Scott Webb (Host): If you're a parent, or maybe a pediatrician, you know that head lice for kids is very common. And though treatment is recommended, there are no lasting health effects that should really concern parents. And joining me today to tell us more about head lice is Dr. Patty Sabey. She's a pediatrician with Stanford Medicine Children's Health. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb.

Doctor, thanks so much for your time today. Thanks for joining me.

Patty Sabey, MD: Yeah, thank you. My pleasure.

Host: Yeah, we're going to talk about something that most of us parents, I know we're both parents, most of us have dealt with and you certainly deal with in the office with, you know, parents and children. We're going to talk about head lice, which when I say that out loud, people I think sometimes just cringe a little bit because we've all been there and they're hard to see and a little bit hard to deal with. And sometimes we need the expertise of a pediatrician. So it's great to have you on. Let's just start there. What is head lice?

Patty Sabey, MD: So, head lice, I like to share the medical name for head lice. It's called Pediculus humanus capitis. So, it's a mouthful, but from the name, it's basically a specific bug that affects the human scalp or infects the human scalp. So it's this microscopic bug you can see it, visibly. The adult is about a sesame seed size and it, they basically just hang out on human scalp. They can attach to human hair and it's just this tiny microscopic companion of human species, as AAP puts it, that has been around for ages. And it doesn't really cause any major diseases.

 It's more of an annoyance because it can cause intense itching of the scalp. It can spread from person to person. So, that's why it's an issue for daycare, preschool, and mostly young school aged children and preschool children.

Host: Yeah, definitely, as you say, it's an annoyance, it's a nuisance, especially with the itching and the scratching. So, you know, I just sort of accepted it as a rite of passage. As a parent with children, they go to school, they play sports, or go to the pool, whatever it might be; eventually, they were going to get head lice, and of course, they did.

Generally, we say this is younger children, but how do people in general get head lice?

Patty Sabey, MD: Yeah, so, lice, actually, they can crawl really fast, and it might sound disturbing, but because they crawl, they don't hop, they don't jump from person to person. They typically spread from hair to hair contact, or head to head contact. So, if you have young children in daycare or preschool setting where they're wrestling each other on the floor or they take a nap and they have head to head contact, if they're sleeping cots are next to each other or head to head; the lice can spread that way. So it's through direct contact.

Host: Well, it is so good to have your expertise because I always thought it was one of these things where if you were just near someone who had lice, they could somehow jump from that head to my head, and then I would have the lice, so it's head to head contact, and I'm guessing when it comes to diagnosis, it's really passing the visual test, right? You can just look at a child's scalp and hair and go, yep, that's lice.

Patty Sabey, MD: Yeah, so if someone is really infested with a lot of lice, then it is possible that the lice can be propelled to someone's head. But generally, you know, even when someone has active lice infestation, you might have about 10 adult lice on the head.

So the spread is really not common besides head to head contact. And to diagnose it lice, you know, actually avoid light. So the best place to look for them is behind the ears or, like kind of just above the neck, like at the neck, and with good lighting and you have to really look close to the scalp because usually lice love to hang out close to the scalp. If they're too far away from the scalp, they don't survive for very long.

Host: I almost laughed out loud when you said that sometimes they can sort of be propelled. And I was just sort of trying to picture, I'm like, how does that happen? How does, how do the lice get propelled from one head to the other? But maybe that's a separate podcast, but I get your point. That if there's a massive infestation that could happen, but generally it's the head to head. And as you say, fairly easy to diagnose either by parents at home, but certainly by an expert like yourself. So then how do you treat lice?

Patty Sabey, MD: So lice is generally treated with a topical medication. So a lot of these topical products are available over the counter, so no prescription needed. So this is something parents can buy at local pharmacies or even grocery stores. You know, at the medication section there may be over the counter lice medications.

