Wash all bedding DKA nursing interventions towels in hot water and dry them in a school-afed dryer on fo Lice treatment for school-aged children setting for 15 schoop-aged. Your child may need a different type of treatment. On this page. To find nits, your child's provider may use a specialized light called a Wood's light, which causes nits to appear bluish. Apply to dry hair and rinse off after 8—12 hours.

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Head lice concerns as kids go back to school

Lice treatment for school-aged children -

Check especially around their ears and neckline. Consult your child's health-care provider or pharmacist before treatment if your child has allergies to select an appropriate lice treatment.

Otherwise, you can proceed to treat your child at home. There are several treatment options. One common option is to use approved, medicated lice-killing shampoos or lotions and special combs. These are available at your local pharmacy without a prescription. Each product is applied differently.

Some products are safe for children over 2 months of age and others can only be used in older children. Please read the directions carefully.

Make sure to rinse the lotion from your child's skin to avoid irritation. Most products are not percent effective the first time you use them; you will usually need to repeat the treatment about a week later.

Various other treatments are available, but some work better than others. Ask your pharmacist for advice on the best option for your child. Some children experience an itchy scalp even after successful treatment and others may experience a scalp rash after treatment.

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clear Share. It looks like your browser does not have JavaScript enabled. Pyrethrum and pyrethrin are compounds extracted from flowers in the chrysanthemum family. The extraction process results in compounds that have variability in their activity.

The labels warn of possible allergic reaction in patients sensitive to ragweed, but modern extraction techniques minimize the chance of product contamination, and reports of true allergic reactions have been rare. In contrast to these extracted compounds, pyrethroids such as permethrin are organic compounds that are synthesized to mimic the action of the esters.

Permethrin and pyrethrin products may have a discernible smell, but there is no need for additional ventilation when in use. Permethrin, a pyrethroid, is the most widely used and studied pediculicide in the United States. It is approved for use for individuals 2 months and older and is regarded as the drug of choice for treatment of head lice during pregnancy.

Conditioners and silicone-based additives present in many shampoos should be avoided on the day of application, because these impair permethrin adherence to the hair shaft and reduce its residual effect.

After washing the hair with a nonconditioning shampoo and towel drying, the product is applied to damp hair saturating the scalp and working outward to the ends of the hair , left on for 10 minutes, and then rinsed off. Hair should not be shampooed for 24 to 48 hours after application.

Pyrethrin, the refined product after extraction from the chrysanthemum flower, is often synergized with piperonyl butoxide RID and generics to enhance activity. These products are available OTC in shampoo or mousse formulations for people 24 months and older. The product is applied to dry hair saturating the scalp and working outward to the ends of the hair and left on for 10 minutes before rinsing out.

Unlike permethrin, no residual pediculicidal activity remains after rinsing. Prevalence of clinical resistance may be highly variable from community to community and country to country. Resistance of head lice against permethrin and pyrethrins is mostly conferred by the recessive knock-down resistance kdr gene mutation.

Collections of head lice from different geographic areas across the United States and around the world have revealed variable frequencies of the kdr mutation, ranging from 0.

Particularly, a study in Germany reporting near-universal presence of kdr mutant alleles did not correspond with clinical failure of pyrethroids. Ivermectin, a widely used anthelmintic agent, increases the chloride ion permeability of muscle cells, resulting in hyperpolarization, paralysis, and death of lice.

Topical ivermectin lotion is applied to dry hair saturating the scalp and working out to the ends of the hair and rinsed after 10 minutes. Only 1 application is required, because when the treated nits hatch, the lice are not able to feed as a result of pharyngeal muscle paralysis and, therefore, are not viable.

The oral formulation of ivermectin Stromectol is FDA-approved for treatment of head lice in adult patients, although it does not have this indication in pediatrics. However, it is approved for treatment of other infections in pediatric patients, so it can be used for the treatment of head lice in pediatric patients.

Oral ivermectin is only available by prescription and should only be used if head lice is resistant to all topical FDA-approved treatments. However, ivermectin acts principally on glutamate-dependent chloride channels in nerve and muscle cells in nonmammals, and these are absent in mammals.

