Maybe a tiny bit of good can come from a very bad situation.

As I write this, the world is still dealing with the COVID-19 pandemic.  Each country is taking their own measures to address this virus.  I live in Canada where I think our governments have handled it all in a relatively thoughtful, organized, and evidence-based manner.  That doesn't mean we are out of the woods yet.  We are still waiting for the second wave of this pandemic and our numbers have already started climbing again.

It's funny - the internet is full of people claiming their rights have been violated because of physical distancing and the expectation to wear masks in public.  When faced with a deadly virus (a virus that has killed and debilitated so many, a virus that we can have and spread without even knowing it) so many people just ignore the science and the news reports and still flock to the malls, restaurants, beaches, and family gatherings.

But when someone gets head lice, watch out!  Many of these same people will spare no effort or expense to rid their home and their little ones of this quite harmless parasite.  I've seen people fumigate their furniture, shave the heads of everyone in the household, spend countless sleepless nights vacuuming from floor to ceiling, and washing anything and everything that can fit in a washing machine in hot water and bleach. They keep their children home from school, cancel play dates and swimming lessons and spend time trying to figure out who they got it from (contact tracing!). These excessive efforts around head lice are astounding and often unfortunate because (a) unlike COVID-19, head lice are not a public health threat, (b) those costs and efforts are not necessary or even effective and (c) I've seen many a well-meaning parent get completely burned out from giving up money, sleep, and sanity in doing what they thought was the right thing in the head lice battle. 

I think that if most people were freaked out about COVID-19 in the same way that they are about head lice, we would have had this thing beaten already.   Unfortunately, COVID-19 is still going strong and no matter how tired we are of these (cue the over-used phrase) unprecedented times and our wishing won't make it go away.  For some of us, its inconvenient and annoying.  For others, its uncertain and stressful.  For others, it's tragic and heartbreaking.

It is hard to find the good in all of this bad.  Still, as one of the privileged ones who can work from home, I have found moments of blessing.  I like having more time with my children.  I like the words of encouragement sent to me by friends and family and the acts of service and courage that we've seen throughout the world.  Somehow, in the midst of the darkness, some light breaks through.

Regarding head lice, it is my hope that physical distancing will have an positive effect on this problem as well. Head lice are shared through head-to-head contact and if people keep their distance and manage the lice in their homes through effective measures like regular combing, the head lice won't have anywhere to travel to. Head lice are not shared through bedding or pillows, toys or clothing.  Head lice are not like a microscopic virus that can live for long on surfaces or linger in the air.  We can see them.  We know how to treat them.  They are a pain in the behind but they are manageable.

I don't like the phrase 'social distancing' because we are social creatures who need connection for our health, but I can get on board with physical distancing.  It has been a proven tool in the fight against the coronavirus.  And maybe, just for this limited time and if people are smart about it, it will reduce the spread of head lice too.

Quick tip: How do you clean a lice comb?

Wipe it with toilet paper or paper towel.  If something is stuck between the teeth, never pry them apart. Clean it out with dental floss.  If you want to sterilize the comb between users, put it in a cup. Pour boiling water over it and let it sit for a couple of minutes.

Hair conditioner...is there anything it can't do?

Here's another point for hair conditioner as a cheap tool in the fight against head lice! I already knew that hair conditioner helps dissolve nit glue as well as, if not better than, the commercial products.  But there's a wee study that showed it might even kill the lice!

The study (HERE)  is from 2004 (so I'm surprised I never saw this before).  They took 8 people for whom other lice treatments were not effective and slathered their hair in conditioner for 2 hours. Then they did the same thing a week later.  In the 8 subjects, it was 100% effective in killing their head lice. The author suggests that the conditioner may block the spiracles or breathing holes of the lice. We don't know what it did to the nits but if conditioner can help dissolve nit glue, I'm sure it does some damage to nits as well.

This study may be teeny but it shows once again, that hair conditioner is your friend in the fight.  And since it is inexpensive, safe, easily attainable, and something I already recommend that you use in wet combing, I have no problem with you giving it a try.  (I still recommend the combing though. Get those bugs and eggs off your head!)

(One word of caution:  Anytime I see people put some creamy or oil based solution on their head for a long time to battle head lice, they tend to want to cover it up with saran wrap or a shower cap or something to keep it from being so messy.  Whatever you do, do not go to bed with your head wrapped in plastic or wrap up the head of a young child.  It can have tragic consequences.)

Why I still say wet combing is a clear choice even when the research is murky.

When I was doing head lice consultations, I never recommended any commercial "shampoos" or pesticidal treatments to deal with the infestation.  I always recommended wet combing.

