The Facts of Lice

When One Sibling Is Sneezing

If one of your children is ill, it doesn’t have to be a matter of time before the others are too. Here’s your guide for caring for a sick kid — be it COVID-19, the flu, a cold, or otherwise — while keeping their siblings well.

C O N S I D E R A Q U A R A N T I N E

Corinna Rea, M.D., a pediatrician in Boston and a Parents AAP panel member, understands that it’s not always realistic to separate siblings. “But in the case of COVID-19, you need to do your best to isolate your infected or exposed child,” she says. If possible, one vaccinated parent can stay with the sick child while the other parent cares for well siblings, says Navya Mysore, M.D., a family physician in New York City.

If your child has a cold, the flu, or stomach bug, Dr. Mysore says you can try a less strict separation. Stagger meals and set up solo activities. For short periods, Dr. Mysore is not overly worried about the psychological impact of isolating a sick child. Instead, she suggests having fun games and candid chats to make it more manageable. “Kids really understand things, and we often underestimate that,” she says. “Explain to them, ‘If you stay in here by yourself, it’s less likely that your sibling will get sick, and they can play with you when you’re better,’ and they’ll get it.”

S T R AT E G I Z E S L E E P I N G

If your kids share a bunk bed, the risk of spreading germs is higher, so you may want to move them at bedtime. If their beds are separated in the same room, keep their door open to let air circulate. It’s a good idea to open windows, too, says Danielle Fernandes, M.D., a pediatrician in Los Angeles and a Parents AAP panel member. “Viruses can build up and circulate. Fresh air can minimize the viral concentration.”

T H W A R T G E R M S

For illnesses other than COVID, Dr. Rea focuses on limiting the spread of germs, rather than quarantining. Think about all the ways your little ones have close contact. “My kids often share a glass when brushing their teeth or take food off the other’s plate,” she says. “I try to limit this when one is sick.”

As always, wash hands often, and remember that germs can linger on towels. “Get different colored towels for this situation,” Dr. Mysore says. “The sick child can use one color, and everyone else can use another.”Then keep them and other germ-harboring items like toothbrushes apart.

If your child has a stomach bug, clean bathrooms and changing tables often. “You can also clean doorknobs and toys, but don’t feel you have to run after your child with wipes,” she says. “Protect your sanity.”

W E A R M A S K S

Your kids have likely become used to COVID protocols, so turn to masks if your child has an upper-respiratory infection. “All family members over age 2 should wear a mask when someone is ill,” Dr. Fernandes says. It’s also not a bad idea to keep kiddos 6 feet apart for movie night, Dr. Mysore says.

Pandemic Pounds in Perspective

One third of kids were above their expected weight last year, says a report from Epic Health Research Network. “This report may not be surprising,” says Natalie D. Muth, M.D., M.P.H., R.D.N., a Parents advisor and author of Family Fit Plan. Kids learning at home were able to graze during the day and had fewer avenues for physical activity. Discuss concerns with your pediatrician, but know that your child’s getting down on themself or developing disordered eating is worse than this lingering weight gain. “Don’t focus on the number on the scale. Instead, discuss what the family can do together to promote healthier habits,” Dr. Muth says.

P A G I N G D R . M O M

“My child seems down lately. Could they have seasonal depression?”

A kid or teen with seasonal affective disorder (SAD) or seasonal depression will start showing symptoms such as persistent sadness, irritability, low energy, or changes in sleep and eating during the fall or winter. This response to fewer hours of daylight is more than just adjusting to the new season. Depressive symptoms will last at least two weeks and significantly impair their ability to do the things they love.

It’s important to discuss your concerns with your pediatrician, who can connect you with a mental health professional or share coping strategies. Effective treatments do exist for SAD, such as combining light therapy from sunlight- simulating lamps with evidenced-based practices like cognitive behavioral therapy and medication, including antidepressants.

As a family, plan fun activities to look forward to. This can be a mood booster, even at times when your child may think they don’t want to join in. Whether it’s being out in the sun, exercising, having social time, or doing volunteer work, anything that gets them up, out, and active can be helpful.

Source: Janine Domingues, Ph.D., a clinical psychologist in the Anxiety Disorders Center at the Child Mind Institute in New York City.

The Fact s of L i c e

Slather their head with bug-killing shampoo, or remove crawlers by hand? Hire a nitpicker, or buy a huge tub of mayo? If you’re bugging out, take heart: We’ve combed through the remedies to investigate your options.

by H O L LY P E V Z N E R / illustrations by E L I S E G R AV E L

I T ’ S A C A L L every parent dreads: Someone at your school, maybe even in your child’s class, has just acquired some hangers-on. Though you fear your kid will bring home their own colony of crawlers, this can happen only after head-to-head (or head-accessory-tohead) contact with the infested party. So don’t freak out yet—but take a look, particularly at the hairline along the neck and behind the ears. If you do find a live louse, panic is probably next on your agenda. (Kids tend to f lip, too, icked out—not to mention itched out—by both the bugs and the stigma they carry.)

