Prevention and treatment of head lice in children

Head louse infestations (pediculosis) are prevalent worldwide. In developed countries, the infestation rate of 4- to 13-year-old children remains high despite preventive efforts. This is due to the existence of numerous ineffective pediculicides, the incorrect use of the effective agents, toxicological concerns and the development of louse strains resistant to insecticides. One of the most effective tools for the prevention and control of lice is the louse comb, which should be used regularly for the detection of living lice at an early stage of infestation, and as an accessory to any treatment method to remove living and dead lice. The louse comb can also be used systematically for the treatment of infestations, for confirmation that treatment with pediculicides has been successful, and for the removal of nits (dead eggs or egg shells). Most pediculicides are only partially ovicidal. Therefore, 10 days after beginning treatment with any antilouse product, the scalp of the child should be examined. If no living lice are found, the treatment should be discontinued. If living lice are still present, treatment should be continued with a product containing a different active ingredient. Suffocating agents such as olive, soya, sunflower and corn oils, hair gels and mayonnaise are able to kill a significant number of lice only if they are applied in liberal quantities for more than 12 hours. However, they lubricate the hair and therefore may facilitate combing and removing lice and eggs from the scalp. Nits may remain glued on the hair for at least 6 months, even after a successful treatment, and lead to a false positive diagnosis of louse infestation. If nits are seen on the hair, the child should be examined, but treatment should be initiated only if living lice are found. Formulations containing 5% acetic acid or 8% formic acid, as well as acid shampoos (pH 4.5 to 5.5) and conditioners, in combination with a louse comb, can be helpful for removing nits. There is no conclusive evidence that using essential oils to repel lice is effective. Regular examination of the child's head using a louse comb is the best measure to detect re-infestation at an early stage. Educating caregivers, nurses and teachers about louse biology, epidemiology, prevention and control is of paramount importance. The psychological effect of an infestation with lice is significant and often associated with anxiety and fear. The child should not be made to feel responsible for having lice, or be punished or reprimanded.