Ivermectin might have theoretical effects on central nervous system gamma-aminobutyric acid channels resulting in inhibition of neurotransmission. Oral ivermectin is likely safe during pregnancy, with limited human data showing a small risk of adverse fetal outcomes.

Permethrin remains the first-line agent for head lice treatment during pregnancy. Ivermectin oral, or in topical form such as a solution or paste for veterinary use is available through Web sites without a prescription but is not condoned for use in humans.

The dose of active ingredients may differ between human and veterinary products. Inactive ingredients may exist in veterinary formulations that would not be tolerated by humans.

Production standards and quality controls are different between human and veterinary products. Although veterinary formulations may be viewed as affordable alternatives for expensive prescriptions, products intended for animal use are never appropriate in treatment of head lice in humans.

The organophosphate cholinesterase inhibitor 0. It is available only by prescription. The lotion is applied to dry hair saturating the scalp and working outward to the ends of the hair , left to air dry, then washed off after 8 to 12 hours. The product has a strong odor, which may dissipate as it dries on the hair.

It may be prudent to use this product in a well-ventilated room or outdoors if the odor is not tolerable. The product should be reapplied in 7 to 9 days of the initial application if live lice are still observed in the interim. However, malathion has high ovicidal activity, 23 and a single application is adequate for most patients.

When compared with pyrethrins and permethrin, malathion was the most pediculicidal and ovicidal agent with highest cure rates after 1 application. Safety and effectiveness of malathion lotion have not been established in children younger than 6 years.

Because malathion is a cholinesterase inhibitor, respiratory depression may occur if ingested. Spinosad Natroba has a broad spectrum of activity against insects, including many species of lice. Activity appears to be both ovicidal and pediculicidal by disrupting neuronal activity and lingering long enough to exert its effect on the developing larvae until they form an intact nervous system.

It is available by prescription only. Spinosad should be applied to dry hair by saturating the scalp and working outward to the ends of the hair, which may require a whole bottle. Spinosad should be rinsed off 10 minutes after application. A second treatment is given at 7 days if live lice are observed after the initial treatment.

Abametapir Xeglyze is a topical pediculicide that inhibits metalloproteinases critical to egg development and survival of lice. It received FDA approval in for use in head lice in patients 6 months and older but is not yet commercially available.

It should be applied to dry hair saturating the scalp and working outward to the ends of the hair, which may require a whole bottle. Abametapir should be rinsed off 10 minutes after application, and hair can be shampooed any time afterward.

Benzyl alcohol lotion formerly known as Ulesfia was FDA-approved in for treatment of head lice in people older than 6 months. Although effective, it was discontinued by its manufacturer because of business decisions and not because of any safety concerns. This medication has not been available for many years, and there has been no indication that it will be brought back in the near future.

Although available and FDA-approved for pediculosis capitis in adults, lindane is not recommended by the American Academy of Pediatrics AAP , the Centers for Disease Control and Prevention CDC , or the Medical Letter 44 for use as treatment of head lice because of its neurotoxicity.

All topical pediculicides should be rinsed from the hair over a sink rather than in the shower or bath to limit skin exposure and with warm rather than hot water to minimize skin absorption attributable to vasodilation. Hair should not be shampooed as part of the initial rinse process, and for most products, the hair should not be washed for 24 to 48 hours after rinsing.

Itching or mild burning of the scalp caused by inflammation of the skin in response to topical pharmaceutical agents can persist for many days after head lice are killed and is not a reason for retreatment. Topical corticosteroids or oral antihistamines may be taken to relieve these signs and symptoms if itching or burning is very uncomfortable or persistent.

It is unclear whether application skin reactions would occur more in people with underlying dermatologic or systemic inflammatory conditions compared with the general population.

