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IPM for Schools
Chapter 11
•
Lice
81
C
HAPTER
11
IPM
FOR
H
EAD
L
ICE
 
IN
S
CHOOLS
The eggs hatch within 7 to 11days. Once hatched, devel-oping lice take 8 or 9 days tobecome adults; after anadditional day, the adultfemale can start laying eggs.Thus, about 16 days in all arerequired for an egg to giverise to a female capable of laying more eggs. Adultslive for up to 30 days.
H
OW
L
ICE
 
ARE
T
RANSMITTED
Most head lice are probably transmitted when aninfested person comes into close contact with another.For example, when children sleep or sit together,enough time and opportunity is provided for a louse towalk from head to head. Lice and their eggs can also betransferred between people via infested brushes, combs,caps, hats, scarves, coats, bedding, towels, and uphol-stered furniture.
D
AMAGE
Although the symptoms of head lice are irritating, headlice have generally been regarded as little more than anuisance by medical personnel. While a louse bite itself is painless, the louse’s saliva usually causes an allergicreaction that produces itching (although some people maynot experience the itching for several weeks). If itching issevere, the lice probably have been present for someweeks. Scratching that breaks the skin creates entrywaysfor germs and lice feces, and can lead to swollen glandsand secondary infections such as impetigo. Severelyinfected individuals may experience fever and feel tiredand irritable.
D
ETECTION
 
AND
M
ONITORING
Frequent head scratching may be the first sign of lice.Adult lice may be present on the head or in the eye-brows and eyelashes, and with careful observation theeggs can be seen. A magnifying glass will help indistinguishing beween nits and dandruff. Eggs are oval-shaped and attached only to one side of the hair shaft.The eggs themselves stay glued to the hair even afterthey hatch, and cannot be removed as easily as a piece
I
NTRODUCTION
Today, the management of head lice continues to be amajor task for parents, school personnel, and health careprofessionals worldwide. The growing resistance of liceto pediculicides (lice-killing insecticides), combinedwith a surprising willingness of many parents to toleratehead lice, is turning a manageable problem into a majornuisance.Head lice are most often found on school childrenbetween the ages of three and ten, less often on olderchildren or adults. The eggs, or nits, of head lice areglued tightly to hairs, most often around the back of theears and at the nape of the neck. The adults are found inthese and other areas of the head, including the eye-lashes, and more rarely on other body hairs.The traditional chemical “first-strike” approach isinappropriate and is not recommended. The chemicalsused in lice shampoos may pose long-term healthhazards and under no circumstances should they beused on pregnant or nursing women or children undertwo. Sound management of head lice involves promptdiagnosis and the use of non-toxic physical treatments,with insecticides only as a last resort. Each of theseelements requires that the person treating the liceproblem have more precise information about thebiology of lice than is usually available.
I
DENTIFICATION
 
AND
B
IOLOGY
The head louse, Pediculus humanus capitis, is one of three sucking-lice species that feed on humans. Thehead louse spends its entire life on the human head; if itdoes move onto other surfaces, it must return to thehead within a few hours to survive. Lice can surviveonly 24 hours without blood and they cannot completetheir life cycle on pets.Head lice can move fairly rapidly, but cannot jump orfly. The adult head louse is 1/16 inch to 1/8 inch long,and ranges from tan to grayish-white in color. Each of its six legs ends in a claw that is used to grasp the hairshaft. The nits are laid near the junction of the scalp andthe hair shaft. The eggs are oval-shaped and are at-tached to the hair with a very tough glue. Each femaleproduces about 6 to 8 eggs in a 24-hour period andthese are laid mostly at night.
Head Louse
 
IPM for Schools
Chapter 11
•
Lice
82
of dandruff or other debris. Because eggs stay attachedto the hair, it is also important to determine whether ornot the egg has hatched. Nits start out as a yellowish togray color and darken to a tan or coffee color beforethey hatch. Hatched eggs are white. Eggs that areshrunken or indented will not hatch.Originally, scientists believed that eggs that were 1/4inch or more away from the scalp would all be hatchedor dead, and therefore it wasn’t necessary to examineeggs that might be farther down the hair shaft. Recentresearch (Taplin and Meinking 1988) shows that this isnot always true, particularly in warmer climates andpossibly on individuals who always wear some type of head covering.
M
ANAGEMENT
O
PTIONS
Lice can be controlled without resorting to shampooswith pesticide, but this depends on thorough combing of the hair with a special lice comb. Because reinfestationfrom playmates is common (regardless of the treatmentused), parents may wrongly assume that the first treat-ment wasn’t strong enough and turn to something moretoxic. To minimize reinfestation, schools are urged toadopt a “No Nit” policy (see below) and to educateteachers and students, but especially parents, in how tofind, control, and prevent head lice.
Education
Most people view lice with disgust. Panicked parentswho would not normally expose their children to poten-tially hazardous materials will apply pesticides in haste,sometimes well beyond the recommended frequencyand dosages. Education can help to overcome theseobstacles to non-toxic lice control.It is crucial that teachers, children, and parents havesome rudimentary information about head lice before alice outbreak occurs. The school can send an informa-tion sheet home with children when school begins in thefall and after long vacations. The sheet can includesome facts about lice and information on how to detectthem (see Appendix H for a sample).Encourage parents to look for head lice weekly as justanother part of personal hygiene. Have teachers in thelower grades talk to students about head lice at thebeginning of the school year. Young children generallyare not hesitant to talk about head lice—for them it’s just another learning experience. Remind them repeat-edly not to share combs, brushes, caps, hats, scarves,head pieces from costumes, etc.When an outbreak occurs, the school can send home apacket that includes information on how to control liceand a note alerting parents that children will not beallowed back into school until their hair is free of nits—the “No Nit” policy (see below). See Appendix H for asample information packet.It is our experience that sometimes only a small groupof families is responsible for the frequent reinfestationof an entire class. It is important to understand thatthere are some parents who do not regard head lice as aserious problem at all. Many cultures outside theUnited States accept head lice as a minor, constantinconvenience, and do not assume that head lice can beeliminated when infestations occur. Families with thisattitude may need to be convinced of the importance of cooperation.
“No Nit” Policy
The National Pediculosis Association (P.O. Box610189, Newton, MA 02161; 617/449-NITS), a non-profit organization that provides education on safe waysto manage head lice, recommends that schools establisha “No Nit” policy, which means that children are deniedre-admission to the classroom until their heads are freeof lice eggs. This recommendation is based on the factthat most parents and teachers cannot easily tell thedifference between an egg that is viable and one alreadyhatched. By tolerating nits, children are allowed toreturn to school and unwittingly spread head lice toothers.When a “No Nit” policy is adopted, each principalshould designate at least one member of the school staff to receive training from the school nurse or other publichealth official in the detection of lice and nits.
Store Garments Separately
Transmission can be reduced through proper storge of hats and other garments that may carry stray femalelice. Head lice are a particular problem among childrenin child care programs, kindergarten, and the earlygrades of grammar school. Facilities should beequipped with separate lockers or “cubbies” for eachchild. Headgear, scarves, and other outer clothing thatcomes into contact with the hair should be storedseparately, one cubbyhole for each child. It is crucialthat the parent or teacher explain the importance of thisbehavior clearly. If separate lockers or cubbies areimpossible, cloth bags that close at the top with adrawstring are another alternative. At the very least,children should be assigned a hook on the wall to use
 
