My Doctor Online The Permanente Medical Group

Causes

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Head lice are very contagious; however, they do not jump or fly. Your child can become infested with head lice after being in close contact with someone else that has them. Your child might get head lice after sharing combs or brushes, clothing, or hats or after touching the clothing or bedding of a person who has head lice. Because head lice are tiny, they often cannot be seen traveling to the next person.

Children between the ages of 3 to 11 and their families get head lice more often than other age groups.

A head louse can survive up to 30 days on the scalp. An adult louse can deposit 7 to 10 eggs (nits) per day on the hair shafts close to the scalp. A nit is about the size of a sesame seed. A nit hatches within 10 days, and the small louse (nymph) makes its way to the scalp where it sucks blood to stay alive. A nymph becomes an adult louse in 7 to 10 days. The adult female louse then lays more nits. Usually, there are no more than 10 to 12 live head lice on the scalp at one time, although there may be hundreds of nits that have not yet hatched. This cycle continues until you notice the infestation and destroy the lice and nits.

How to Tell if Your Child Has Lice

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Children may complain of a "tickling" feeling in their hair. They may also have intense itching on the scalp and develop red bumps or sores from scratching their heads.

Your child may not have other symptoms from head lice. Head lice do not carry disease, unlike other types of lice (body lice).

Checking for Lice

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You can check your child for lice at home. Wear disposable gloves to check your child's head closely for nits or head lice. Place your child's head under a bright light and carefully part their hair. Look closely at the hair shafts near the scalp to identify nits, which look similar to sesame seeds attached to the hair shafts. You may need to use a magnifying glass to see the nits. Continue parting the hair in small sections until you've examined your child's entire head.

It is sometimes easier to see nits that are deposited in the hairline above your child's ears and around the neckline. Rarely, nits may be deposited in the eyebrows or eyelashes, so be sure to also check these areas as well.

Prevention

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To prevent an infestation of head lice, make sure your child understands how important it is to never share combs or brushes with friends or any other person. They should also not place another person's hat or hair ornaments (such as barrettes) on their head or wear someone else's clothing, especially if that person has head lice. They should also not share towels, bedding, or toys with someone who has head lice.

Schools and daycare centers should have policies in place to alert parents when there is an outbreak of head lice. They should also have disinfecting practices in place to ensure that the head lice and nits are destroyed to prevent repeat outbreaks. Similarly, if you find that your child has lice, notify your daycare provider or child's school.

Treatment

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Even if you only find one nit, we recommend that you treat your child for head lice.

Most lice can be safely treated at home, usually with a combination of over-the-counter medicated shampoo and fine-tooth combing to remove nits.

However, it is important to keep in mind that medicated shampoos and lotions used to remove lice and nits can cause side effects in children under 1 year of age. If your baby is younger than 1 year old, please call us before using a lice shampoo or lotion.

Head lice removal products can also cause significant side effects if you overuse them. Do not repeat a treatment more than once –  even if the product is nonprescription – without calling or e-mailing us first.

Medicated shampoo

You can purchase a medicated shampoo at your local drugstore. Lotions and shampoos that contain 1 percent permethrin (such as Nix) remove nits and kill lice. Nix is safe to use on children ages 1 year and older.

The medication needs to stay on your child's hair for 8-10 hours, or overnight, so you may want to start the treatment at bedtime. 

Review package instructions for application technique. Also, be sure your child's hair is loose. You will need to remove braids.

Treating your child

Wash your child's hair with shampoo, but do not use conditioner.

• Rinse hair with water.
• Towel dry hair until damp, not wet.
• Apply medication to hair as directed on package. Note: Do not use near eyes. (If your child has nits in his or her eyebrows, apply Vaseline 4 times daily for 7-10 days.)
• Use a plastic showercap to cover your child's hair.

8-10 hours after application, rinse medication out with WATER ONLY:

• After rinsing, immediately start removing nits with nit comb while hair is damp
• All family members should put on clean clothes immediately after treatment
• Do not use shampoo, vinegar or nit removing solution for 48 hours
• Do not use hair conditioner for 1 week after treatment

Nix continues to kill lice and eggs after it has been rinsed off. After 1 week, check your child's hair and scalp again. If nits or lice are present, we recommend that your re-treat your child using the same steps and non-prescription medicated shampoo. This second treatment can help ensure that all live lice are killed.

Once you have treated your child, be sure to follow the directions in the home treatment section, as well. This will ensure that you remove nits from your child's hair and home environment.