But does using only wet combing really work?

Earlier this year, I read a literature review that can be found on  the Canadian Paediatric Society website, among other places. It reviews the research on different methods and products for eliminating head lice infestations.  It mentions wet combing and says that "There is little evidence to support wet combing as a primary treatment for head lice."

In this report, there are two studies mentioned, both from 2002.  In one study, wet combing got rid of the lice in only 38% of the people treated.  In the other study, adding wet combing to those treated with permethrin seemed to offer no benefit.  I couldn't find the studies mentioned in the article.

This would be discouraging to me if I didn't also know of other studies where wet combing shows effectiveness:

Hill N, Moor G, Cameron M, Butlin A, Williamson M, Bass, C. Single blind, randomised, comparative study of the Bug Buster kit and over the counter pediculicide treatments against head lice in the United Kingdom. BMJ 2005;331:84 (Bug busting is just a commercial wet combing kit.)

Tebruegge M, Runnacles J. Is wet combing effective in children with pediculosis capitis infestation? Arch Dis Child 2007;92:818–20.

Of course, in my own experience time and time again with head lice, wet combing works. Period.

But wet combing is not a chemical solution that you dose out. It is a technique and no two people are going to do it exactly the same way or use the same lice combs.  We should expect to get different results between studies.

What makes wet combing the most effective for me though is that you can do it again and again.  This alone increases its effectiveness in my book. If you buy a good comb, it is there for you to use whenever you need it.  No running out in the middle of the night to find a open drugstore to buy a "shampoo".  You just grab your comb and start combing.  I can do a combing whenever I want and as often as I want (unlike with pesticides which can have side effects and where there is a limit to how much and often you can use them.)

And wet combing is just so much cheaper.  A good comb costs less than the "shampoo" needed for one treatment. I used to feel so bad for families who thought they were finally rid of their head lice only to get it months later when it started going around their child's classroom again. They would always be stressed out about the anticipated costs of buying all those products.  I was always happy to tell them that they didn't have to spend oodles of money if they did wet combing.  (The comb in the picture is a good one at Walmart.  It's $10.47 CAD.)

Wet combing does take some time but that time will decrease each time you do it.  And again, most commercial 'shampoos' still recommend combing and multiple treatments so you aren't really saving time by using them. (Another great reusable tool in the fight against head lice is your hair dryer.)

Check out other posts for how to wet comb.  Worry less about perfecting a technique and just get combing.

Smartphones - is there nothing they can't be blamed for?

The head line for this article is "Smartphones Blames for Dramatic Rise in Head Lice as Schoolchildren Gather Together to View Screens".  I had an instant reaction to it because I thought "Are they saying lice are being transmitted via smartphones?  Smartphones are inanimate objects and head lice wouldn't go on them!"  Then I read further and realized that it was about children having higher instances of head lice when they have their own smartphones or tablets and experts guess that this is because they are gathering close together to watch something on the small screen.  Though higher transmission around this particular activity is just a guess, I think this makes sense as the idea that lice are transmitted from head to head contact is proven. And it really is head touching head - don't believe this article when they use the unhelpful choice of words "allowing the bugs to jump between heads" because as we all know, head lice can't jump.

One thing to note though - the researchers were somehow able to determine that taking selfies was not a significant contributor to this stat.  I don't know how this was determined but it also makes sense to me.  The head to head contact of a selfie is brief and I think it is less likely that a louse would take the risk of leaving one warm head for another in this short period of time.

I would love to read the research on all of this but I could not find the original study with these claims.  (Update:  I found it.)And I really hope that no one becomes hyper-vigilant against children having personal electronic devices just because of this study.  While smartphones and tablets are often blamed for causing children to be isolated or disconnected from in-person relationships, here's one example where they are bringing children together.  Let's leave the children to their own devices (see what I did there?) within healthy limits for media use, encourage closeness, and do regular wet combing lice checks to prevent any lice sharing from becoming a problem.

The Zen of Head Lice

When I was doing lice removal in people's homes, I always found that my main job was not actually the lice removal - this was really something the families could do themselves.  Where I was most helpful was in calming panic.  Because parents generally didn't call me until they were at the end of their rope after having tried every so-called treatment paired with marathon sessions of cleaning and laundering and wiping everything else from their schedule.  Their panic was causing them not only to freak out about the lice of today but they imagined many more weeks and many more dollars spent on this lice frenzy. They pictured lice living on everything in their home forever. I loved that I could just come in and say,

"You can stop all this now. Breathe."

