medications, however, are still effective. Instead of pyrethroids, these products contain other chemicals such as benzyl alcohol, ivermectin, malathion, and spinosad. On the downside, prescription meds can cost roughly 12 times as much. For example, benzyl alcohol lotion costs about $195 for 7.7 ounces compared to Rid shampoo at $16.26 for 8 ounces (Consumer Reports 2015).

Drying them out
When scientist Dale Clayton moved from England to Utah, he discovered that lice died in the hot arid climate. Realizing that lice need moisture to survive, he began experimenting with ways to dry them out. He and a team of engineers developed a machine, which looks like an old canister vacuum cleaner, to blow hot air on the scalp. It was patented in September 2010.

Once the FDA cleared the device for sale and public use, Clayton began selling the invention, called the LouseBuster™, for $2,000 to $2,500 to nonprofit organizations such as schools and medical clinics. His company also leases the device to salons, staffed by trained and certified LouseBuster operators. You can Google “LouseBuster locations” to find local services.

The device blows air at about 138 degrees Fahrenheit, a lower temperature than common blow dryers. Treatment takes about a half hour, which includes a comb-out to remove dead lice and nits. It costs $125 to $275 a person, depending upon whether you go to a salon or have the treatment at home. Use is limited to adults and children 4 years and older.

Salon operators and customers claim that this method is highly effective, killing the eggs as well as the lice. One newspaper reporter whose family had an infestation tested three salons and one in-home treatment (Garone 2014), and all worked.

Conventional methods
Despite the problem with over-the-counter medicines and the claims of LouseBuster users, pediatricians and various agencies continue to recommend conventional treatment. For example:

Unless resistance is known in the community, the American Academy of Pediatrics recommends over-the-counter medications containing 1 percent pyrethroids as a first choice. If the community has seen resistance or parents’ efforts don’t work, the Academy urges parents to call their doctor for a prescription medication. The Academy also recommends laundering pillow cases and hairbrushes but not “excessive environmental cleaning, such as home pesticides” (AAP, 2015).

Similarly, the websites of the Centers for Disease Control and Prevention as well as the U.S. Food and Drug Administration recommend over-the-counter or prescription medications. Both websites also give detailed steps for treating an infested person and supplementary measures such as laundering clothing, bed linens, and hair care implements. Except for the FDA’s acknowledgement of the LouseBuster, neither website mentions a machine-drying method.

The FDA also urges the following safety precautions:
Before treating young children, talk with your child’s doctor or pharmacist for recommended treatments based on a child’s age and weight.
Use medicine exactly as directed on the label and never more often than directed unless advised by your health care professional.
Use treatments on children only under the direct supervision of an adult.

The nonprofit National Pediculosis Association on its website HeadLice.org offers these warnings and recommendations:
If you continue to be infested with live lice after treatment, discontinue use of products and don’t use other products in the hope of killing the lice. Remember, these products are not mere shampoos, creams, or lotions. They are pesticides.
Never resort to dangerous remedies such as lindane, kerosene, or pet shampoos.
Manual removal is crucial. Beyond snipping or pulling out the nits, you should also be screening for and removing live lice. Having at least two people check an infested person is important as one person cannot see the entire scalp. Lice move quickly and shy away from light when you are checking.
Don’t spend hours on end cleaning your environment. Head lice need human blood to survive. Vacuum surface areas only. Save your time and energy for what will benefit you most, delousing the individual. NEVER USE A LICE SPRAY!
When screening for lice with a nit-removal comb, it may be helpful to dip it into water and clean it before going to the next section of hair.
Equip yourself and your helpers with a magnifying glass, tweezers, safety scissors, and a nit-removal comb.

Stressing safety, Consumer Reports recommends combing out as the sole treatment. Citing the increasing resistance of pyrethroids as well as some level of risk from chemicals, the organization recommends wet combing as follows:
Work outdoors or under a bright lamp.
Coat the hair with conditioner or a lubricant such as olive oil.
Separate the hair into small sections, and comb each section with a metal (not plastic) nit comb.
After combing each section, wipe the comb with a paper towel and inspect it for lice and nits.
Dispose of the paper towels in a sealed plastic bag.
Continue to comb out the child’s hair every day until no live lice are seen and then every few days for about a month.

A final word
“Once the lice have been treated, you do not need to retreat unless live lice are found,” said Renee Acosta, clinical professor at the University of Texas at Austin College of Pharmacy. “If nits are found on the hair later, but there are no live lice, then the nits should be removed but retreatment is not necessary.” 

Acosta added the following advice that she always gives her students:
When lice are found, usually the entire family is treated. Ask the physician or pharmacist before treating to ensure that everyone can and should be treated. A good estimate is approximately 2 ounces per person, with more needed for thick longer hair and less for thin short hair.
Things that can be washed should be washed in hot water.
Things that cannot be washed, like stuffed animals, can be sealed in a trash bag for two weeks and the lice will die.

Editor’s note: Thanks to W. Renee Acosta, Registered Pharmacist and University of Texas clinical professor in pharmacy, for reviewing this article.

