Why Holding Off Isn’t the Answer

14 days after being treated with dimethicone. The only hitch: It’s not as readily available as a lice treatment in the United States as it is abroad. But there are some products sold in the U.S. that contain dimethicone, such as Nix Ultra, which may make the treatment more effective .

The Rx Route

There are also a handful of prescription options that are more powerful than OTC treatments (and which, happily, lice are less likely to be resistant to). One is benzyl alcohol lotion, which kills lice over two treatments but does not kill nits, and is approved for use on children 6 months and older. Another is the lotion sold under the brand name Sklice, whose active ingredient is ivermectin. (If the name of this drug sounds familiar, it’s because you’ve likely heard about people attempting to treat COVID-19 with it—unsuccessfully, and at great risk to their health, since they’re using a version of the drug meant for horses.) This treatment does not kill nits either. But another option, malathion lotion, kills both live lice and some nits, and can be used on kids age 6 and up. Finally, spinosad (brand name Natroba) is a topical medication that is effective at killing both lice and nits, requires no combing, and is typically effective after one treatment.

Perhaps you’re wondering: If they work so well, why not just start with a prescription? Some doctors do recommend this, but many others insist that making prescription options the norm will only increase lice’s resistance to these chemicals. Another major downside to prescription treatments is that these powerful topical pesticides can be even more irritating to the skin than OTC options, and even more potentially dangerous if they get into the eyes or are ingested. (If your child is prone to dry skin or eczema, mention this to your pediatrician so they can take this into account when prescribing.) In fact, it’s worth noting that the American Academy of Pediatrics advises washing all chemical treatments, both prescription and OTC, out of the hair only over the sink, not in the shower, to prevent the

T h e B i g g e s t L i c e Tr e a t m e n t M i s t a ke

Parents who are worried about lice may see what they assume are nits and treat their kids unnecessarily. “ I often see parents who think they’ve found lice but haven’t,” says Bernard Cohen, M.D., of the Johns Hopkins University School of Medicine. What else might it be? Dandruff, dried hair products, scaly skin, and more are often confused with nits. In order to truly diagnose a case of lice, you must spot a live and crawling louse. If after a thorough check you don’t see anything moving, your child might just have an itchy scalp from cold weather, or their hair gel is flaking. Congrats!

lotions from coming into contact with other parts of the body.

So when should you pull the trigger on a prescription? Head to the pediatrician only after nothing else has worked. “ If you’ve used an OTC treatment but your child still has active lice after five to seven days, don’t wait to do the second treatment,” Dr. Bode says. “Just go see your child’s physician for a prescription.” In this situation, it’s very likely that the bugs aren’t all from just-hatched eggs but are instead survivors of the first treatment. “It’s also smart to see the doctor if you did the recommended two treatments, then within a month the lice are back,” Dr. Bode adds.

Nonchemical Solutions

For many parents, dousing a child’s head with an insecticide is simply a nonstarter. That’s a reasonable position to take, Dr. Bode says. “I think it’s always important to have some concerns anytime you’re giving your child medication or a topical treatment.” However, not all “natural” treatments are superior. For instance, excessive or inappropriate application of essential oils (tea tree and other oils are often falsely billed as treatments) can poison children, even through the skin.

Other popular alternative treatments aren’t as potentially dangerous but do tend to lack clear data indicating that they work. Many methods involve the application of food-grade oils, hair conditioner , or lotions to the head. “These are thought to smother lice on the scalp,” Dr. Pollack says. “But none of them have been sufficiently tested for use against lice, and none are labeled for this purpose.” That said, there was one small study that reported a 96 percent cure rate when Cetaphil face cleanser was applied to hair, combed out, dried with a blow-dryer, left overnight, and shampooed in the morning. (This was repeated once a week for three weeks.) However, “this wasn’t a randomized controlled trial, which is the gold standard of studies,” Dr. Cohen says. “There’s really no definitive data to support that this is effective.”

What we do have, though, are anecdotal reports from parents who say it works. “While there’s no proof that covering

your child’s hair with a thick or oily substance, like mayo or Cetaphil, suffocates lice, I do think this practice could be an effective treatment if you’re lucky enough to catch the infestation very early, with just a couple of live crawlers and nits,” Dr. Bode says. But she speculates that it’s actually the extensive combing that’s effective, not the attempted smothering. Also, “when the hair shaft is coated with something greasy, it makes it easier for you to detach and remove the nits and bugs with a lice comb,” she says.