Not because I was coming in to save the day but because the things they were doing were not actually helping.  I was able help families step away from their panic and future worries and guide them to focus on the simple steps they could take each day to address the problem. I tried to help them to be mindful about head lice.

Jon Kabat-Zinn says mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.  For me, this means to look at head lice objectively for what they are and what they aren't.  They are a bug - a parasite that lives on the heads of humans (other creatures have their own lice.).  They just cause itching (and not death which is what I assume some people think based on their reaction to lice.) They are not the result of uncleanliness.  They are not a virus that is transmitted through the air or even passed through inanimate objects. They are not living in your furniture or stuffed animals.  If you have them, you will find them on the head.

Being mindful when you have head lice also means that you look at yourself and others objectively too.  Take a moment and check your own body's reactions and emotions to the people around you.  How do you feel about the person that you think you got head lice from?  Are you angry?   How do you feel about the parent of the child who first had head lice in the classroom? Are you resentful?  Think of the people you hang around - your friends, co-workers, or the parents of the friends of your children.  Do you feel judged?  Think of yourself.  Do you feel shame?

Regarding the person that you think gave you head lice, they didn't choose to have head lice and there is no guarantee that you didn't get it from someone else. If fact, you may have actually been the first one to get it and they just noticed it on their head before you did. Before you judge others for not dealing with the problem, think of how many "treatments" you have already tried to combat your head lice?   Don't you think others are doing their best, just as you are?

Head lice are not a result of someone doing something wrong any more than mosquitoes or ants are.  They are just a part of life on earth.  So feel free to release any anger, resentment, judgment, or shame that they stir up in you and continue to release those feelings whenever you feel them surfacing.

Another thing to think on regarding mindfulness and head lice is self care.  When we pay close attention to what we are feeling, we can give ourselves what we really need.  Finding out that you have head lice can be a trauma when you don't know how easily it can be taken care of.  If discovering that you have head lice in the home is a shock to you, then you need to treat the shock.  Not by avoiding the problem and pretending it isn't there but by equipping yourself so that you can stay in control - of the head lice and of yourself.  Don't waste time in cleaning and laundering but spend a little time wet combing the head every couple of days until the head lice are gone.  You can read posts on this blog for more tips on how to do that. And tend to your own care through it all.  For each minute that you spend on head lice removal, plan for a minute of self care at another time.  What restores you? A hot bath? A nap?  A nice walk?  A good meal?  If you are dealing with head lice for the first time, then this is something new and with everything new there is a learning curve; with every change comes stress.  Do not allow this stress to be the kind that overwhelms you. With mindfulness, this stress can be the kind that will motivate you.  To be effective and helpful and patient and gracious. 

Now take your partner's hand and start singing "Kum By Yah".  Just kidding.  Mindfulness is not just for the meditators and the yoga instructors. It's for all of us as we muddle through this life and it helps us focus on what we actually have to work with. And I'm positive that you have all you need to deal with the inconvenience of head lice.   Namaste.

Just when I thought I was out...they pull me back in!

Your child comes home with head lice.  Instead of freaking out, you did the right thing.  You got informed. You got a good lice comb and started the wet combing. You didn't waste time doing unnecessary and ineffective things like extra cleaning, extra laundry and bagging up items. And within a few combings of no longer seeing any eggs or bugs, you thought, "I got this!  I've beaten head lice."

 

And then, the next day during what you think will be a super-quick combing, you find a nit. It must be old, right?  And then you comb a couple of more times and low and behold, you find a tiny louse.

 

You sigh, smile,  and say the serenity prayer.  Or, more realistically, you say, "What the !$#*&!!! Are you freakin' kidding me!?!?!" 

 

Snap.  You lose it.

 

I just want you to know that you don't have to.  If you reading this blog, then I'm certain you are dealing with head lice.  Let me assure you that with each combing it will get better and better.  But let me also assure you that finding a nit or a louse days after you thought you were rid of the problem is very common and is, in my mind, to be expected.  Because even a good lice comb can miss something the first time around. Or the second.  New eggs and new lice are often too small to be picked up by the lice comb. 

 

If you are going through the very unpleasant experience of finding a sign of head lice after you thought you had beaten it, please remember the following:

1. It took you months to get head lice.  Beating it will require an intentional but manageable effort over the next few weeks.  Don't burn yourself out, but don't give up.  Just remember you are in a marathon, not a sprint.  Pace yourself.
2. If you found something, it doesn't mean that you have failed.  In fact, it means the opposite; it proves the combing is working. 
3. It also means you are outrunning the lice cycle.  Lice hatch and as they grow, you can get them out with your lice comb. With the combing that you are doing every few days, you will still get them out before they can lay their own eggs.
4. Just because you found something, it doesn't mean that you are in any way back at square one. A few head lice does not an infestation make.  You are still ahead of the game and all of the hard work you have put into this is paying off. 

