Dr. Mike Smith (Host): Welcome to Children's Mercy, the Parent-ish podcast. I'm Dr. Mike. And with me is Dr. Chelsea Wolfe from Children's Mercy. Today, we're diving into lice lowdown, what every parent needs to know. Dr. Wolfe, welcome to the show, and my scalp already itches.

Dr. Chelsea Wolfe: Thank you so much for having me. And yes, it is hard not to itch when you are thinking about lice.

Dr. Mike Smith (Host): Right. Let's just start with the basics here. What are lice and how do kids usually get them? Like, what are some of the risk factors for it?

Dr. Chelsea Wolfe: Sure. So, lice are tiny insects or bugs. They're about the size of a sesame seed and they live on people on our scalp, and feed on blood from the scalp. Most commonly, they're in kids who are in preschool or elementary age. And actually, millions of kids get head lice in the U.S. every year.

Luckily, while they are very annoying, they do not cause any serious illness or carry any diseases, like when you think about a tick or a mosquito, so mostly just annoying. Children get them usually from close contact with another individual who has lice.

Host: You said a million cases a year.

Dr. Chelsea Wolfe: Yes, they're very common.

Host: I did not know it was anywhere close to that. That's amazing.

Dr. Chelsea Wolfe: And that's just in the U.S. That's not even including all the other countries in the world.

Host: So, are there certain environments or something that these cases are happening more than others?

Dr. Chelsea Wolfe: So, a lot of people associate school and some transmission does happen in schools or preschool environments. But once life kind of spread from a child, they actually are more commonly transmitted in the home than in the school.

Host: Wow. Okay. So if you're a parent, what are some of the signs they should be looking for if their kid maybe has lice or something?

Dr. Chelsea Wolfe: Sure. So, the most common sign of lice is actually itching of the hair scalp, as you might expect. Although interestingly, the first time a child gets an infection with lice, they may not even start itching for about four to six weeks after they get the head lice. And that's because the itching is actually from sensitization to the saliva from the bite.

Host: I want to make sure I'm understanding this correctly. So, a million cases in the U.S. alone a year. Okay. Are they more prevalent in certain parts of the country or lice don't care, they're all over the place?

Dr. Chelsea Wolfe: Lice do not care. So, lice attaches to anybody. They don't care if your hair is clean, if your hair is dirty, they don't care about socioeconomic status. So, they're in all areas of the country. And they actually don't care about curly or straight hair, race or ethnicity. Anybody and everybody can get them.

Host: They're all in. They're having a great time. Okay. So, itching, right? Kids itch all the time. How do you tell the difference between a real case and a false alarm or something?

Dr. Chelsea Wolfe: So, the best way is to get a good look at your child's head. So, sit them down in a chair, get a really well-lit room, and just take their hair section by section. Usually, lice like to hang out kind of at the base of the scalp, or behind the ears. And so, that's the easiest place to find evidence.

If you're having a hard time seeing it, you can use specialized combs that you can buy over-the-counter like a lice comb, but even just looking. The adults are actually hard to see, and you may not even see those because they're very fast. They don't like light, so they'll move quickly. But what you'll usually see is the eggs or the nits on the base of the scalp, which are kind of stuck to the hair. The big thing to look out for is not to confuse dandruff with lice. So, dandruff will move really easily. So as you kind of shake the hair or you comb it, dandruff will come out really easily. And nit or an egg will be stuck on tight to the hair.

Host: Oh, okay. That's really helpful then. So, you may not see the parents running around, right? But you will most likely see the eggs. And the eggs are gonna be really stuck versus something like, as you said, dandruff. So, I think that's very helpful.

Dr. Chelsea Wolfe: Yes. And interestingly, they may hide the eggs by kind of pigmenting them a little bit. So, eggs may actually be a little bit different color on different color scalps. But once the lice have hatched what's left, that eggshell, will always be white. So, you can see that pretty easily, no matter the hair color.

Host: Are you telling me that the lice can modify the egg shell color?

