Question period...

Many questions have come up in recent comments and conversations. I think that there are others that might have similar questions, so I thought I'd answer some questions here to the best of my ability.

Question: I combed and got rid of the lice but found no nits.  Am I lice free?

Answer: Where there's smoke there's usually fire and where there's lice, there are usually nits.  Not always, but you should keep on wet combing every few days just in case a missed nit turns into a unwanted bug.  When you have been regularly combing for 2 weeks with no new bug sightings, that's when I think you can breathe a sigh of relief and reduce your combing to routine lice checking.

Question: Two months ago we had head lice and we beat it but now my daughter has it again.  Why?

Answer: I don't know.  Either something was missed the last time your daughter had lice or she just got it again from someone else.  Beating lice once doesn't mean that you will never get lice again.  Just take a breath and start combing.  Remember, don't waste your time on ineffective busy work - no extra laundry washing, vacuuming, or bagging up toys.  Just get those suckers off the head.

Question: Is there anything I can do to prevent from getting head lice?


How many studies will we need before we see pyrethrin/permethrin as ineffective with head lice?

These are the related pesticides in products such as Nix and R&C.  I don't know how many studies we will need before our health professionals stop recommending these products but here's another one. It basically says that almost all North American lice have developed a genetic resistance to this pesticide.  Please, please, please don't waste your money on it. The effectiveness quoted in the pamphlets of these products was true when they first came out in the 1980s but our overuse of these products have made them almost useless now.  The last line of this study's abstract says, "Alternative approaches to treatment of head lice infestations are critically needed." Enough said.

Hair Conditioner - fights more than split ends!

If you have ever had head lice, and I am assuming that you are acquainted with it since your reading this blog, then you know that nits are a pain to remove.  Lice eggs and egg shells are cemented to the hair so well that they can be stuck on the hair long after the lice are gone.  This is one reason why I dislike no-nit policies - they don't take this into account. I am sure that many a child has been sent home from school because a nit was seen when no actual lice were present.  The only way to be sure you have head lice is to actually find one on the head.  I have gone into homes where parents found some nits but no lice - and I didn't find any lice either.  The nits were usually a few inches away from the hair shaft, indicating that they had been laid long ago,  and I then had the good fortune to tell the parents the child had lice at one point but for some reason doesn't any more.

This problem of cemented nits has spawned an small industry of products claiming to dissolve the substance that glues the nits to the hair shaft.  Sprays, rinses, creams - you can find many that claim to loosen or remove nits.  Probably the most common home remedy that I have seen people use for nit removal is vinegar.  Have you ever had vinegar in your eyes?  The kids whose parents gave them a vinegar rinse are not usually appreciative of this technique. 

As you may know, I feel the best way to remove lice, eggs, and shells is manually.  I recommend using a good metal lice comb (with very rigid teeth, such as the Licemeister or the Nit Free Terminator).  But I also recommend wetting the hair and slathering it in cheap hair conditioner.  This process of wet combing is proven to greatly increase your chances of lice detection and it is a non-pesticidal and effective way to remove lice and nits.  The conditioner helps the hair remain wet (slowing down the lice), makes it easier for the hair to stay detangled, and allows the comb to glide through the hair more smoothly.  I always recommend the cheapest conditioner because you may need a lot of conditioner and beating head lice should never break your budget.

Interestingly, hair conditioner was part of a head lice study that came out this past spring.  The study was called "Efficacy of Products to Remove Eggs of Pediculus humanus capitis (Phthiraptera: Pediculidae) from the Human Hair". You can read the study's abstract here. In other words, it compared different products that made claims that they removed lice eggs from the hair shaft. The conclusion? Egg removal was significantly helped with just water and hair conditioner.  Specialty products were no more effective than these simple tools and some substances had no effect at all. 

So, join me in buying that vat of generic conditioner from your local dollar store. This is just one more example of how effective does not have to mean expensive.


More great information...