One other thing I should let you know is that even if you have beaten this round of head lice, you can always get a brand new case of head lice.  So, if you find head lice again, it may not be because you didn't deal with it properly the first time. It could just be that you got it again.  Lucky you. (At this point, my children would say that I'm being a 'Mommer Bummer' - it's like a 'Debbie Downer' but more maternal).  That's why it is important that even when you do beat your current case of head lice, you do regular lice checks via wet combing.

You do have this.  Really.  If you found another bug, don't think of this as a setback.  Think of this as progress. Because you can always manage the head lice as long as you can manage your own emotions and expectations.

Head Lice 2016: Can't we all just get along?

 In the days after the polarizing American election, we are being reminded by politicians, activists, celebrities, and late-night hosts to hold on to hope.  We must continue to speak up for those who do not have a voice but we cannot stoop to the level of the haters.  We must sort through the madness and appeal to the good in each person.  It is so easy live in fear and point fingers but we must stop and let sanity prevail. This is good advice to remember for pretty much everything in life. 

Even head lice.

A lot of commenters who weigh in on this blog spend a considerable amount of energy on being upset with the people that they feel gave them the head lice.  They are either mad at their child's school for not adopting a no-nit policy, or they are mad at the parents of their child's friend who they don't feel is dealing with their child's head lice effectively, or they are mad at the roommate/family member who will not allow them to check their head for lice. They get furious because now they feel they have to ban their child from going to their friend's house, or they feel they now have to put their child's hair up whenever they go to school, or they have to avoid sitting on THAT couch.  It's bad enough that their own head lice is taking up their time and energy - now they feel they have to change their life because someone else isn't changing theirs in dealing with their head lice.


I get it.  Head lice sucks.  And resentment can easily build when you think that you are the only one taking the problem seriously.


But before you go and have a stern talk with that person that you think is not being responsible about their head lice problem, please consider a few things.

Regarding schools, no-nit policies do not reduce the number of cases of head lice. They just don't.  Because nobody goes looking for lice and nits until the itch starts.  And if a child has not had head lice before, they might not even see or feel anything until they've had lice for 3 months or so.  So, even when no one thinks head lice is in the class, it may already be there. I know that some of you wish that we had school nurses who checked everyone for head lice every week, but seriously, that would just be a huge waste of resources. Parents can check their own kids. We need schools to be spending money on education and health authorities to be spending more money on things that actually address real health problems (By the way, I'm all for vaccinations!)

And what about that friend/cousin/study buddy/soccer coach that you are certain gave your child head lice.  You may be enraged at them but unless you saw that person pull a live louse off of their head and drop it on your child's scalp saying "Mwahahaha!" with an evil grin, you cannot be sure that they gave your child head lice, or that they even have it (unless they tell you).   And if you know they have lice, do you think they wanted it?  They are not spreading it on purpose and they want to be rid of it as much as you do and just because you can't see them dealing with it, that doesn't mean that they aren't.  And if they swear that they don't have it, what are you gonna do?  Tackle them and give them a combing?  Will that make your own lice go away any faster?

When I was a child, I never got head lice.  But now almost everyone I know has their own head lice story.  People don't get head lice because they are dirty or spread it because they are neglectful.  Head lice happens where humans connect and regardless of who gave it to you, the only thing you can control is your own actions.

And I hope your actions are kind.  Let your child go to his friend's house.  Don't freak out if your roommate sits in your chair.  Don't cancel those soccer practices.  Head lice are a bother, for sure, but not a health issue and the melt down doesn't come from the bug - it comes from the energy we spend on frenzied cleaning and angry paranoia.  If you've changed your whole routine because of head lice, that's on you, not on the bug or your neighbour.  You don't have to comb for 6 hours straight because you are not going to get it out in one sitting anyway.  You don't have to clean from morning to night because that doesn't affect your head lice problem at all.  When faced with the challenge of head lice, practice mindfulness - control your emotions and give grace to yourself and others.  If you think your problem may have come from someone you know, gather up all the love, patience, and humour you have and start a accepting conversation.  If they aren't ready for it, don't be defensive - wish them well and let them know you're their for them should they change their minds.

Let love trump hate in every area, even when dealing with these bugs. Together, can we beat head lice?  Yes, we can! 

I didn't know him. But I liked him.