Dr. Chelsea Wolfe: Correct. But not once they hatch, so they'll always be white after the lice have hatched out of the egg shell, but it'll still be stuck to the hair.

Host: So, you got a kid, they're itchy and stuff. You sit them down, you look for those things. What do you do? Okay. If they don't find anything, because parents aren't clinicians like us, Dr. Wolfe, right? So, they may not see something, their exam may not be a quality exam. What do you say to that?

Dr. Chelsea Wolfe: I think if you want a second opinion then pediatricians, school nurses are both very experienced in looking for these and we're happy to do the exam. I think also just knowing that we don't recommend treating just for simple exposure, again because kids get it from close head-to-head contact most commonly. We recommend only treating for exposure if they shared a bed with another child who had head lice. If it was just in the school and you don't think you've seen anything, you can get a second opinion before you go ahead and treat.

Host: When I was young, especially like in middle school playing baseball, we would share baseball hats and everything. That's kind of how they can spread.

Dr. Chelsea Wolfe: Yeah. So, most commonly, it's close head to head contact, but there is some transmission from sharing personal items. So, definitely talk with your children. Recommend they don't share hats, jackets, brushes. Especially think about the coats in this cold winter season, they can kind of shove their coat into their backpack or put it in a cubby instead of hanging it next to other coats, that's preferable. And when your kid goes for a sleepover, you can even send their own pillow And then just wash that pillowcase when they get home.

Host: As you said, in the home is where it really spreads, and it's usually two kids maybe sleeping right next to each other. When a parent is doing all this and they're doing their exam and they do see eggs, or maybe they see some parents running around, what's the very next step they need to take other than don't scream and scare your kid.

Dr. Chelsea Wolfe: It's very important in trying to keep our kids from being embarrassed or ashamed by this infection to talk with them calmly. Try to reserve your heebie-jeebies when you're talking with them, and really just take it calmly step by step. You should go ahead and treat your child the same-day that you discovered to prevent transmission in the . And we recommend treating. You could do it over-the-counter or you can see your pediatrician for a prescription. Both are effective. Try not to ostracize your child after you've done that first treatment. They're no longer an infection risk. So, lice are spread by crawling. They can't jump, they can't hop, they can't fly. And like I said, those nits or eggs are really stuck on the head. So, those aren't the problem. It's the adult lice. So once you've treated your child, they can go back-to-school the next day. They don't need to stay home if they have shown that they don't have any nits, for example. So, this is a little bit different from maybe when we were kids.

Host: Yeah. Well, I don't know. So, the idea is it was like so contagious. When you really compare it to something like a respiratory virus or something, they're really not.

Dr. Chelsea Wolfe: Correct. They are not nearly so contagious as a common flu or cold.

Host: So, what are the treatment options today?

Dr. Chelsea Wolfe: So, there's a few different treatment options. Most of them center around being shampoos or lotions that you put into the hair. Let it sit for usually about 10 minutes, and then rinse from the hair. Now, some of Those are over-the-counter and some of them are prescription. There is a little small resistance to some of the over-the-counter treatments, although it varies by area. So, most of the time we recommend starting with those. And then if there's resistance, you can always get a prescription for a different one from your pediatrician as like a second line.

Host: Just to back up, can you start with the shampoo for instance that's over-the-counter, or do you need a prescription strength?

Dr. Chelsea Wolfe: No. So, many of the over-the-counter FDA approved are very similar in efficacy to the prescription strength. And so, you can start with what you can buy over-the-counter at the store. For example, the Nix or the Rid shampoos. And then, most of those, I will say, require a repeat treatment about seven to 10 days later, just check your bottle. And that's because most of the over-the-counter shampoos kill the adults, but don't kill those nits. And so, unless you've been combing every day in between and gotten all the nits out, those can still potentially hatch. And so, you do the second treatment to kill any of those that hatched.

Host: So, I want to back up to something you said earlier that the lice really don't care if it's curly hair, straight hair, whatever. When I was a child-- and I want to speak honestly here, because I want to bring this up-- when I was a kid, there was a stigma of the type of kid who got lice, and it usually was the child who maybe their hair wasn't always combed so well, or maybe it looked a little more in the greasy side or something. None of that's true, right?