And depending on your local, I guess degree of infestation, you know, how common it is. Some areas, you might need stronger medications, or prescription strength. So generally what we tell families is, if you're worried about head lice, you can try the over the counter medications, and if that's not effective, and the child continues to have symptoms or you continue to discover lice or like the eggs of lice called nits. If you continue to discover that, then see your doctor and consider getting a prescription strength medication. And it's not necessarily more expensive. It may just be stronger to,

Host: Stronger, sure.

Patty Sabey, MD: treat the lice. And there are actually hair salons or places that will, for a fee, help you treat the lice. So you can actually take your child to a place like that.

Host: Yeah, for sure. So whether then it's OTC or, you know, something a little stronger, once you begin applying it or treating it, whether it's at home or at the salon, how long before a child can return to, you know, school, daycare, those kinds of places?

Patty Sabey, MD: Yeah, so generally from the perspective of pediatricians, once, you know, we counsel on the treatment of lice and the family, does the treatment, then really the following day the child can return. So there's not a waiting period before the child can go back. Generally we do recommend treating again, depending on the medication, most of the time we need to treat again in a week, because it takes about a week for the lice egg to hatch so to effectively get rid of the lice, a repeat treatment is usually recommended.

We also recommend any items that the child has used in the last 48 hours, either bedding or stuffed animals and items that can be laundered; they should wash those items and things that cannot be washed should be put in a plastic bag or container and stored away for a couple weeks before the child uses those items again.

Host: Yeah, is there any chance, Doctor, that once you've had head lice and or been treated for it, that somehow you're immune, that you can never get head lice again, or is that, is they sort of repeat visitors or repeat companions? I think you used that word earlier.

Patty Sabey, MD: Yeah, so head lice actually, can be a recurrent problem and probably the more common scenario is that one person in the family gets head lice and technically everyone should get checked, but if it's not discovered first round and the first person gets treated, but then another child gets head lice, then it can basically recirculate in the household.

So that's probably the most common reason that someone can get head lice again. So you're not immune per se after you get the first round of treatment. But as the child gets older, less head to head contact, and they're more aware of how to prevent themselves from getting head lice than the risk of head lice goes down.

Host: Yeah, and I want to talk to you about that. You had said earlier, there's no real massive sort of big negative health impacts other than lots of irritation, annoyance, and scratching; but how do we explain to our kids how to avoid head lice? Is it just as simple as that? Like, you know, don't rub heads, don't bump heads, don't wrestle, don't be a kid. I mean, we have an easier time, as you say, with the older kids getting them to avoid that head to head contact, but how should we present that to our kids?

Patty Sabey, MD: Yeah. So, I actually have firsthand experience as a parent.

Host: Okay.

Patty Sabey, MD: A couple of our kids got head lice. So if you know, for sure, someone just had head lice, then be a little more careful, you know, you can, you're still friends with them. You can still play with them, but try not to share a hairbrush with them or, you know, share a hat. Although transmission through a comb or a hat is much less common than head to head contact, it's still possible. So try not to share a helmet, a hat, or a comb. When you play with your friend, try to avoid, leaning against their head, if you know for sure, they just recently had head lice. But in general, you know, I think it's okay to let kids be kids and play the way they feel comfortable. But generally, as we talk to our children, you know, we can reassure them just because you have head lice, or you had head lice, or your friends have head lice, it's not a bad thing. It's part of the human experience, and it's something that could cause some annoying symptoms, but we should still treat everyone kindly and you know, you deserve to be treated kindly even if you have head lice.

And we have treatment for it, just like if you have a cold, you know, we wait it out, it gets better. So, we'll keep it positive for our children.

Host: Yeah, whether it's head lice or anything else, any other communicable types of things. So it's been really great today, Doctor, really educational. Head lice is one of those things that, we all know is out there. We don't talk about it much. We sort of scrunch our faces a little bit when you hear, Oh, head lice. Yeah, but it happens. It happens to all of us parents and kids, and good to know that there are treatment options and there's not really lasting effects. So, uh, thanks so much. You stay well.

Patty Sabey, MD: Yeah, thank you so much.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.