Thank you to the commenter who let me know about the death of Rick Speare, researcher, doctor, veterinarian and photographer of my favourite lice pictures.  If you would like to know more about this amazing man, here's his Wikipedia page, and if you would like to donate to his memorial fund at James Cook University, you can do so here.

 

 

No Cleaning, No Cry

I am a bit baffled.  Lately, I've been getting comments from people who say they love reading the blog but that they are exhausted by all the cleaning that you have to do when you have head lice.

Which once again makes me wonder if they have really read many posts.

Because if you read the research, you know that extra cleaning doesn't do anything in the fight against head lice.  Lice are not spread by inanimate objects in any significant way.  Lice researcher Ian Burgess has basically said that if a louse falls off your head, it is either dead or dying. Those suckers are designed to stay on the head.  In the 2010 paper, "Indirect Transmission of Head Lice via Inanimate Objects", researchers Deon V. Canyon and Rick Speare conclude: "The control of head lice should focus on the head, not on the environment.  Head lice scholars should focus on how to limit reinfestation rather than providing erroneous control advice...The promotion of inanimate objects that play an epidemiologically important role in head lice dispersal is unsupported by the evidence base..."

What does this mean?  You are not going to get head lice from your couch.  Or your bedding. In this paper, the authors call bedding a "hostile environment" for head lice.  Which means, lice don't want to leave your head because it has the climate (the right temperature) and the sustenance (your blood) that it needs to survive.  Lice will not find this on your cool linen sheets. Or on a hair brush.  Or on a hat.  So don't waste your time cleaning or laundering these things beyond your normal cleaning routine. Excessive cleaning won't help in the fight and it certainly could hurt (exhaustion, burnout, stress, anxiety, extra expenses, etc.)  When I did lice removal in the home, I would sometimes hear, "I didn't have time to do the lice combing what with all of the cleaning and laundry I've had to do." Constant cleaning makes us feel like we are dealing with the problem and being effective, but it is a sad illusion. It is the combing that gets rid of the head lice, not the cleaning.

You are going to get head lice from the head of someone else who has it. Head to head.  And you can't even be 100% certain who that person is, so don't waste your time worrying about that either. Follow the advice of the researchers.  Focus on the head, not on the environment.



 

It's a bird...It's a plane...No, it's just a bug.

My friend sent me a link to a news story about a new study on "Super Lice" - lice that have gene mutations that have been linked to permethrin/pyrethrin resistance (the two most common pesticides found in lice "shampoos".)  Click here for The Telegraph's take on the story.

This big new news story is sure to cause some people to panic about head lice and wonder, "What ever will we do to stop head lice?" The answer is wet combing.  This news story is not new; lice have been shown to be resistant to these chemicals for years.  And, when I was doing home lice removal, almost 100% of my clients had first tried lice treatments that had contained permethrin (as found in Nix) or pyrethrin (as found in R&C).  But lice cannot build up a resistance to the simple act of taking the lice and nits off of the head.

Lice combing is not the most exciting activity.  But it is cheap (cheaper than buying the "shampoos")  and it works (better than the shampoos).  Now, I have a cheap but good lice comb already (and I recommend you have one on hand as well).  If one of my kids were to get head lice, which has happened, I would grab my comb and my conditioner and give my kid a combing faster than the time it would take me to go out and purchase a "shampoo", treat the hair, wait the amount of time the directions tell you to wait, wash the stuff out of the hair. I know that I would have to do more than one combing, but don't kid yourself with the "shampoos" - you have to do these more than once; some studies say that you have to now do them three times.  AND these "shampoos" still come with a comb and tell you to comb out the bugs and eggs.  These convenient treatments are not so convenient.  And, as we see with these news stories, they are not that effective.

So, have no fear of Super Lice.  You may not be able to leap over tall buildings in a single bound, but with a good lice comb, you can still fight the bad guys.

The Only Time I've Wanted To Shave Someone's Head. Carefully.

In dealing with head lice, there is a quick - almost immediate - solution.  Shave your head. Lice hold on to the scalp by holding on to the hair.  Eggs are laid on the hair.  Nits and lice need the warmth of the hairy scalp to develop and grow.  No hair, no lice.

But I'm not really recommending this.  Not because you wouldn't look good with a shaved head (I think you would probably look great) but because shaving your head is a very drastic response to a problem that is usually easily remedied with a few combings over a couple of weeks.  The time put into a bit of lice combing is significantly shorter than the time needed to grow your hair back.

However, there was one time that I wish I could have shaved a head.