Dr. Chelsea Wolfe: Correct. None of that is true. Lice just want your scalp and to be able to drink the blood from your scalp. They don't care if your hair is clean or not. And so, transmission doesn't matter.

Host: Yeah. And they don't care if you're rich or you're poor, or you come from one side of the city or you're across the tracks. They don't care about that stuff.

Dr. Chelsea Wolfe: They do not care.

Host: I think that's important. I feel bad that I think a lot of kids got made fun of when they got the lice. Because there was that stigma to it. But I'm glad to hear you clear that up. So, how can parents talk to their kids about lice without adding that stigma, like, "Oh, well, you're not washing your hair enough," or "You're not-- you know, whatever"?

Dr. Chelsea Wolfe: Yeah. So, I think just talking with them, sharing, you know, this is a common infection. A lot of adults have stories of their own infections they had as children, and that it just comes from close contact. Talk to your kids about how they can be a little bit safer and not sharing their personal items to prevent infection. But really talk with them about how this doesn't have to do with your hair type or how well you're cleaning it. It's nothing to do with you personally, and that there's no reason to shame anybody who may or may not have given it to them.

Host: What are some of the, I don't know, go-to hacks or tips that you can give to parents for preventing lice?

Dr. Chelsea Wolfe: Unfortunately, there's no like, definite way to keep your child from getting it. Basically, it's the things we talked about. Especially in this winter season, being really careful about what they're doing with their jacket, not throwing it into a pile with other jackets as they run off to play on the playground, if it's a little bit warmer outside, but putting it away in their backpack or in their cubby, not sharing things. And then, really, parents especially, sending their own pillow with their own pillowcase and washing it for sleepovers, those kind of things. Not trying on hats in stores. You never know who tried it on before you.

Host: That was a big tip when we were kids. Don't try on hats. Don't do that. I do remember that. But it is funny. So, the best tips that we have are for kids to like not throw their jackets or whatever in a pile before they go and play.

Dr. Chelsea Wolfe: Yeah. And also, just talking to kids about personal space. You know, the sooner kids learn to give a little personal space to their peers and not put their head right up against their peers head, that will really decrease the transmission.

Host: Oh boy. Any last words that you would like for parents to know about lice and current treatments?

Dr. Chelsea Wolfe: So, again, just pointing out that lice do not harm your child and don't pose any risks. They're just annoying. And really focus on FDA-approved treatments. There's all kinds of things you can find on the internet that are said to maybe help or not help, but really focus on things that we know are safe and have been proven safe as treatments for children.

And then, just thinking about when to talk with your pediatrician or seek care. If you look at your child's scalp and you notice any sores or wounds, say, they scratch so hard that they've opened something, then talk with your pediatrician about whether there could be an infection. If it's a small infant and you're not sure if any of the over-the-counter treatments are safe, then reach out to your pediatrician.

Again, if you've done the exam and you don't think you see lice, but you're not sure, then always reach out. We're happy to examine them and tell you yes or no, this is or is not lice. And then, if you're concerned that you've done the treatments at home and they haven't worked, then reach out to us. We're happy to help.

Host: Yeah, for sure. I think to summarize all that up, parents aren't alone. They got their Drs. Wolfe in their lives, right? That's really good.

Dr. Chelsea Wolfe: Correct. Don't be afraid or ashamed to come talk with us. We see head lice all the time.

Host: I really appreciate this, Dr. Wolfe. This was good information. I thought you gave some really good tips and insights. So, this was great. Thank you for coming on the show today.

Dr. Chelsea Wolfe: Yeah. Thank you so much for having me.

Host: For more information, head over to childrensmercy.org/parent-ish. If you enjoyed this podcast, please share it and check out our entire podcast library for topics of interest to you, This is Children's Mercy, the Parent-ish Podcast. I'm Dr. Mike. Thanks for listening.