Early detection might be all the treatment you need.

It has been a while since I offered lice removal services. Thankfully, I still get to experience the joys of head lice through friends and family. In my own home, we do weekly lice checks - my girls get a quick combing during one of their baths each week. One evening a week or so ago, one of my daughters said her head was itchy.  I did a quick spot check and saw nothing but knew that we would be doing our regular lice check the next day.  Now, the process of wet combing for lice detection is exactly the same as wet combing for lice removal.  Wet, condition, and detangle the hair.  Then start combing. A fine-toothed plastic comb can still be effective in detecting bugs but a metal lice comb with long rigid teeth is best for lice removal.  I usually comb around 40 -50 strokes all over the head; it takes less than 10 minutes.  If a child has lice, I will usually find some evidence of it within that time.

When I did the combing on my daughter's head, I found a louse after about 20 strokes. Unlike you when you found lice on the head, I was thrilled.  Anyway, once evidence of head lice is found, you keep on combing.  After a few more strokes, I found two more smaller lice. Then nothing after that.  I combed 100 more strokes with no more findings.  We were done.

A few days later, I combed again. 100 strokes. Nothing else was found.

A few days later, I combed again. 100 strokes. Nothing else was found.

I will keep on doing this until I have had two weeks of "nothing else was found". It is likely that the brief amount of combing that I was originally doing just for the detection of head lice was also fully sufficient as the treatment for it.

What else did I do when I found out that my daughter had head lice? Nothing.  No extra cleaning.  No extra laundry.  Because wet combing works and I knew that based on what I was finding (or not finding) in the comb that I had it beat.  This is the great joy of regular lice checks through wet combing.  They are so easy to do, take very little time, and are effective in finding something before it becomes a big problem. People ask me about how to prevent head lice. There is really nothing you can do to prevent it. But early detection is just as good as prevention in my books.  Head lice are truly a non-issue in my house because I know that as soon as someone brings them in, I will be able to get them out quickly and easily. 

If you are surfing the web looking for information, it is likely that your problem is bigger than one or two lice.  When you are faced with a bigger problem, the treatment is no different - with more lice, you do the same thing (wet combing) but you just do it for longer. Read more posts on this blog for more info about wet combing and other inexpensive tools in the fight against head lice. You may have to put in more time this time before you get to 100 strokes with nothing found.  But, if you do regular head lice checks after this, it is unlikely that you or your loved ones will be dealing with so many head lice again.

So don't worry about things that you can't control - like tricks or tips on how to prevent head lice. Early detection is the key to keeping this problem at bay. And when you find a louse during a routine lice check, don't despair - celebrate!  You will have just proven that you have this under control.

Something old, something new

The American Academy of Pediatrics just put out a new report on Head Lice.  It is a doozy - it covers everything from lice biology and life cycle, to transmission, diagnosis, and treatment.  It looks the different pesticides you can use on lice in the United States (which I do not recommend) and non-chemical treatments such as the very expensive machine from Lareda Sciences and in-expensive lice combing.  It doesn't give you all the info from all the studies that are out there, but it tries to provide an overview of what is going on in the lice world today.  Most of what you read here you probably have read before.  However, there are a few new nuggets of interest.

Check it out here.  Of course, there are things I like and things I'm not so keen on in this report.  I'm not going to go through all of it with you here; review it for yourself. Here's just a few things that caught my eye:

"Additionally, because lice infestation is benign, treatments should not be associated with adverse effects and should be reserved for patience on whom living lice are found." 
LIKE - Lice are benign, people!  They are a nuisance to be sure, but they are not the health risk that many schools and parents make them out to be. 

DISLIKE - I really like that it says you should only do a "treatment" when lice have actually been found on the head. However, this paper later says that perhaps you should also do a treatment on people who don't have head lice if they share a bed with someone who does.  Which contradicts the statement above. They say this is prudent but don't back this idea up with research.  I say this is not prudent but I don't recommend any chemicals anyway. What I recommend is that when lice are found on one person in the home, everyone should get a lice check through wet combing. Low cost, no side effects, proven effectiveness.