But then it’s time to turn your attention to solutions, which is where things can get confusing. You’ve got three main options: over-the-counter chemical treatments like Nix or Rid; pediatrician-prescribed topical treatments, which also contain chemicals; and chemical-free methods, like hiring a local lice person to pick out nits (eggs) or coating your child’s head with something greasy to choke each louse before combing them out

yourself. Every lice parent is forced to make this call, and everyone has their own reasoning. Rachel Ellis, a mom of three in Decatur, Georgia, who has powered through six bouts of lice, says she’s “all about the chemical treatments. I feel guilty, but it takes care of the problem.” Then there’s Lisa Meyer (not her real name), a mom and stepmom of seven near New York City, whose entire household has had lice at least once. “I used to use the over-the-counter stuff,” she says, “but I was never sure it had worked completely.” Eventually, she shelled out hundreds for a lice pro. “Now I just copy what she did—a thorough comb-out after coating the head with conditioner—and I haven’t touched a chemical since,” Meyer says.

The sad truth is that ridding yourself of lice will never be easy. “Treating lice and getting all the eggs is hard no matter what method you use,” says Sara Bode, M.D., medical director of Nationwide Children’s Hospital’s Care Connection School-Based Health and Mobile Clinics in Columbus, Ohio. Indeed, 71 percent of moms said they had failed to treat the condition successfully on their own, according to a 2017 report by Arbor Pharmaceuticals, the makers of the lice treatment Sklice . But with a little background knowledge on each method, you can improve your chances of success—and choose a remedy you’re comfortable with.

The Chemical Options

Obviously, no one enjoys putting insecticides on their kid’s head, but over-the-counter options remain a go-to for many parents and pediatricians. One downside of these treatments, which contain the chemicals permethrin or pyrethrin, is that they can cause skin irritation. Another is that you need to apply them at least twice to see results. The first shampooing kills lice; the second kills any lice that have hatched since the first treatment. These remedies also do not kill nits, so every two to three days for two to three weeks, parents have to comb out lice and nits to make sure they’re really gone. “It’s a lot of work, but these products are inexpensive and safe,” says Bernard Cohen, M.D., professor of dermatology and pediatrics at the Johns Hopkins University School of Medicine.

Unfortunately, lice treatments often fail due to user error. “You need to get the chemicals all the way down to the base of the hair,” Dr. Bode says. “Bugs like being close to the scalp where the temperature is the warmest, and you also need to remove all the eggs from this area.” This can take a while. “Together with the treatment and combing, it took me two to three hours to do just one head of hair,” Ellis says.

It’s also imperative to vigilantly check (and treat, if needed) every member of the family. “If you don’t, you’re just going to keep getting reinfested. I see this a lot,” Dr. Bode says. And even though lice can live “off head” for only 24 hours and don’t jump or f ly, it’s prudent to wash the bedding of anyone who’s infested in hot water. Also, advises Dr. Bode, “put anything on the bed that can’t be washed, like a throw pillow or a stuffed animal, into a sealed garbage bag for two weeks. This prevents anyone from lying down on yet-to-be-hatched eggs.” Do all of the above perfectly, and you’ve got a good chance of success. If you’re concerned about chemicals being ineffective on so-called super lice, given unnerving reports that lice are mutating in ways that make them more resistant to OTC treatments, there’s good news. Though some studies have found that most lice have genetic mutations that may make them more resistant to the chemicals in OTC treatments, “that does not mean that these treatments won’t work,” says Richard J. Pollack, Ph.D., senior environmental health officer at Harvard University. “ Many lice will likely still die, even if they possess that genetic mutation. From what I’ve seen, many folks still successfully eliminate their infestations by use of OTC products.”

Another product that’s popular—at least in Europe—is dimethicone, a type of silicone that smothers lice. “There’s pretty good data from other parts of the world that show it can be just as effective as our prescription agents,” Dr. Cohen says. For instance, a report in BMC Pediatrics found that more than 96 percent of kids remained free of live lice and 81 percent had no viable nits

T he Truth A bout “Pr even tion”

Don’t be fooled by any “clinically proven” statements on OTC lice repellents, which claim to stave off infestation with herbs like rosemary, citronella, or tea tree oil. “ ‘Clinically proven’ is just an advertising term for subjective testing on one or a few persons,” says Harvard University’s Richard J. Pollack, Ph.D. “While some repellents seem to affect the behavior of lice in the laboratory, I’ve yet to see anything that wards off lice in real life.” The only true ways to keep lice away are shaving your child’s head (please don’t do this) or ensuring they have zero head-to-head contact with other people. In other words, it’s pretty much impossible.