References
American Academy of Pediatrics. April 27, 2015. AAP Updates Treatments for Head Lice,” AAP, www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Updates-Treatments-for-Head-Lice.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR:+No+local+token, accessed July 6, 2016.
Centers for Disease Control and Prevention. Dec. 28, 2015. “Parasites – Lice – Head Lice: Treatment,” www.cdc.gov/parasites/lice/head/treatment.html, accessed July 6, 2016.
Consumer Reports. Sept. 2, 2015. “How to get rid of lice? Comb them out instead of using Nix, Rid, or other chemicals,” www.consumerreports.org/cro/news/2014/09/to-get-rid-of-head-lice-comb-them-out-instead-of-using-nix-rid-or-other-chemicals/index.htm, accessed July 6, 2016.
Garrone, Elizabeth. May 20, 2014. “Lice-Eradication Services: Testing Salons and an At-Home Service,” The Wall Street Journal, www.wsj.com/articles/SB10001424052702304547704579566091385016808, accessed July 7, 2016.
Healthychildren.org. Sept. 24, 2015. “Head Lice Treatment Myths & Realities,” American Academy of Pediatrics, www.healthychildren.org/English/health-issues/conditions/from-insects-animals/Pages/Head-Lice-Treatment-Myths-Realities.aspx.
Henn, Steve. April 9, 2012. “The Key to Keeping Lice at Bay? A Lot of Hot Air,” NPR News, www.npr.org/2012/04/09/150299564/the-key-to-keeping-lice-at-bay-a-lot-of-hot-air.
Manacher, Ilene. Aug. 19, 2015. “Lice resistant to common treatments in many states,” CBS News, www.cbsnews.com/news/head-lice-resistant-to-pyrethroid-common-treatment/, accessed July 6, 2016.
Mozes, Alan. Aug. 18, 2015. “Head Lice Resistant to Common Meds in 25 States,” WebMD, www.webmd.com/skin-problems-and-treatments/news/20150818/head-lice-now-resistant-to-common-meds-in-25-states.
National Pediculosis Association. n.d. “Resistant Lice?” www.headlice.org/faq/treatments/pest.htm, accessed July 6, 2016.
Phys.Org. Dec. 6, 2010. “The LouseBuster Returns,” http://phys.org/news/2010-12-lousebuster.html, accessed July 6, 2016.
U.S. Food and Drug Administration. Jan. 23, 2014. “Treating Head Lice,” www.fda.gov/ForConsumers/ConsumerUpdates/ucm171730.htm, accessed July 6, 2016.

Note: Use of trade names is for identification purposes only and does not imply endorsement by Texas Child Care.

Hello, Teacher! Yes, you!

Many parents look to child care and early education not only to enable them to work but also to provide teachers that will help their children learn. The fact is, however, that children begin learning from day one in the home.

Parents’ care and nurturing develops the emotional bonds that help a child feel safe and secure and thus eager to learn. Everyday experiences such as feeding, diapering, and playing help establish and organize brain function, laying the foundation for thinking and learning. Interaction and conversation build language and communication skills. Perhaps most important, parents serve as role models for behavior and problem solving.

How can you enhance your effectiveness as your child’s first teacher?

Hugs. Be generous with warm embraces, gentle pats, quick kisses, and kind words.

Conversation. Engage in the simple back-and-forth of talking and listening to help children increase their vocabulary, express ideas, and grow in self-confidence.

Play. Remember that children learn best through play, whether it’s banging pot lids or making mud pies. Even ordinary materials, such as cardboard boxes, allow children to explore and discover. Include plenty of physical play to strengthen muscles, prevent obesity, and improve mental health. Cultivate a playful attitude.

Reading. Orient children to books by reading a favorite story at a specific time each day, such as bedtime. Read printed matter such as billboards, traffic signs, newspapers, and greeting cards. Take turns repeating favorite folk tales and family history, or making up stories.

Art. Encourage children to scribble and draw by providing pencils, crayons, and paper. Offer junk mail, used wrapping paper, fabric scraps, safety scissors, and paste for collages. Such open-ended activities can help develop creativity, self-expression, and pre-writing skills.

Diapers: Disposable or cloth?

You’re using cloth diapers?” says Judy incredulously to her sister-in-law. “I’ll bet that doesn’t last long.”

“Well, I’ve researched diapers, and I think cloth will be best for us,” says Mandy confidently. “We use disposables in day care and when we travel. But we use cloth at home.”

As a parent, if you’re thinking that cloth diapers went out with eight-track tapes, think again. Cloth diapers have been improved, cost less than disposables over time, and have less impact on the environment.

But like Mandy, you need to do the research and consider which type best fits your lifestyle.

Research. If your child care provider insists on disposables, ask her which brands most parents use and where to find the best bargains. Talk to family and friends as well. Word-of-mouth can be a powerful source of information.

Look for information on the Internet. For a timely and comprehensive article, see Consumer Reports’ “Diaper Buying Guide,” May 2016, at http://www.consumerreports.org/cro/diapers/buying-guide.htm.

Lifestyle. Caring for a newborn can be overwhelming, especially for first-time parents. Getting up during the night for feedings, having easy access to laundry facilities, and feeling the need to return to work can affect your choice.

If cost is a major factor in your decision, you’ll be happy to learn that the purchase price of cloth diapers can be a third to half that of disposables over the couple of years you will use them. But you may need to add the cost of waterproof diaper covers, which will prevent soiling crib linens and your lap, as well as flushable liners to simplify cleanup.

Don’t forget laundering expenses such as electricity or gas power, water, and detergent. On the plus side, you can re-use cloth diapers if you plan to have another baby.

Environment. Many parents choose cloth diapers to avoid adding thousands of disposables into landfills. While this impact is significant, the choice is not completely eco-friendly. Remember that laundering uses energy that may be produced from fossil fuels and adds dirty water to the sewage system.

In another nod to protecting the environment, some cloth diapers are manufactured from organic cotton, hemp, or bamboo. Expect these to cost a bit more, however.

Baby’s comfort. The key is to change diapers as soon as possible after they become wet or soiled to avoid diaper rash. Advocates of both disposable and cloth diapers claim their type is highly absorbent. Be alert to fragrances and other chemicals that might irritate baby’s skin.

Over time as your baby grows, you will face other choices: larger sizes, overnight diapers, swim diapers, and pull-ups for potty training, for example.

If you’re having trouble deciding, feel free to try both cloth and disposable diapers. Once you decide, remember that you can always change your mind.