Getting the Low-Down On Lice
(and Other Critters*)
*Lice, Scabies, Insect bites and stings
Pediatrician Dr. George D. Fain, M.D.
Office Telephone (228) 875-1184 or 1185 -- 24 hours
Nits (white eggs) are firmly attached to hairs.
Unlike dandruff, nits can't be shaken off:
Gray bugs (lice) are 1/16th inch long, move quickly, and are difficult to see.
The scalp itches and has a rash.
The back of the neck is the favorite area.
The nits are easier to see than the lice because they are white and very numerous.
With treatment, all lice and nits will be killed.
Your child's antilice shampoo is KWELL, NIX, or RID. NIX is the only one of the hair treatments that claims any sort of protection after the shampoo. Pour about 2 ounces of the shampoo into the hair. Add a little warm water to work up a lather. Scrub the hair and scalp for 10 minutes, by the clock. Rinse the hair thoroughly and dry it with a towel. These shampoos kill both the lice and the nits. Repeat the antilice shampoo once in 7 days to prevent reinfection. (NOTE: Nix only needs one application.)
Remove the nits by back combing with a fine-tooth comb or pull them out individually. The nits can be loosened using a mixture of half vinegar and half rubbing alcohol. Even though the nits are dead, most schools will not allow children to return if nits are present. Obviously, the hair does not need to be shaved to cure lice.
Lice in the Eyelashes
If you see any lice or nits in the eyelashes, apply petrolatum to the eyelashes twice a day for 8 days. The lice won't survive.
Cleaning the House
Lice can't live for more than 72 hours (3 days) off the human body. Your child's room should be vacuumed. Combs and brushes should be soaked for 1 hour in a solution made from the antilice shampoo. Wash your child's sheets, blankets, and pillowcases in hot water. Items that can't be washed (hats or coats) can be set aside in plastic bags for 3 weeks (the longest that nits can survive). Antilice sprays or fumigation of the house is unnecessary.
Check the heads of everyone else living in your home. If any have scalp rashes, sores, or itching, they should be treated with the antilice shampoo even if lice and nits are not seen. Your child can return to school after one treatment with the shampoo. Reemphasize to your child that he or she should not share combs and hats.
CALL OUR OFFiCE During regular hours if
Itching interferes with sleep.
The rash is not cleared by 1 week after treatment.
The rash clears and then returns.
New eggs appear in the hair.
The sores start to spread or look infected.
Scabies are little bugs (mites) that burrow under the skin and cause severe itching and little red bumps. They are so small that they can only be seen with a microscope. They rarely attack the skin above the neck, except in infants. Usually more than one person in a family has them.
Scabies Cream or Lotion
Your child's medicine is Kwell lotion or Eurax Cream. Apply the cream or lotion to every square inch of the body from the neck down. (Infants less than 1 year old also need it carefully applied to the scalp, forehead, temples, and neck. Avoid the lower face.) Don't forget the navel, between the toes, or other creases. Leave some under the fingernails. Areas that don't seem infected should still be covered.
Twelve hours later give your child a bath and remove the cream or lotion. If Kwell is used, babies under 1 year of age should have it washed off in 4 hours. Leaving Kwell on longer than this can cause side effects. Swallowing Kwell can be quite harmful, so cover the hands with gloves or socks if your child is a thumb sucker. One treatment is usually effective. For severe rashes, repeat the treatment once in 1 week.
Pregnant women cannot use Kwell. If you use Eurax, leave the first coat on. Apply a second coat 24 hours later. Wash the Eurax off 48 hours after the second application. The Eurax 8-day treatment needs to be repeated in 1 week.
The itching and rash may last for 2 to 3 weeks after successful treatment with Kwell or Eurax. This itch can be helped by frequent cool baths without use of soap, followed by 0.5% hydrocortisone cream, which you can buy without a prescription.
Children can return to school after one treatment with the scabies medicine.
Scabies is highly contagious. The symptoms take 30 days to develop after exposure. Therefore everyone living in the house should he treated preventively with one application of the scabies medicine. Close contacts of the infected child (such as a friend who spent the night or a baby sitter) should also be treated.
Cleaning the House
Machine wash all your child's sheets, pillowcases, underwear, pajamas, and recently worn clothing. Blankets can be put away for 3 days. Scabies cannot live outside the human body for more than 3 days.
A bite involves biting with the insect's mouth parts and removing a drop of blood from the human. A sting involves injecting a poison into the human from the insect's stinger. The following three types of bites or stings are covered:
Itchy or painful bites
Your child was stung by a honeybee, bumblebee, hornet, wasp, or yellow jacket. Over 95% are from yellow jackets. These stings cause immediate painful red bumps. Although the pain is usually better in 2 hours, the swelling may increase for up to 24 hours. Multiple stings (more than 10) can cause vomiting, diarrhea, a headache, and fever. This is a toxic reaction related to the amount of venom received (that is, not an allergic reaction). A sting on the tongue can cause swelling that interferes with breathing.
CALL OUR OFFICE IMMEDIATELY if
Breathing or swallowing is difficult.
Hives are present.
There are 10 or more stings.
A sting occurs inside the mouth.
If vou see a little black dot in the bite, the stinger is still present (this only occurs with honeybee stings). Remove it by scraping it off. If only a small fragment remains, use tweezers or a sterile needle just as you would to remove a sliver. Then rub each sting for 15 minutes with a cotton ball soaked in a meat tenderizer solution. This will neutralize the venom and relieve the pain. If meat tenderizer is not available, apply an ice cube while you obtain some.
Some bee stings can also be prevented by avoiding gardens and orchards and by not going barefoot. Insect repellents are not effective against these stinging insects.