Here is a link to a great information source.  It is a health bulletin on head lice from the Cardiff and Vale University Health Board in Wales.  It gives links to great research and what I love about it is that it includes wet combing as a main treatment in the fight against head lice: http://www.wmic.wales.nhs.uk/pdfs/bulletins/Head%20Lice%20Bulletin%20Jan%202014.pdf 
While this publication also gives lots of information about chemical lice "treatments" (and you know I don't recommend them), it at least does not recommend products with permithrin (in Canada, this would be Nix which in my experience is the most prescribed lice treatment by health professionals).  I like that this article says that you don't have head lice if you don't find a live louse on the head.  (Old nits can stick around for a long time and do not indicate an active case of head lice.) Around wet combing, I have some different opinions than what is presented in this document - for instance, I have personally found metal combs to be more effective and I see no need to shampoo before a wet combing unless you want to.  I also much prefer the use of conditioner over vegetable oils - conditioner is much less messy, smells so much better, and rinces from the hair easily, whereas vegetable oils often don't come out without a stronger detergent such as dish soap. 
This publication mentions chemical treatments that are mechanical.  What this means is that they don't kill the lice and eggs by poisoning them.  (Nix and other permethrin based products do this - they are neurotoxins and the lice can adapt to these poisons over time.)  Mechanical treatments coat the lice and eggs and kill by either drying out the shell of the bug or egg or by plugging up the openings (mouth and anus) of the bug.  The idea is that because the animal is not affected by ingesting the product, they won't build a resistance to it. This may be a selling feature but I have been to many homes where all treatments we have available in Canada, including mechanical chemical treatments,  have been tried according to the product directions and living lice were still found.  Because the chemicals are not 100% effective, because they are costly, and because they all recommend manual lice removal to occur along with the treatment, I just think we should skip the unnecessary step and focus on the treatment that is readily available, cheap, and effective:  Multiple wet combings over time until there are no new sightings of lice or their eggs.  This document says that you can stop combing when you have had 3 thorough combings where no lice or eggs were found. On this blog, I say that you should have 2 weeks of combings with no sightings of lice or their eggs before you can say you are lice free.  If the 3 combings listed in this document are 4 days apart from each other as recommended, it means you have to comb and find nothing for 12 days.  12 days.  Two weeks.  Almost the same deal.
Anyway, this bulletin is a nice, research based overview that for once does not say that lice are spread in hats and bedding.  Check it out. 


The comb is only as good as its user.

Here's a blurry picture of my cheap but good purple lice comb that I bought at Wal-Mart for under $10.  I got to use it this evening. Tonight my daughter had a wonderful friend over.  The friend was scratching her head at supper time so I asked about her head lice - my daughter told me she had been dealing with it.  This girl said that her parent said her hair would be cut right off if they didn't get a handle on the lice soon.  I offered to do a combing.  After supper, we put on a movie (Puss In Boots) and got to work.  She sat on a stool I sat on the couch behind her.  I sprayed her hair with water, conditioned it, detangled it with a brush, and then started combing with the lice comb.  Hundreds of eggs. Dozens and dozens of bugs.  As I was combing, I told this friend that I would be sending the lice comb home with her so she could continue combing every couple of days.  I was surprised at her response.

"Oh, we have that comb."

Upon talking to the parent later, I found out that comb had been used a couple of times but was then set aside because they didn't feel it was doing the job. Now, this girl had quite a lot of lice, so I do not know how the comb was being used or if it had really been used at all.  I must mention that this parent is not neglectful. Time, energy, and money had been put into this problem; the parent tried to deal with the child's head lice by giving the child a lice "treatment', doing extra laundry, and spraying the furniture with some supposed lice-killing chemical. Attention was given to the problem.  However, the problem didn't go away and for some reason, the lice comb was not really given a chance.

But it's the lice comb that works.  So-called "treatments" and "shampoos" will not solve the problem. Spraying furniture does nothing. The key to beating head lice is combing over time.  I told this parent to bring out the comb again and to comb every couple of days for a couple of weeks.  The combing sessions don't have to be marathons - even just combing for a 1/2 hour every couple of days will lead to success.

If you are dealing with head lice, stop looking for the quick fix.  Get combing and keep on combing until the lice and nits are gone.  If the chemical treatments worked, I would recommend them, but they don't.  A lice comb may not seem like a very snazzy solution and may not make the promises of a lice "shampoo", but it is simply your best tool in the fight against head lice.


