Head lice: Scratch the belief your child is safe

While head lice had been on Sarah’s radar — she uses a preventative spray on her children’s hair — she was surprised her eight-year-old was only back in school 10 days when the problem manifested. “I hadn’t even had a chance to get a new bottle of spray before she arrived home with head lice. I felt a little daunted at having to deal with it, but I wanted to do it thoroughly, so they wouldn’t linger.”

Clare Fitzell, head of strategic policy at the Irish Pharmacy Union, says the life cycle of head lice explains why treatment to eradicate them has to be so meticulous.

“Head lice can’t jump or hop, but they can crawl fast from one head to the next. So maybe you get two adult lice and the female lays eggs — called nits — at the base of the hair, close to the scalp. They like that warmth.

“It takes six or seven days before the eggs hatch, and the adults continue laying eggs: 10 the first day, the same the next day, and so on. It takes five days for the young lice to grow and after about 10 days they start mating and they go on to lay eggs, and by now you have much more live lice in your hair.”

Fitzell says that we can only treat the problem once live lice are found in the head. “They can be very hard to detect in the early stages. Nits are a brownish colour, while live lice may be translucent, with a dark patch. The live lice look like an insect and are a lot easier to detect. Discarded egg shells are white.”

While you could unknowingly have head lice in their initial stages, you will know eventually. “With repeated cycles, you’ll start to feel the itchiness and you’ll see them,” says Fitzell.

Head lice are not a medical issue, but they will not go away on their own. The key to treating them is to break their life cycle, which is “not a two-minute job”, she adds.

Meticulous fine-combing can work to get rid of head lice, but it needs to be fastidious. “You’d have to get every egg and all live lice. And you’d have to keep doing this until you knew you’d got rid of everything. Most people choose to treat.”

Monitor for a month

Products range across natural (generally tea tree-based), chemical (more like an insecticide), and oily, which coat the lice and smother them.

Fitzell says: “If someone has an allergy or very sensitive skin, you might veer towards one product over another. With most products, you have to reapply seven to 10 days later.

“You do need to follow the instructions exactly and to focus on the scalp area, making sure it’s completely soaked with the treatment. People can think it’s a once-off treatment, but you have to keep a close eye for the next month or so, and fine-combing is very important.”

Treatment can be costly for parents who are managing head lice among multiple children, so Fitzell says there is a common misconception that, ‘Oh, we’ve got the head lice back again’, when, in fact, the first infestation wasn’t eradicated. “You might have just missed one, or missed an egg: Managing it requires a lot of patience and determination.”

Sarah found the reality of treating the head lice wasn’t as bad as she’d feared. “I alerted the school straightaway and they emailed parents, letting them know there was a case in the class.”

It was time-consuming. “I combed through the hair first to remove the lice and then applied the spray, which stayed on the hair for a period, before being washed out. I repeated this two nights in a row. On the third day, I thoroughly checked the hair. Luckily, the lice were visible in her fair hair. I was confident by the third day that they were all gone.

“I continued to check her hair daily for about a week, just in case I’d missed any. Thankfully, she had no itch, and I do feel it has been sorted. I also treated my son’s hair, as a preventative measure.”

One in 10 children suffers from head lice at any one time, with 80% of head-lice infestations occurring between the ages of four and 16.

“It’s an all-year-round problem, but they do seem to flare up at the start of the new school year and after Christmas.

“They never disappear, however: A percentage of the population always has them,” says Fitzell.

Not a wealth or cleanliness issue

Head lice are difficult to prevent. And while some countries offer a head-lice school-check service, Fitzell does not think this is warranted. “It would need to be done every week to be sure, because you could check 10 days later and find an infestation. I think it’s better if people take individual responsibility.”

A good preventative starting point is to keep hair tied back and to avoid sharing combs, hats, or other headwear or accessories. “If your head is very close to someone with an infestation, it’s just bad luck if you get it. Of course, you don’t want your child to not socially interact with their peers, so vigilance is needed.”

This, says Fitzell, means, routinely, on a weekly basis, checking your child’s hair.

“Invest in a good nit comb with very fine teeth. You have to section the hair well — a bit of conditioner will help — and then comb through the hair, section by section, to get rid of anything.”

A mum of three who has, “unfortunately, seen my fair share” of head lice, Fitzell does not believe there should be any stigma around having it. “It’s such a ubiquitous issue. Because I work in a pharmacy, I know how widespread the problem is — no one’s immune to getting head lice. It isn’t related to socio-economic status or whether your hair is clean.

“And these insects are very effective at what they do. They’re a fabulous parasite — they’ve been around so long and they very rarely cause any harm to the host.”

On the issue of stigma, Sarah says: “No one likes to admit when their child has head lice — and, of course, it is horrible and creepy to think about — but it’s a thing most parents will face at some stage. I found it was easily enough sorted and the shampoo was very effective — and schools are well-versed in alerting other parents anonymously.”

For information on symptoms, treatment, and prevention of head lice, visit www2.hse.ie/conditions/head-lice-nits/