Prescription medications

If head lice return or are not destroyed with nonprescription treatment, we may recommend a prescription lotion or shampoo. 

Removing Nits

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Another important part of treatment is to remove all nits from your child's hair with a special nit comb that usually comes with the medicated shampoo. Leaving even one nit may result in reinfestation of lice. Repeat combing your child's hair with the nit comb every 2 to 3 days for up to 2 to 3 weeks to ensure you've removed all lice and nits.

You may want to first apply a small amount of dishwashing soap or olive oil through your child's hair to help loosen the nits from the hair shafts. You can also apply bee's wax to the nit comb. Metal nit combs with fine teeth sometimes work better than plastic nit combs.

If your child has head lice, be sure to check all other family members for infestation, including yourself. Anyone who has signs of lice should be treated.

Around the home
Thoroughly wash all bedding and clothing that your child has come in contact with (including your own) in hot water with detergent. Lice can live for a short time when not on a human body, so you must make sure you kill any that are alive on clothing or bedding.

You can seal items that are not washable (for example, stuffed animals) in a plastic bag for 3 to 4 days to kill adult lice or recently hatched nymphs.

Be sure to also disinfect toys and your child's play and living areas. Be sure to thoroughly vacuum carpets and furniture and then immediately empty the vacuum filter or bag.

Returning to school
Children can return to school once you have treated them. Children should not miss school because of head lice, but be sure to check with your child's school or daycare to learn about their policies.

Your Child's Care with Me

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If you are concerned about your child’s symptoms, and your concerns are urgent, please contact our Appointment and Advice line, which is available 24 hours a day, 7 days a week.

Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.

Depending on your child’s symptoms and medical history and your preferences, the nurse may:

• Provide advice about how to care for your child at home.
• Send me a message so I can follow up with you directly.
• Offer you a telephone appointment with me or a trusted colleague.
• Make an appointment for your child to be seen in person.

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site, once you have registered to use the Act for a Family Member feature. You can also schedule an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.
• Depending on your child’s symptoms, you may also have the option to schedule a telephone appointment – with me or another pediatrician, if I am unavailable. Please let the telephone staff know what you prefer and what is convenient for you.

Coordinating Your Child's Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care for your child easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your child’s care to stay current on your child’s health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your child’s condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your child’s visit, you will receive information about when he or she is next due for a well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed. 
• At the end of your child’s visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your child’s height, weight, or vital signs. (If your child is under age 12, you can also view these summaries online, under Past Visits.)

If you schedule a telephone appointment

• In addition to in-person visits, we now offer the option of telephone appointments for certain common pediatric concerns. Depending on your child’s symptoms, you may have the option to schedule a telephone appointment with me or another pediatrician, if I am unavailable. We will call you at an agreed-upon time, at whichever phone number is most convenient for you.
• Many parents like this new option, but if you prefer to be seen in person, it’s always your choice. Just let the telephone staff know what type of visit you prefer.
• Telephone appointments are not appropriate for all health concerns. The advice nurse can help you decide what type of care is best for you and your child.

If I prescribe medications

We will work together to monitor and assess how your child’s medications are working and make adjustments as needed. 

Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically, in advance.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your child’s medications at the pharmacy.
• If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department. 

When the results are ready, I will contact you with the results by letter, secure e-mail message, or phone. In addition, you can view most of your child’s laboratory results online, along with any comments that I have attached to explain them.

If I refer your child to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your child’s condition. In some cases, I may contact them during your visit, so we can discuss your child’s care together. If we decide your child needs a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

Convenient Resources for You

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My goal is to provide high-quality care and to offer you choices that make your child’s health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to help you manage your child’s care at any time that is most convenient for you. From my home page you can:

Manage your child’s care securely

You can begin to manage your child’s care online by requesting access through our Act for a Family Member feature. Once you have added your child to your account, you can:

• View and compose secure e-mail messages.
• Manage your child’s prescriptions and refills.
• Schedule well visit and nonurgent appointments.
• View your child’s Preventive Services to see whether your child is due for any immunizations or well visits.
• If your child is under 12, you can also view most lab test results and review information about past visits.

Learn more about your child’s condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your child’s condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Help your child stay healthy

• Sign up for our online newsletters for parents, customized to your child’s age.
• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you keep your child healthy.
• Check to see when your child is next due for immunizations and a well visit (checkup).