I thought it was just dandruff...

When I ask parents when they first noticed their child's head lice, it usually becomes clear that the signs of head lice were present long before the parents would like to admit.  They say things like, "Sure, my daughter's head was really itchy, but I thought it was just because of dandruff" or "My son's been taking swimming lessons and I thought his head was itchy from the chlorine".  Sometimes, these parents have had no experience with head lice or they never knew anyone who had it so the possibility of head lice doesn't even come to mind.  However, many parents  are just in denial about head lice because they don't want to have to deal with it.  Later they tell me, "I thought it might be head lice but I didn't do anything at first because I was too busy" or "I knew that her friend at school had recently had head lice but I didn't think it would happen to my child".

In my house we have a rule - if you scratch your head, you get a quick spot check.  It is even true for me - if I scratch my head, my youngest daughter says, "Mom, c'mere. Let me take a look."  And these spot checks, because they are not always reliable, are still done in conjunction with weekly wet combing checks. Of course, someone's head is really, really itchy, they get a wet combing check right away. (I should mention that routine combings will often prevent the itchiness of head lice. Most people are asymptomatic - they don't get an itch - until they've had head lice for quite a while.  Routine combings will often find the bugs before the itching starts.  It happened to me!)

If someone is itchy, investigate. If you find that you or your child do have a lot of dandruff, use a dandruff shampoo to remove the dandruff before doing a check for head lice. With head lice, you need time to be on your side and the sooner you find the little critters, the sooner you can get rid of them. 


Of all the human parasites, head lice is the one you want.

I love talking with people about head lice.  Think Bubba in 'Forest Gump' talking about shrimp or Harlan Pepper in 'Best in Show' naming nuts.  I just love talking about head lice.  However, it seems like the conversations that people have with me about head lice turn to talk about other parasites...bed bugs and scabies.  And in my mind, these parasites are a whole different ball game. I once heard someone say, "I'd rather have bed bugs than lice.  At least they don't live on your body."  My response was something calm and rational like, "ARE YOU KIDDING ME!?!?"

Head lice, though they live on your body, are simple to treat.  Just get the bugs and the eggs off the head.  They won't survive for very long off of it.  If you forget the hype and look at the research then you know that you can deal with them relatively quickly and for little cost.  You don't have to worry about your home, belongings, or clothing. Head lice are a pain but the problem is still quite contained and manageable.

Bed bugs are different.  They can reside almost anywhere in your home. They can live without a host for a year. As with head lice, they are manageable but are much harder and more expensive to treat and usually require a home treatment of some kind which is costly.  You often have to replace some furniture.  If you are dealing with bed bugs, I highly recommend that you talk to a professional exterminator - even if you don't use them, they might help you get your facts straight and equip you with the knowledge to help yourself.

Scabies are different.  They live under your skin.  They are microscopic.  They are contagious. Most doctors diagnose scabies based on the skin reaction - you usually need to get a skin scraping from a dermatologist to get an actual proper diagnosis.  With scabies, our only line of defense is pesticide and even after treating yourself and everyone in your household,  it is still difficult to be sure if you have actually beaten it. You have to do laundry, vacuuming, cleaning. Dealing with scabies is real work. You can beat scabies but it can be cost and labour intensive.

Other lice, like body lice and pubic lice (crabs), are pretty easy to treat.  Got body lice? Wash your clothes in hot water, dry them on high heat, always wear clean clothes, keep yourself clean. Got crab lice? Well, you might not find a buddy to remove them manually, so it might be easier to try the pesticidal cream which is still effective on these little critters.

With any of these parasites, we have to push back the paranoia and get informed. We need to stop giving energy to action that doesn't actually work and be willing to work on doing what is actually effective. Keep things in perspective - these parasites just create an itch. They are an uncomfortable inconvenience, not a life threatening situation.  We can handle that, can't we?  Still, I want to stick up for the little pediculosis capitis. The little head louse is hearty and resilient but it also has its weaknesses.  Even without a comb, we can remove lice and nits faster then an adult louse can lay them, so we always have the advantage in the fight. If I had to choose between parasites, I'd always pick head lice - because it is the only one I can actually pick.