But the leading “natural” method for ridding yourself of lice is just manually removing them one by one. Is it pleasant? No—not for you or for your child. Nor is it quick. “I’d use an extra-large bottle of thick white conditioner on my child’s head, and spend 45 minutes to an hour combing through the hair, section by section, with a light, a magnifying glass, and a long-toothed metal nit comb, wiping the nits and lice that got stuck on the comb onto a paper towel,” says Meyer, who’d repeat the process until no lice were spotted. (Dr. Pollack notes that this sort of manual lice removal requires a combthrough daily, or at least every few days, until you haven’t seen a crawling louse in two weeks.) “Because there’s no chemical killing the lice, you need to pick off every single bug and nit, and check regularly,” Dr. Bode says. “So this is best for mild cases, in which there are relatively few bugs and nits. And the failure rate is still high, meaning that it’s very easy to miss nits that later hatch into lice, perpetuating the problem.” (Also, note that the “treat everyone in the house” and “wash the bedding” rules apply here too.)

There is one no-chem alternative that’s effective and FDA-cleared: a special form of heat from a device called AirAllé. “Both lice and nits can be killed by it,” Dr. Pollack says. “But it can be used only by trained persons, so there may not be a center near where you live, and it can be costly.” (It’s only available at one of the 350+ Lice Clinics of America and costs more than $150 a pop.) A study in Pediatrics showed that one 30-minute treatment killed nearly 100 percent of nits—that’s a better rate than most prescription options—and 80 percent of live lice. (By the way, if you’re thinking that a blow-dryer will do the job just as well, let us assure you that this is not a good idea. Not only are there no standard heat levels on hair dryers, meaning you could burn your child’s scalp, but using one could cause live lice to become airborne and land on surfaces where they might spread to new hosts.)

In the end, no matter which method you choose, know this: “Of all the nasties your child might bring home, at least head lice aren’t dangerous to your child’s health,” Dr. Pollack says. (Your mental health, on the other hand ...) Sure, remedying lice takes a good deal of work, and their very presence is understandably upsetting, but you’ll get through it. Ellis agrees: “The first time my kids got lice, I was completely overwhelmed and stressed by the whole ordeal. I somehow felt it was a ref lection on me.” Not anymore. Today, she greets lice with a sigh and a shrug. “I finally get it. Lice are just an annoyance, not a scarlet letter to bear or a big worry. I just grab a box of the OTC stuff off the drugstore shelf, roll up my sleeves, and get to work.”

T H E L E A D I N G “ N AT U R A L” M E T H O D F O R R I D D I N G YO U R S E L F O F L I C E I S J U S T M A N U A L LY R E M O V I N G T H E M . I S I T P L E A S A N T ? N O . N O R I S I T Q U I C K .

W hy Hold i ng O f f I sn’t the A nswer

There have been many rumors about the COVID-19 vaccine, and, of course, no one wants to do anything that could put their child at risk. For any parent with questions, this information will help ease your mind about vaccinating kids.

by TA M E K I A R E E C E

W H E N T H E F D A authorized the emergency use of the Pfizer-BioNTech COVID-19 vaccine for children ages 5 through 11 last October, many parents were relieved that their kids could finally get the shot. But according to a Kaiser Family Foundation poll, one third of parents said they’d wait to see how things go with other kids before getting their own child vaccinated, and another 30 percent said they won’t vaccinate their child at all. Some of the reasons parents gave for their hesitancy included worries about long-term effects of the vaccine, side effects their child might experience, and the possibility that the shot might affect their child’s future fertility.

Most parents and their children have a lot of experience with vaccinations already: By age 2, more than 90 percent of American kids are vaccinated against chicken pox, polio, hepatitis B, and measles, mumps, and rubella. Health experts say we should view the COVID shot the same way we view those other necessary vaccinations, yet at press time, only about 17 percent of kids ages 5 to 11 had received their first COVID shot.

All parents want what’s best for their children, so we asked pediatricians and infectious disease specialists, who have devoted their careers to keeping kids healthy, to answer a few questions.

If kids are less likely to get seriously ill from COVID, does my child really need the vaccine?

There are many reasons why vaccination is a good choice for your child. While many COVID infections in children are mild or asymptomatic, others are serious. More than 7 million children have tested positive for COVID, and more than 700 have died. “Between 30 and 40 percent of children who wind up in the hospital with serious COVID have no underlying risk factors,” says Parents advisor Yvonne Maldonado, M.D., chair of the Committee on Infectious Diseases for the American Academy of Pediatrics (AAP). Even mild or

asymptomatic cases can have long-term effects. In addition, kids play a crucial role in protecting others, including immunocompromised children and older people who are still at risk for serious illness or death from COVID, and as a society, we can all do our part.