Application instructions and management of subsequent adverse events are unchanged. It is prudent to ensure control of the underlying medical condition, if possible, before head lice treatment. When faced with a persistent case of head lice after using a pharmaceutical pediculicide, health care professionals can consider several possible explanations, including: misdiagnosis no active infestation or misidentification ;.

inadequate treatment not using sufficient product to saturate hair; failing to follow directions ;. Considering the familiarity and convenience of OTC permethrin- or pyrethrin-based formulations and the lack of clear evidence that kdr genetic mutations diminish clinical effectiveness, permethrin, or pyrethrin—piperonyl butoxide are first-line treatments for head lice.

If treatment failure specifically, detection of live lice within 3 weeks of completing therapy is not attributable to improper use of an OTC pediculicide, then a full course of topical treatment from a different class of medication is recommended.

These alternatives when age-appropriate and not cost-prohibitive include topical ivermectin lotion, spinosad suspension, and malathion lotion. When head lice are resistant to all topical agents, oral ivermectin may be used in children weighing more than 15 kg.

A suggested treatment algorithm is provided in Fig 1. Alternative approaches listed below and in Table 2 are not FDA-approved or recommended but are included because many families may choose to use them.

Close surveillance of patients treated with products and devices not approved by the FDA may improve discovery of treatment failure early, so other evidence-based and FDA-approved treatments might be implemented. Although not condoned for treatment of head lice, a wide variety of essential oils have been used for the eradication of head lice, 45 , 46 and some studies have identified organic compounds such as anethole, cineole, cinnamaldehyde, cymene, eugenol, linalool, limonene, pulgeone, terpineols, and thymols, which are known to have neurotoxic effects on insects, and these may play a role in the reported antiparasitic effect of some essential oils.

Products containing essential oils vary in their composition even from batch to batch , and responses to them may not, therefore, be consistently reproducible.

Many of these oils and their components are known to be sources of contact irritation and contact sensitization, and may cross-react with other agents the patient is using. Although some essential oils such as eucalyptus, lavandula, melaleuca may have pleasant scents, others may have unpleasant or offensive odors, limiting their use.

Recent publications also raise the possibility that some essential oils such as lavender appear to be associated with premature thelarche and prepubertal gynecomastia because of the estrogenic and antiandrogenic properties of the oils. A citronella essential oil formulation has been shown to be effective in a single clinical trial in Israel.

It was used as a repellent for head lice as a means of reducing the incidence of reinfestations and to minimize lice transmission among children and adolescents. As natural products, essential oils are not required to meet FDA efficacy and safety standards for pharmaceuticals.

Although many plants naturally produce insecticides that may be synthesized for use by humans, some of these insecticidal chemicals produce toxic effects, as well. The safety and efficacy of natural or herbal products are currently not regulated by the FDA, and until more data are available, their use in infants, children, and adolescents should be avoided.

A meta-analysis comparing neurotoxic versus occlusive topical agents suggest the latter being more effective, although significant bias existed. Dimethicone is an emollient that has been used for head lice treatment. Natrum muriaticum is available OTC brands include Vamousse and is essentially hypotonic saline solution table salt in varying concentrations with the intent to dehydrate lice and nits.

No studies are available to assess efficacy. The AirAllé device formerly known as the Lousebuster is a custom-built machine that is cleared by the FDA. A regular blow dryer should not be used in an attempt to accomplish this result, because investigators have shown that wind and blow dryers can cause live lice to become airborne and, thus, potentially spread to others in the vicinity.

The published studies on desiccation as a head lice treatment note that no adverse outcomes were reported. Although there is little peer-reviewed information in the literature about the benefits of the manual removal of live lice and nits, the inherent safety of the manual removal relative to the minor toxicity of the pesticides is real and can be part of the toolbox used by medical providers when determining treatment options.

The manual removal process may be beneficial in allowing a caregiver and child or adolescent to have some close, extended time together while safely removing infestations and residual debris. Furthermore, manual removal of nits will help to diminish the social stigma and isolation a child or adolescent can have in the school setting.

Individuals may also want to remove nits for aesthetic reasons or to decrease diagnostic confusion. Nit removal can be difficult and tedious. However, it appears that it is less important the type of comb used and rather that combing occur after treatment, which may be most easily accomplished on wet hair.