What's the least you can do to feel sane?

Last spring, my friend's daughter got head lice.  Naturally, my friend called me for reassurance. Though my friend and I have had many discussions about head lice, her perspective on head lice changed when it actually made an appearance in her own house.

She said, "I know that the research says that doing cleaning won't help. But I want to clean.  I want to vacuum everything, including the children. I want to do laundry.  It would make me feel better."

I like a clean home as much as the next person, but I know the cleaning marathons that are triggered by the discovery of head lice.  All other activity (including sleep) is discontinued in and out of the home.  What's worse is that people actually cut back on the time they spend in lice combing because they are too exhausted from their newly adopted morning-to-night rituals (get kids up, strip beds, throw bedding in wash, vacuum mattresses, vacuum room, throw pajamas in wash, throw pillows in the dryer...all before the morning coffee.) Though NONE of this helps, I understand that it is our natural survival instincts that get us moving in a crisis.  Being busy makes us feel better.  Knowing the panic that ensues in a home that just discovers these uninvited guests, I asked my friend a question:

"What is the LEAST you can do to still feel sane?"

My friend already knew that she needed to put the time and effort into a thorough wet combing of her daughter's head every couple of days over the next 2 weeks and that this would already give her plenty of work to do.  But in her mind, she wanted to do more.  In answer to my question, she said, "The pillows.  I think my rational mind would let me give up most of the cleaning, but I know I couldn't rest if I didn't change my daughter's pillow case every day." 

"Ok, as long as you know that this activity will have no effect on your daughter's head lice, right?"

"I know."

So my friend resisted the demon of excessive cleaning and even stopped changing the pillowcase after a couple of days.  She used no chemical treatments and simply used a proper metal lice comb on her daughter's wet, conditioned hair.  Though she combed over a 2 week period, no lice or eggs were seen after the 3rd combing. When I congratulated her on the success of her efforts, she admitted that she had doubted that the solution could be so simple.  (Simple but not easy; even though things get easier and faster as you go, keeping up with the combing is still a pain in the arse.) I asked her why she stopped washing her pillowcases every day.  She said that as she did more combings, her confidence in her own abilities to detect and remove the bugs and eggs grew every day.  She was pleased that I had steered her away from doing more and being less effective.

If you have just discovered head lice in your home, get informed before you do or spend anything. If you are reading this blog for the first time, check out the other posts.  Learn about wet combing. Read the research links.  Think with your head based on the most current knowledge and try not to give into cleaning urges.  But if you just can't resist, then choose your battles wisely.  Ask yourself the question, "What is the least I can do to feel sane?" Not the least you can do in the combing/picking department - nothing will relieve you of this necessary task - but what is the least you can do in the home. Less time cleaning means more time combing. Get a good comb, do the combing, and trust the process.


Have a question? It might already be answered...

This is a small request from me to anyone who wants to contact me regarding their head lice struggles.  Please read a number of my blog posts before you contact me.  Most of the questions I receive have been answered in past blog posts.  When someone writes to me and says, "I love your blog! I've read every post!  I have a question...when can I stop washing all my bedding every day?", then I know that this person has not read much of my blog because I have said time and time again that doing any extra cleaning/laundering is a waste of time.  Many "experts" in different fields have very simple messages and techniques.  In the area of parenting, the Supernanny promotes the "naughty spot", positive reinforcement, and consistency. In finance,  Gail Vaz Oxlade promotes techniques such as using cash only, developing a realistic budget, writing down every purchase, and communicating with your partner.  My message in the field of head lice prevention and removal is also simple and can be summed up in a few points. 

So, if you have read this blog, here are the highlights:

1. Don't waste any extra time or energy doing cleaning or laundering.
You don't have to wash the bedding or clothes (including hats), vacuum the rugs or the furniture, pack away the toys or stuffed animals.  Clean your home as you would in your regular routine.  Lice will not survive off of the head.

2. Don't waste your time and money on ineffective quick fixes.
I don't recommend any "shampoos" or "treatments"with the exception of some excellent metal lice combs.  The solution to the problem of head lice should never cause financial hardship. 