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Lice
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throughout the school year. There is evidence thatassigned hooks can reduce the spread of lice through aclassroom.If, during head lice outbreaks, cubbies or lockers areunavailable, sturdy plastic bags can be used. Placeidentifying decals on individual bags so children knowwhich is theirs. Bags containing clothing should bedoubled over and wrapped with a twist tie. This pro-cess should be supervised to make sure the children aredoing it properly. Torn bags should be replaced imme-diately.
Housekeeping
The rugs and upholstered furniture in classrooms withlice outbreaks should be thoroughly vacuumed. If lostand found articles are stored in the classroom, they canbe separated by placing them in individual plastic bags,and then sealed.
Treatments
This must be left to the parents, but the school canprovide them with accurate information on how to combfor lice and nits, and on the hazards and proper use of insecticidal shampoos. The Sample Information Packetin Appendix H provides this information.
Physical Controls
It is possible to eliminate a lice problem using thefollowing physical controls without resorting to moretoxic chemicals. Success depends on several factors,including the determination of parents, existence of good relations between the parent and child, and thelength and texture of the child’s hair.
Combing
Combing is the most important aspect of head licecontrol. Combing removes nits from the hair and helpsyou to find adult lice. Unfortunately, there is no safesolvent for the powerful glue that holds the nits to thehair, and though insecticides may kill some eggs, they donot kill them all. Box 11-A provides detailed instructionson combing that should be followed carefully using acomb with specially tooled metal teeth designed toremove head lice and their eggs from the hair. Metal licecombs are available from pharmacists. Ordinary fine-toothed plastic combs are not adequate, even thoughthey may be sold along with various insecticides for thecontrol of head lice.There is no denying that the combing process demandstime and patience from parents and children; however,many parents tell us that their children grow to enjoy theprocess and even look forward to it because it feelsgood and the child is the center of the parent’s attention.Based on the life cycle of the female head louse, andassuming the child is not immediately reinfested, thecombing process should be repeated every 5 to 7 daysduring the period when head lice are a problem at theschool. If the child becomes reinfested before a week has elapsed, the combing will have to be repeatedsooner. Parents should refrain from using pesticideswith these cases of immediate reinfestation; instead, useonly the combing method to remove lice and nits.
Salad Oil
The use of salad oil is sometimes recommended tosmother adult lice, but personal experience has shownus that lice can survive in hair covered with oil evenwhen it is left on overnight. Do not count on oil to killadults or nits. Oil can be very useful in combing,however. Oil prevents the hair from tangling whichmakes combing much easier. In this respect, oilworks better than shampoo or conditioner and doesn’tdry out during the combing process. Washing thehair twice with any ordinary shampoo will remove alltraces of the oil.
Washing Clothing and Bedding
Since lice may wander from the head to the pillow or toheadwear, washing these items at the time the child isinitially treated is a good idea. Putting clothing orbedding through a wash cycle with hot water andordinary detergent in a washing machine and thendrying in a hot dryer is sufficient. Anything thatcannot be washed can be stored in large, sealedplastic bags for 2 weeks.
Vacuuming
Clothing can also be vacuumed to remove stray nits andwandering lice. Upholstered furniture and rugs can bevacuumed too, but, in general, head lice do not leave thehead and there is no need to go into a frenzy of launderingand cleaning. The time and energy spent in washingclothes and cleaning the home environment would be farbetter spent combing out nits, and educating the child andother parents, teachers, and children with whom thechild associates.
Chemical Controls
Ordinary shampoo
Certain fatty acids in soaps have insecticidal properties,but shampoos are detergents, and you cannot count onshampoo to kill young or adult lice. Although it might
of 00

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