I was asked to do lice removal on a wonderful woman who had long beautiful hair.  Her hair was her crown, her glory - she was so proud of her hair.  She had a really bad case of head lice; the kind that makes you think she has had it for years. From far away her hair was lovely but as soon as you got close, you could see rows and rows of dark brown lice, bug upon bug. It wasn't the worst case of head lice I had seen but it was clear that her head lice would not be dealt with in just a couple of combings. And as I started, it was also clear that her problem was bigger than expected.

Her head was one big scab.  Months, maybe years,  of bites and scratching had left her head inflamed and infected.  Puss oozed from the sores and every time I touched her head, she flinched with pain.  I told her she needed to see a doctor.  She refused and demanded that I comb which I did. I tried to be as gentle as possible but it was clear that she was very uncomfortable. As I continued, I noticed that the glands in her neck were swollen.  I asked her if she had any other unusual symptoms besides itching and she told me she had regular chills and body aches. She wasn't sleeping well and had no energy.  I told her I felt she was having an allergic reaction to the lice and that her scalp looked infected. This concerned me because I knew she also had other conditions that compromised her health.  I explained my concerns but she wouldn't see a doctor.  Maybe she didn't want anyone else to know about her head lice. Maybe she was afraid that the doctor would tell her to cut her hair. Either way, she was adamant that she would be fine with a bit of lice combing.

Because her scalp was in pain, she could not handle the combing for very long.  I gave her my lice comb and told her that she needed to comb her hair daily, as much as she could handle, and reiterated her need for medical attention.  She refused to see the doctor and had me come to her home for one more short visit the following week which was not enough to complete the lice removal process. I asked her if she had used the lice comb.  She said she had been too tired to do the combing.  I told her she absolutely had to see a doctor. She again refused. I suggested she shave her head to get rid of the lice and allow her scalp to heal. She got upset. I did what I could that day but there were no more follow up visits.

Head lice are not normally a health issue.  They are an annoyance.  But the wounds caused by this woman's scratching became infected and her body started reacting to the infection and all the saliva and feces they left there by hundreds of lice.  As I have said before, there are things much worse than head lice.  Please, never let the stigma of head lice or the pride of your appearance keep you from getting the help you need. If your head lice has been going on for months or years, you should get support.  Talk to a friend or family member. Find a trusted professional.  And if you are having any symptoms besides a bit of itching, please talk to a doctor.

Another Question Period

Still recovering from the busy holiday season, I'm trying to catch up on some questions I've received from commenters.  I have paraphrased and combined some questions just to get at the heart of what is being asked. Let's begin...

You say that a hair dryer is a good thing but I did a lice treatment and the instructions said a blow dryer is a bad thing.  Also, I've heard my child can't go swimming after a head lice treatment. Why?

I cover this in an earlier blog post but I still have been asked these questions recently.  The neurotoxic pesticide in many lice treatments doesn't kill lice instantly.  It kills over time.  But things like blow drying or the chlorination from going swimming may make the pesticide inactive. Which is fine by me because pesticides like permethrin are no longer that effective anyway which is why I never recommend them.

What is your personal lice checking routine with your family? Describe your spot checks?

My daughters get a quick lice check in the bath once a week. My son does his own lice checks now. When I say quick, I mean quick.  I don't even use a metal lice comb for it.  I have a regular plastic fine tooth comb and I comb through their detangled conditioned hair.  I check the comb after each stroke for signs of bugs. Takes about a minute. If I find an egg or a bug, then I bring out the lice comb and start combing while my child is still in the tub. This lice combing takes about 20 minutes. I used to then follow this up by blow drying my child's hair and then going through the hair strand by strand to get eggs but I honestly don't do this any more.  I just do another 20 minute combing in the bath 4 days later.  And another one 4 days after that.  And another one 4 days after that.  Though, I rarely find anything past the second lice combing.  As you know, that's all I do - I do no extra laundry, washing of bedding, vacuuming, braiding of hair, changing of schedules, staying up late - anything.  I find that routine lice checks make lice a non-issue.  You find the lice before anyone was even aware there was a problem and you deal with it while the problem is small and easily remedied.

I'd like to talk about spot checks because my position on these has changed.  If someone in the house was scratching their head, I used to stop everything and do a quick look at the scalp to see if there were any signs of head lice.  But now I think this is (a) paranoia inducing, (b) inconvenient, and (c) ineffective.  Visual lice checks only really work if you have a major lice problem and in my home, we never have major lice problems because we catch things early.  So, if someone scratches their head, I ignore it.  If someone scratches their head a lot or complains of itchiness, they get a quick wet combing because wet combings are way more effective than visual lice checks.