3.  Do commit time and energy to what's on the head.
A thorough wet combing ever 2-3 days until 2 weeks have gone by with no evidence of head lice is a system that works.  Make sure you have a proper metal lice comb.

4. Talk to others and educate them about what really works.
I find it hard to believe that in a world where sex is on almost every billboard and violent shows are on TV at all times of the day, that the topic of head lice still brings shame.  This shame is based in a misunderstanding of the problem.  Read the research (there are links on this blog).  Get equipped and start talking with others.  Become the lice lady/man in your area.

Of course, there are more details to be found within each of these simple messages.  Normally, I would link these points to other posts that support their message, but this time I want you go on a treasure hunt.  Click around the blog and look at past posts.  Once you've read the info, if you still haven't had your questions answered, feel free to leave your question in the comments section of any post.  I will be happy to answer.


Thoughts on Tea Tree Oil

Let me start this post by saying I don't recommend, endorse, or even use any special lice shampoos or treatments.  If you've read this blog before, you know this.  However, you also know I'll let you know about lice research.  And one of the questions I get asked about most is tea tree oil. 

For years, I've looked, but never found any strong research on tea tree oil in relation to head lice.  But today I found the synopsis of a 2010 study done at the University of Queensland.    Follow the link to see the abstract. The catchy title says it all: "A randomised, assessor blind, parallel group comparative efficacy trial of three products for the treatment of head lice in children--melaleuca oil and lavender oil, pyrethrins and piperonyl butoxide, and a "suffocation" product."

This study seems to demonstrate that a shampoo with tea tree oil AND lavender oil has effectiveness against head lice.  Before you go out and buy a bunch of essential oils, please consider these points:

1. Just because something is seen as "natural", it doesn't guarantee safety.
The American National Institutes of Health offers these cautions about tea tree oil:
  • Tea tree oil contains varying amounts of 1,8–cineole, a skin irritant. Products with high amounts of this compound may cause skin irritation or contact dermatitis, an allergic reaction, in some individuals. Oxidized tea tree oil (oil that has been exposed to air) may trigger allergies more than fresh tea tree oil.
  • Tea tree oil should not be swallowed. Poisonings, mainly in children, have caused drowsiness, disorientation, rash, and ataxia—a loss of muscle control in the arms and legs causing a lack of balance and coordination. One patient went into a coma after drinking half a cup of tea tree oil.
  • Topical use of diluted tea tree oil is generally considered safe for most adults. However, one case study did report a young boy who had developed breast growth after using a styling gel and shampoo that contained both lavender oil and tea tree oil.
  • Tell all your health care providers about any complementary health practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
And the University of Maryland Medical Centre says this about lavender oil:
  • A small study published in the New England Journal of Medicine in 2007 concluded that lavender and tea oils in some shampoos, soaps, and lotions may cause gynecomastia, breast development in a male, in boys. 
  •  Lavender oil is toxic if taken orally.
  • There are no known scientific reports of interactions between lavender and conventional medications. However, because lavender promotes relaxation, it may make the effects of central nervous depressants stronger.
2. Effective once doesn't mean effective always.
It is now common knowledge around lice circles (though seemingly not common knowledge with our local school systems and public health authorities) that permethrin/pyrethrin based products, like Nix, have lost their effectiveness.  There are other products that are also losing their effectiveness and tea tree oil has also lost effectiveness in some parts of the world.  Lice researcher, Ian Burgess says, "‘Tea tree oil has a component that works in the same way as the insecticide malathion, so lice are also resistant to it.’  My own anecdotal offering is that I have been to many, many homes where people have tried a variety of products that include tea tree oil with no success. 

When trying to get rid of head lice, we often grasp for any miracle cure, and if that cure seems natural, then we often buy into it hook, line, and sinker.  You know my thoughts about this.  If you choose to use any "shampoo", you will still need to do manual lice and nit removal.  But manual removal, done with a proper comb on wet, conditioned hair is also proven to be very effective.  And it is much cheaper.  You know my vote.  Skip the tea tree oil.