Pediatric Group Issues New Lice Recommendations

AAP reiterates its stance against school "no-nit" policies and risky remedies.

ByDAN CHILDS, ABC News Medical Unit
July 23, 2010, 5:11 PM

July 26, 2010— -- Call it a new battle plan in the war on lice.

The American Academy of Pediatrics released a new set of guidelines in the current issue of "Pediatrics" for the treatment of head lice, the first update in recommendations that the organization has issued since 2002.

The new report is unlikely to end humankind's age-old struggle against the itch-inducing bugs, but it is intended to alert the public to the various ways to solve lice infestations in schools and to inform on the resistance of lice to certain treatments and the new methods of treatment emerging today.

Lice infestation is not life threatening, but the stigma of lice has led parents to attempt dangerous methods of treatment ranging from acetone, bleach and WD-40 to loosen eggs from the hair, to dousing their children's scalps with gasoline. When all else fails, parents have been known to resort to shaving their children's heads -- an effective option for getting rid of lice and their eggs, but traumatic nonetheless.

Infestation's comparatively non-serious nature may be partly to blame for the relative lack of reliable statistics on the extent of the problem.  An oft-quoted 1997 report estimated that between 6 and 12 million infestations occur each year, but experts caution the public not to place too much stock in this ballpark range

"Many doctors would say [lice infestations in schools are] no problem, since lice usually don't cause any medical problems -- just itching," said Dr. Barbara Frankowski, professor of pediatrics at the University of Vermont in Burlington and one of the authors of the report.  "Since it is not reported to health departments, the actual extent of the 'problem' is just a guess."

AAP Suggests Anti-Lice Options

Lice are rapidly evolving resistance to chemicals in many anti-louse shampoos and other remedies, and the new guidelines expand the recommended arsenal against the bugs.

While the 2002 guidelines listed permethrin (commonly known as Nix) as the approved treatment, the new set adds products known as pyrethrins to the lineup, as well as benzyl alcohol, which is to be used only when other methods fail.

"The guidelines provide info on new and traditional approved options," said Dr. Bernard Cohen, director of pediatric dermatology at the Johns Hopkins Medical Institution in Baltimore, Md. "Some off-label [treatments] are also effective, in my opinion, but there are a number of ineffective costly meds and techniques that desperate parents embrace."

The recommendations also strengthen the AAP's stance against school screenings for lice, stating as its first key point, "No healthy child should be excluded from or allowed to miss school time because of head lice. No-nit policies for return to school should be abandoned."

A similar, albeit less strongly worded recommendation was part of the 2002 guidelines, but the practice is still a fixture at some schools.

"Although the Association of School Nurses agreed that a no-nit policy does not make sense over a decade ago, many school still try to enforce the policy," Cohen said.

One thing the new report is unlikely to solve is the stigma that surrounds lice infestation.

"Many parents perceive lice infestation as a sign of poor hygiene or poor parenting, which isn't true," said Dr. Steve Lauer, vice chairman and associate professor at the University of Kansas Medical Center Department of Pediatrics in Kansas City.

"[I] think it is important to understand that lice infestations do not indicate uncleanliness," said Dr. Sara Rizvi, assistant professor of pediatrics at the Baylor College of Medicine in Houston.

These perceptions, pediatricians hope, will soon fall to the wayside as new treatments become available.

"There are numerous treatment options for head lice infestation," said Dr. Amit Deokar, a pediatrician with the University of Kentucky's Division of Adolescent Medicine in Lexington. "Because of various treatment options available these days, the infected person and family members living with them can be treated at the same time ... some of the treatment options are extremely effective."

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