" Note that some experts refer to "eggs" as containing the developing nymph and use "nits" to refer to empty egg casings; others use the term "nits" to refer to both eggs and the empty casings."
LIKE - I simply like statement his because I have heard other lice professionals say that those of us who use "nits" for both developing eggs and egg shells are wrong.  I use "nits" for both because most people, myself included, should not be wasting any time trying to guess if the egg shell is full or empty.  It is much quicker just to get everything out of the hair.
"Pruritus results from sensitization to components of the saliva". - Don't get worked up about this.  Pruritus simply means itching.
"However, there are reports that combing dry hair can build up enough static electricity to physically eject an adult louse from an infested scalp for a distance of 1 m."
DISLIKE - I have never heard this before, but it seems there is a study to back this up. Still, mentioning this seems like fear mongering. What are all the factors that would have to be in place for this to happen?  And if it did happen, so what?  If a louse gets ejected off my head due to static electricity, great! One more louse off the head.  It is unlikely that it will be thrown perfectly onto someone else's head.  Wherever it goes, this paper reminds us that the louse cannot live off of the head for very long.  Static electricity is a not a significant factor in the spreading of head lice and mentioning it in this paper will probably cause some panicked parents to keep their children away from static-electricity-causing balloon animals.  This is just one more thing that will distract people from the important work of getting the lice and nits off the head.
"A regular blow dryer should not be used in an attempt to accomplish this result [the same results as the modified hair dryer created by Lareda Sciences] because investigators have shown that wind and blow dryers can cause live lice to become airborne and potentially spread to others"
DISLIKE - This statement really concerns me. It is research done by Lareda Sciences that showed the effectiveness of a home blow dryer in the fight against head lice, but they have been trying to suppress this information ever since their report.  In their original research around their product, which you can read about here, they showed that a regular blow dryer at high speed, directed at small sections of hair, killed 98% of the eggs - which was the same result that their modified machine produced.  The notion that we should abandon the hair dryer as a tool in the fight against head lice in the chance that a louse may be blown off the head is ridiculous.  When I am blow drying the dry hair of someone who has head lice, I am directing the air in a controlled way on one section of hair at a time.  I'm not blow drying the hair all over the place in a crowded room. I'm usually in a bathroom or a kitchen and the air is blowing in the opposite direction of me and most people in the room.  If a louse were to be blown off, where would it go?  The bathroom floor?  How will that louse get on someone else's head?  If this is a significant way of getting lice off the head, why are we not recommending it as a removal technique?  Again, the effectiveness of using a blow dryer as directed in the original Lareda study far outweighs the minimal risk of blowing a louse on to someone else's head. As with the notes on static electricity, I find statements like these to be more hurtful than helpful.
So, much like most broad papers, this article still recommends the use of chemicals, and surprisingly, it still recommends he use of products like Nix and R&C.  This is astounding to me as there are so many studies showing that these chemicals have lost their effectiveness in Westernized nations. It also recommends doing some extra cleaning and laundry, which is disappointing. However, unlike older papers, this paper recommends that schools DO NOT adopt "no-nit" policies and that such policies might even be human rights violations. Now that I agree with.
Anyway, here are my favourite parts of this article:
"There is an obvious benefit of the manual removal process that can allow a parent and child to have some close, extended time together while safely removing infestations and residual debris without using potentially toxic chemicals on the child or in the environment...Because none of the pediculicides [chemical treatments] are 100% ovicidal [egg-killers] nits (especially the ones within 1 cm of the scalp) should be removed manually after treatment with any product."
LIKE - No matter what you use, you still have to manually remove the eggs!  But most people buy chemical treatments because they think that it will allow them to avoid this step -they don't want to have to do the work of nit picking or combing. And yet, no matter what so-called "treatment" you choose, you still have to do the work. Of course, you know that in my experience, it is the wet combing that actually solves the problem in the first place, so I think you should save your money and energy by skipping the "treatment" and go right to the wet combing.
"As new products are introduced, it is important to consider effectiveness, safety, expense, availability, patient preference, and ease of application."
LIKE - I agree. Keep these things in mind when dealing with your head lice.  I've said it before, effective doesn't have to be expensive. You don't have to put your family at risk for side effects - remember, head lice are benign! The various chemical treatments listed in this study are often not effective, can have side effects, can be very costly, not readily available, and can have confusing instructions for use. In my mind, lice/nit picking, wet combing, and safe blow drying (don't use high heat - the lice can dry up without the scalp getting burned!) are the only treatments that cover all the criteria for effectiveness, safety, and accessibility.


The best intentions, the most tragic consequences.

My heart goes out to the family in Springfield, Massachusetts whose daughter died earlier this year after trying a head lice home remedy. She was suffocated when the plastic bag that was placed over her mayonnaise drenched scalp slipped over her face.  You can read the details here. Mayonnaise on the scalp is a common home remedy for head lice that has no proven effectiveness and most people who try it then wrap the scalp in plastic to contain the mess. I am certain that this family was just trying to do the right thing and deal with this head lice.  In this family, a boy had head lice as well but they shaved his head instead.  This is common as the girls generally don't want to shave their heads but the boys are usually ok with it.

This was a tragic accident that demonstrates how we can sometimes lose perspective when we panic over head lice.  We can get so worked up about the bugs, which are rarely a health threat, and this can cause us to  take actions that are much more risky than the head lice themselves. Like putting a plastic bag over a child's head. Like the woman I met who slept in her car in the middle of winter thinking that the cold would kill the bugs when it could also have killed her.  Or the families I have met that have tried to treat their lice with their dog's flea treatment. Or Raid.  Or kerosene. Or gasoline. 

It is obviously that this family loved their little girl and they were trying to take care of her.  Many people turn to home remedies because they cannot afford the expensive lice "treatments", especially since these treatments require repeated use.   However, you don't need expensive products - head lice can be treated very inexpensively with tools that you can use again and again.   Lice combing on wet, conditioned hair is effective and safe.  You can get a good lice comb for the same price as any homemade concoction. If you are dealing with head lice, take the time to read the info in this blog and then proceed with good sense and perspective.  Take care in what you do - remember that there are things much worse than having head lice.