CALL OUR OFFlCE Later if
You can't remove the stinger.
The swelling continues to spread after 24 hours.
Swelling of the hand (or foot) spreads past the wrist (or ankle).
You want a nurse or physician to look at the sting
You want a nurse or physician to look at the sting
lTCHY OR PAINFUL lNSECT BlTES
DEFINITIONBites of mosquitoes, chiggers, fleas, and bedbugs usually cause itchy, red bumps. The size of the swelling can vary from a dot to 1 cm (1/2 inch). The larger size does not mean that your child is allergic to the insect bite. Mosquito bites near the eye always cause massive swelling. The following are clues that a bite is due to a mosquito: itchiness, a central raised dot in the swelling, bites on surfaces not covered by clothing, summertime, and the age of the child (that is, he is an infant).
Itchy lnsect Bites
Apply calamine lotion or a baking soda solution to the area of the bite. If the itch is severe (as with chiggers), apply nonprescription 1% hydrocortisone cream. Another way to reduce the itch is to apply firm, sharp, direct, steady pressure to the bite for 10 seconds. A fingernail, pen cap, or other object can be used. Encourage your child not to pick at the bites or they will leave marks.
Painful lnsect Bites
Rub the area of the bite with a cotton ball soaked in meat tenderizer solution. This will relieve the pain. If you don't have any meat tenderizer, ammonia is a fair substitute. If these substances are not available, an ice cube may help.
Mosquitoes and Chiggers
Many of these bites can be prevented by applying an insect repellent sparingly to the clothing or exposed skin before your child goes outdoors or into the woods. Repellents are essential for infants (especially those less than 1 year old) because they cannot bat the insects away.
The bed and baseboards can be sprayed by a licensed exterminator but young children must be kept away from the area because these substances are somewhat poisonous. You should not do this job yourself.
Usually you will find the fleas on your dog or cat. If the bites started after a move into a different home, fleas from the previous owner’s pet are the most common cause. Fleas can often be removed by bringing a dog or cat inside the house for 2 hours to collect the fleas (they prefer the dog or cat to living in the carpet) and then applying flea powder or soap to the animal outdoors. Careful daily vacuuming will usually capture any remaining fleas.
Precautions with DEET insect Repellents
Insect repellents containing DEET must be used with caution. DEET can be absorbed across the skin into the blood stream and can cause seizures or coma. Young children may also have reactions to DEET from licking it off the skin. To prevent harmful reactions, take the following precautions:
Apply repellent mainly to clothing and shoes.
To prevent contact with the mouth or eyes, don't put any repellent on the hands.
Don’t put any repellent on areas that are sunburned or have rashes because the DEET is more easily absorbed in these areas.
Warn older children who apply their own repellent that a total of 3 or 4 drops can protect the whole body.
Because one application of repellent lasts 4 to 8 hours apply it no more than twice daily.
If repellent is put on the skin, wash it off after your child comes indoors.
CALL OUR OFFICE Later if
The bites are from fire ants.
Itching or pain interferes with sleep.
The bites become infected.
A tick is a small brown insect that attaches to the skin and sucks blood for 3 to 6 days. The bite is usually painless and doesn't itch. The wood tick (or dog tick), which transmits Rocky Mountain spotted fever and Colorado tick fever, is up to 1/2 inch in size. The deer tick, which transmits Lyme disease, is the size of a pinhead.
The simplest and quickest way to remove a tick is to pull it off. Use tweezers to grasp the tick as close to the skin as possible (try to get a grip on its head). Apply a steady upward traction until the tick releases its grip. Do not twist the tick or jerk it suddenly because these maneuvers can break off the tick's head or mouth parts. Do not squeeze the tweezers to the point of crushing the tick; the secretions released may contain germs that cause disease.
If you have no tweezers, pull the tick off in the same way using your fingers. Some tiny ticks need to be scraped off with a knife blade or the edge of a credit card. If the body is removed but the head is left in the skin, use a sterile needle to remove the head (in the same way that you would remove a sliver). Wash the wound and your hands with soap and water after removal. A recent study by Dr. G.R. Needham showed that embedded ticks do not back out with the application of a hot match or when covered with petroleum jelly, fingernail polish, or rubbing alcohol. We formerly thought that petroleum jelly, fingernail polish, or alcohol would block the tick's breathing pores and take its mind off eating. Unfortunately, ticks breathe only a few times per hour.
Children and adults who are hiking in tick-infested areas should wear long clothing and tuck the end of the pants into the socks. Apply an insect repellent to shoes and socks. During the hike perform tick checks using a buddy system every 2 to 3 hours to remove ticks on the clothing or exposed skin. Immediately after the hike or at least once daily, do a bare skin check. A brisk shower at the end of a hike will also remove any tick that isn't firmly attached. Because the bite is painless and doesn't itch, the child will usually be unaware of its presence. Favorite hiding places for ticks are in the hair, so carefully check the scalp, neck, armpit, and groin. Removing ticks promptly may prevent infection because transmission of Lyme disease requires 18 to 24 hours of feeding. Also the tick is easier to remove before it becomes firmly attached.
CALL OUR OFFICE Later if
You can't remove the tick.
The tick's head remains embedded.
A fever or rash occurs in the week following the bite.
You think your child has some of the symptoms of Lyme disease.
You think your child has been bitten by a deer tick and it was probably attached for more than 18 hours.
NOTE: You do not need to call if your child was bitten by a tick and it was removed promptly.
Instructions for Pediatric Patients by Barton D. Schmitt, M.D., Pediatrician.
Adapted from YOUR CHILD’S HEALTH.
Copyright (C) 1991 by Barton D. Schmitt, M.D.