I cannot get a lice comb through my child's hair for various reasons.  (Or, I don't have access to a metal lice comb.) What do I do?

If your child is traumatized by the pulling of a metal lice comb even through detangled and conditioned hair, then just use a regular plastic fine toothed comb.  It will take out adult bugs and if you comb often enough you will get out the bugs before they lay eggs; this may take longer but you can still outrun their cycle. But if all combing is problematic, go through your child's scalp with your fingers and just take out what you can. Get under some good light (a head lamp is very helpful in this process.  My dollar store head lamp cost $2.50.) This is actually a very relaxing process for children.  We used to put on comfy clothes, put on a movie, and my children would lay down on the couch with their head on a pillow in my lap and I would just go through with my fingers.  For me, it was like knitting - very calming.  For my children, it was also relaxing - they would sometimes fall asleep and I would have to wake them up to turn over so I could look at the other side their head. As I mentioned above, you can also use a blow dryer; check out how here.  You know, if I knew of lice products that really worked so well that you didn't have to remove the bugs and eggs off the head, I would recommend them. Honest. But, I've been to homes where every lice product available in my country has been used correctly and repeatedly without success.  Manual removal is your best bet - it's cheap and can still be effective if you put in the time.

I'm combing with the lice comb and finding nothing but I feel still itchy.  I can feel something crawling on my head.  I'm sure I still have head lice!  What do I do?

The best thing you can do is to calm down.  Trust the comb.  Itching can be caused by many things that are not head lice, including hyper-awareness.  Everyone starts to scratch their heads at the thought of head lice, including me. If you are not finding anything in the lice comb, then you don't have a lice problem.  That said, still do regular combings once in a while just to make sure.  If the itching persists or gets worse, talk to your doctor.

My child has head lice and you say that I don't need to wash her bedding, vacuum her mattress,  or bag up her stuffed animals.  Are you $!#*% serious?

Yep.

I'm combing my head and this white flaky, sometimes sticky stuff is in my comb.  What is that?

It is "not nits".  It may be dandruff. It may be the build up of some hair product. It may be something gross that the wind blew your way or that your toddler wiped on you.  Nits are uniform in shape; not flaky but oval.  When you get them off the head, they can sometimes even seem to have a teensy little tail - this is not the egg but a piece of your hair that was ripped off with the egg. The bugs always look the same - they just change in size. A louse the size of a speck of pepper looks just like a grown up louse when you check it out under a microscope. So any particles of varying size or shape should not be a major concern. 

My daughter's friend's mom just told me she has lice. My daughter has played with her friend recently.  Does this mean my daughter has lice? 

No.  Whenever I find out that someone we have hung out with has lice, I actually wait until our weekly routine lice check to follow it up. (Unless we have been feeling particularly itchy, then I will do a wet combing to check within the day.)  If nothing shows up in the routine check, I just wait until the next week to do another routine check.  And if I do find lice, I start the routine of wet combing every few days until we have had no sightings of nits or bugs for two weeks.

These head lice wouldn't bother me so much if they didn't bite me all over my body?  What can I do to deal with that?

Talk to a doctor or public health nurse because your problem isn't head lice.  Head lice only bite on the scalp or a bit down the neck or around the ears.  If you have bites somewhere else, you may be dealing with bed bugs, fleas, scabies, or an allergic reaction to something else.

And lastly, my favourite question:

What makes you a candidate for head lice?

Being human.

Margaret Cho sings "Lice"

Margaret Cho, comedian extraordinaire, performed a soulful song on The Late Show with Stephen Colbert that I will be singing for days.  Anything that puts the lowly louse in the spotlight is welcome and refreshing.  It is musically lovely and a truly enjoyable performance. But as you listen, see if you can you find the misconceptions about how to manage this critter crisis.

 