Great Expectations.

Got head lice? This blog can give you tips and techniques on how to beat it.  But before you even worry about the bugs on the head, you need to deal with the thoughts inside it - what are you feeling?  Are you freaking out or staying calm? Dreading the worst or expecting the best? If you want to beat this problem, you need to make a decision now about the attitude you will have going into it.  Your attitude can make or break how successful you are in managing your head lice.  If you start this battle by being panicked, paranoid, or petrified,  you are going to make it a bigger problem than it really is.  These extreme feelings and attitudes toward head lice can cause you to deal with it in a couple of different ways.  When you allow yourself  to have extreme feelings about head lice, you usually take extreme actions, such as:
  • Becoming hyper-vigilant and managing the problem by staying busy all the time doing tasks that are not necessary, not effective, and possibly harmful because you are feeling overwhelmed.
  • Avoiding the problem entirely and doing nothing because you are feeling overwhelmed.
Neither of these responses will be helpful to you and will probably cause a strain on your time, resources, relationships and personal wellbeing.  However, if you can put aside the panic, get the actual facts about head lice,  and stick to the simple tasks that need to be done, such as regular wet combing, you will be more than able to get through it. 

I recently heard from a family that got themselves informed about head lice and became their own lice experts.  It became evident to me that they approached their head lice issue with the right attitude when the father of the family told me that his 8 year old daughter had been going around the house singing this catchy little ditty:

"Bed bugs are mean but lice are nice!"  (T., I think you are AWESOME!!!)

This family did not see head lice as a sickness, punishment, or failure.  They treated it like one of life's inconveniences and obviously addressed it with patience, perseverance and humour.  And they beat it! 

You can too.  Give your lice a bit of attitude (positive, that is!).  Expect the best outcome here. If you don't want to sing about lice being nice, then come up with your own mantra to keep your spirits up through this process. Quote Rosie the Riveter, the Little Engine That Could, Barack Obama, or even Yoda if it helps you to stay positive. With a good attitude (your thoughts) and some helpful information (this blog) I know you can deal with head lice effectively.


Oooh, I like this one...

Here is a Sept 2014 article from the CBC (that's the Canadian Broadcasting Corporation - if you are not from where I live).  I think it is a good article, but that's because of my personal bias towards wet combing with conditioner and a metal lice comb and my bias against using so-called "treatments". Check it out: http://www.cbc.ca/news/health/head-lice-most-used-treatments-no-longer-very-effective-scientists-say-1.2776917


If you can't be with the comb you love, use the comb you're with.

I've recommended specialty lice combs on this blog because combs designed for the task of lice and nit picking - combs with long, rigid, tight metal teeth - save you a lot of time.  But what if you don't have access to an actual metal lice comb?  Grab the comb you do have. If it has teeth that are narrow and close together (i.e. not a hair pick), it can still have some effectiveness. The more rigid the teeth the better. Wet, condition, and detangle the hair. Then start combing.  If  you have large egg-laying bugs on your head, you should still be able to comb out a lot of them out.  This is still progress. Get the better comb when you can but for now, just get busy.

You probably need information more than you need a professional.

Though I am not doing home lice removal services at this time, I am still getting many requests for visits.  As I've said before, a lice removal professional is handy but not a necessity when dealing with head lice.  If you can pay to have someone to clean your home, cook your meals, and dry clean all your clothes, then you probably have enough breathing room in your budget to hire a lice professional.  But, if you, like most of us out there, would rather spend your hard-earned money on almost anything else, then I think you should deal with your head lice on your own.  Or grab a friend to walk this journey with you.  If you ever called me in the days when I was taking calls, you know that I spent most of my time encouraging people to deal with head lice on their own.  I mean, if you choose to hire a head lice professional, you'll still need to do your own checking and combing on a regular basis anyway.  Read articles on this blog, check out the links, and get informed.  Trust that with the right information, you can do this.

Another thing I get frequently asked about is what products I endorse.  While I don't have any connection to particular products, I have good things to say about effective metal lice combs such as the Licemeister and the Nit Free Terminator.  But that doesn't mean that you have to have one of these combs.  I also have good things to say about the generic metal, purple-handled, cheap, dual-sided comb that sells at my local Wal-Mart. It's the comb I use. If you find a metal comb that has teeth that are long, very rigid, and close together, then I'm sure it will have some effectiveness and get the job done over time. 

Lice removal should be accessible, inexpensive, and easy to do.  Don't think that you have to trouble yourself by ordering items from far away, travelling a long distance to get to a lice professional, or spending buckets of money on so-called "treatments".  If you are not a lice expert now, you will be once you read the research and have tried a few days of wet combing. If there are services or products you want to try and you have more than enough money to spend on them, go for it.  But if you are sacrificing your schedule, budget, or sanity to acquire these things, know that they aren't necessary.  Your time might be better spent by grabbing the comb closest to you and getting started on that wet combing.  Your money might be better spent by renting that new video you've been wanting to see to watch while doing it.


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.