Studies have suggested that head lice removed by combing and brushing are damaged and rarely survive. Their instructions warn not to use on people with a seizure disorder or a pacemaker. Other devices under preclinical investigation include nit combs that use ultrasonographic actuation or production of localized ionized gas plasma to loosen or kill nits and lice.

Vinegar or vinegar-based products are intended to be applied to the hair for 3 minutes before combing out the nits. There are Web sites suggesting that these products may be used and rinsed off before applying permethrin, although no clinical benefit has been demonstrated.

Although effective for removing head lice and nits, shaving the head generally is not required nor recommended, because it can be traumatizing to a child or adolescent and distressing to the caregiver. Highly flammable substances, such as gasoline or kerosene, or products intended for animal use eg, flea shampoos are never appropriate in treatment of head lice in humans.

As new products are introduced, it is important to consider effectiveness, safety, expense, availability, patient preference, and ease of application.

Assessment of the severity of the infestation, the number of recurrences, the local levels of resistance to available pediculicides, exclusion of children or adolescents from school, and the potential for transmission are also important when deciding about the use of newer products.

If a person is identified as having head lice, all household members should be checked for head lice, and those with lice or nits within 1 cm of the scalp should be treated.

In addition, it is prudent to treat family members who share a bed with the person with infestation, even if no live lice are found.

Fomite transmission is less likely than transmission by head-to-head contact 6 ; however, it would be advisable to clean hair care items and bedding used by the individual with the infestation.

Only items that have been in contact with the head of the person with infestation within 2 days before treatment should be considered for cleaning, given the fact that louse survival off the scalp beyond 48 hours is extremely unlikely. Such items may include clothing, stuffed toys, headgear, furniture, carpeting, and rugs.

Machine washing with hot water and hot air cycles should be used, because lice and nits are killed by exposure for 5 minutes or more to temperatures greater than °F. Pediculicide spray is not necessary and should not be used. Items that cannot be washed can be bagged in plastic for 2 weeks, a duration when any nits that may have survived would have hatched and nymphs would die without a source for feeding.

Dry cleaning is another option for clothing and similar items. Several public health Web sites, as well as the CDC, state that exposing infested items to below-freezing temperatures in home freezer or outdoors may kill head lice and nits, although duration varies.

Exhaustive cleaning measures are not beneficial. It is unlikely that all head lice infestations can be prevented, because children and adolescents come into head-to-head contact with each other frequently.

It is prudent to teach children and adolescents not to share personal items such as combs, brushes, hats, and pillows, but individuals should not refuse to wear protective headgear because of fear of head lice.

Regular surveillance by caregivers is one way perhaps on a monthly cadence to detect and treat early infestations, thereby preventing the spread to others. Close quarters shared by persons in congregate settings such as group homes, shelters, long-term care facilities, and immigration centers have the potential for direct head-to-head contact or fomite transmission with persons not otherwise related to the infested individual.

If an outbreak occurs in a congregate setting, priorities of outbreak control are to reduce the number of persons affected and educate unaffected individuals to not engage in activities that may result in transmission of head lice.

Close contacts usually family members should be examined and treated if active lice or nits are seen. Individuals who shared beds with an infested person should also be treated. After treatment, close follow-up of individuals in the next 3 weeks the life cycle of the organism is prudent to detect any live lice which survived hatching from nits not killed by the treatment.

Screening for nits alone is not an accurate way of predicting which children or adolescents are or will become infested, and screening for head lice has not been proven to have a significant effect on the incidence of head lice in a school community over time.

In addition, head lice infestations have been shown to have low contagion in classrooms. School screenings do not take the place of these more careful checks by the caregiver. The success rate in the permethrin group was At the four-week follow-up visit, the rates were 72 percent, 78 percent and No major side effects were noted; three children discontinued treatment because of a rash that appeared to be related to administration of TMP-SMX.

The authors conclude that combination treatment with 1 percent permethrin creme rinse and a day course of TMP-SMX is an effective treatment for head lice infestation. This therapy should be given only to patients who have previously failed treatment or in whom resistance is suspected.

It should not be considered first-line treatment. Hipolito RB, et al. Pediatrics March ; e This content is owned by the AAFP.

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