Another important reason to vaccinate is to protect kids’ overall well-being. The pandemic has taken a toll on kids’ mental and emotional health, causing anxiety, depression, loneliness, grief, and even suicidal thinking. Being vaccinated can help them get closer to normal life by letting them safely do regular kid things, like see their friends, attend birthday parties, go to camp, and participate in sports, says Parents advisor Jennifer Shu, M.D., a medical editor of the AAP’s website HealthyChildren.org.

How exactly is this vaccine different from the one for adults?

It’s one third of the adult dose, and smaller needles are used to give the shots to kids. The vaccine works similarly to ones your child has had before. When someone gets an infection for the first time, the body remembers the infection to help protect against it in the future. The COVID vaccine contains messenger RNA (mRNA), which prompts the body to make a piece of protein that looks like the COVID virus but is only a harmless piece of the virus, says Aaron Milstone, M.D., a pediatric infectious disease specialist at Johns Hopkins Children’s Center. The body identifies the virus protein and reacts to it by producing antibodies that protect a child as if they’d been exposed to the real virus. The vaccine does not contain live virus and won’t give a child COVID, Dr. Milstone explains.

The vaccine can’t alter someone’s DNA, and it never enters a cell nucleus, where DNA is located. There’s also no evidence that the vaccine causes fertility problems in adults, and experts are confident it poses no risk to a child’s fertility in the future. One final thing: The science behind COVID vaccines wasn’t rushed. Yes, they’re new, but researchers have been studying mRNA technology and other mRNA vaccines for decades.

Doctors say all kids ages 5 and older should be vaccinated against COVID. The only ones who shouldn’t receive it are those who have an allergy to a vaccine ingredient, which is extremely rare, or who had a severe reaction to a prior dose of the COVID vaccine, Dr. Milstone says. If you have concerns, the best thing to do is to talk to your pediatrician or provider about whether your child should get it. At press time, Pfizer was the only vaccine authorized for kids ages 5 to 11. Clinical trials are underway now to determine the vaccine’s safety and effectiveness for children ages 6 months through 4 years old. And Moderna vaccines for children and adolescents are also being evaluated. Experts say both the Pfizer shot and the Moderna vaccines for younger kids may be authorized in the coming months.

How do we know that it’s safe for kids?

In clinical trials that monitored approximately 3,100 children, the Pfizer vaccine was found to be safe for kids ages 5 to 11, and it had to meet rigorous scientific standards for safety and effectiveness to gain authorization by the FDA. In addition, almost 8 billion doses of the COVID vaccines have been given worldwide to adults since December 2020, to kids ages 12 and up since May 2021, and to kids ages 5 and up since November 2021. Says Dr. Shu, “That’s reassuring, because if there’s going to be a side effect from a vaccine, it typically shows up either immediately, within the first day or two, or by six to eight weeks afterward.”

It’s also helpful to know that, due to the immense publicity and media attention surrounding the authorization of the COVID vaccines, they have been (and will continue to be) monitored more closely than any in history, says Stanley Spinner, M.D., vice president and chief medical officer at Texas Children’s Pediatrics, in Houston. There are several safety monitoring systems in place, including the Vaccine Adverse Event Reporting System (VAERS), which is managed by the FDA and the Centers for Disease Control and Prevention (CDC). VAERS allows anyone (patients, parents, health-care workers, pharmacists, and vaccine manufacturers) to report side effects or potential illness after vaccines.

The vaccine isn’t just safe; it’s highly effective: Clinical trials showed the Pfizer vaccine was 90.7 percent effective at preventing COVID for kids ages 5 to 11. No kids who were vaccinated in the clinical trials developed severe COVID.

Isn’t there a chance it can cause heart problems?

No children in the trial for the 5-to-11 age group experienced a heart problem. There have been reports of some adolescent and young adult males experiencing myocarditis or pericarditis, an inf lammation of the heart muscle or outer lining of the heart, usually after receiving the second dose of the vaccine. However, this is extremely rare (about 12 to 25 cases per million doses given). Most heart issues have been very mild, including slight chest discomfort or an elevated heart rate that went away after a few days, Dr. Spinner says. COVID itself can cause severe cases of myocarditis and pericarditis.

What are the immediate side effects?

The lower dose of the vaccine—and maybe kids’ strong immune systems—seem to be producing fewer or milder side effects than the adult version. When they do occur, they may include soreness at the injection site, headache, fatigue, muscle pain, and chills. Side effects usually happen within the first couple of days and go away shortly after. Experts advise against trying to prevent symptoms by giving your child pain medication before the shot. If your child takes those medications regularly for some other

“Between 30 and 40 percent of children who wind up in the hospital with serious COVID have no underlying risk factors.”

—Parents advisor Yvonne Maldonado, M.D.