• The song starts with an implication that you get lice from an impoverished nation. Lice has no nationality - wherever there are humans, you will probably find lice. Though, there are some populations which seemingly have a lower chance of getting head lice.  At least for now.
• In this song, Cho says you need shampoo, which I'm assuming means a pesticide treatment.  This is not true, especially when the pesticide in the most popular lice "shampoos" have been shown to be ineffective. Lice have built a resistance to them.
• Cho mentions a fine toothed comb.  If you have lice, this is your greatest weapon in the fight.  Combs with long, rigid, metal teeth are the best. Plastic fine toothed combs, while still somewhat effective on getting out adult bugs, are not as effective on eggs and nymphs.
• Shaving the head.  Drastic, yes. Not the way I would go but it is a way to get rid of your head lice in no time at all. Just getting an army buzz cut isn't enough - lice can still thrive on a scalp with very little hair. Did you watch the end of the song?  Cho totally rocks that look. In the song, shaving the head is mentioned in the context of having dreadlocks.  I have to say, I know of no truly effective ways to treat head lice on people with dreads. If I had dreads for religious reasons, head lice wouldn't be a good enough reason to shave my head. Since someone with dreads can't get a lice comb through the hair, the fast blowing air of a blow dryer might be their next best tool.
• With lice you don't have to 'go to the mattresses'.  In fact, you don't have to do anything with your mattress because lice don't live on your furniture. They live on your scalp.  Save the dragging of your mattress outside to bake in the hot sun for your bed bug problem. Lice also do not thrive in your garbage. Do they make apartments in your ears? No. Around your ears? Yes.
• Will lice seem like they are dead after a shower? Sort of.  When wet, lice sort of hunker down and close themselves off - they move more slowly and may seem like they are no longer a problem. But those suckers can hold their breath for a long time and can stay alive in water for a day. So, while your shower won't get rid of your lice problem, a wet louse, is easier to detect and comb out.  And if you add some hair conditioner, you can even get the nits out more easily too. 

Even though I disagree with some of Cho's lice premises, I still love the song. Head lice shouldn't be something that we freak out about. Some laid-back humour is just what we need to get through the pain-in-the-arse that head lice is. Anything to get us past the stigma of having this very common pest.

Now, if I could only find out where I can get that awesome louse hoodie.

Head Lice: Do You Ask? Do You Tell?

So you have head lice?  Who have you told?  (Besides me.)  In so many of the emails I receive, people say, “I don’t know what I will do if my (insert close relative or regular acquaintance) found out!!”  In my own home, there is no stigma around having head lice.  My children have never been grossed out about it, even in those times where they have had it.  We respect the bug but we know that it is no match for us. So, talking about head lice with the people we know – friends, family, co-workers, teachers – is a non issue. I would love a world where everyone can be so comfortable with this issue; most of the time and energy wasted on the problem of head lice is due to misinformation and paranoia. Because I am familiar with what head lice are (and are not) I think everyone should just talk about it freely.  

But it isn’t that easy.  I get messages from teenagers who say that their parents would ruin their lives if they found out.  I hear from parents of children who will be cut off from seeing people they love if their head lice is discovered. This issue can bring blaming and fighting and stress.  People’s lives are often restricted or tormented because of the head louse. The tiny louse can bring a huge tension into the home that can have very real consequences. 

So, who have you told?  Who will you tell?  I usually encourage people to tell everyone about their head lice because we will not end the stigma of head lice unless people get comfortable talking about it. And of course, this is still what I think is best.  Ramit Sethi said, “Success in life is directly proportional to the number of awkward conversations you are willing to have.”  I know it can be difficult and embarrassing to start the awkward conversation about head lice.  But once it is started, I believe you will find people are more understanding and helpful than we often expect they will be.

Unless they aren’t. There are things in life that are so much worse than head lice.  Panic. Isolation. Fighting.  Abuse.  If the people in your circle are going to be hurtful to you because of head lice, then I understand why you might want to keep your head lice a secret. It is such a polarizing issue. I have met some people – mostly people who have never had head lice before – who feel that there is some moral obligation for people to disclose if they have head lice.  As if going to work when you have head lice or sending a child to school who has head lice is seen as the most irresponsible act imaginable - the equivalent of going into public with the plague. It is so sad to me that with all the horrible things in this world, people still get ostracized or bullied because of lice.

Because of this, though I would prefer that everyone talk openly about their head lice, I don’t think they should absolutely have to or should be forced to.  Who you talk to about your head lice is your personal choice.  If you discover that your child has head lice, do you have to tell the teacher or the parents of the other children?  Do you have to tell your roommates or your family members?  That is a question you must answer for yourself.    Whatever you do, I hope you can find at least one person who you can confide in about your head lice. I’d say email me, but the reality is, by the time I respond to your email, your louse problem might have already come and gone.  If you can think of one person in your life who is open, caring, non-judgmental, and isn’t grossed out by bugs, maybe that’s the person you should reach out to. Test the waters by asking, “Have you ever had head lice?” Their response, and the panic or lack of panic that goes with it, might inform you about how they might take your news.  And everyone will take the news better if you can demonstrate that you actually know something about this problem and are taking steps to beat it – get informed by reading the posts on this blog and check out the research links.

And if someone discloses to you that they have head lice, follow the golden rule.  Treat others the way you would like to be treated. Kindness is the best lice treatment that there is.

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.

 

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