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 at 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.