Pediculosis – Lice (Pediatric Nursing)

00:00 Now let's talk about lice. Lice is Pediculosis capitis and this is caused by a wingless insect.

00:08 It feeds on human blood and humans are the only known host. Fortunately they do not transmit disease and this requires the mechanical removal or chemical treatment. So, lice is Pediculus humanus capitis and adult head lice are about 2-3 mm in length. It is spread by close person-to-person contact. Dogs, cats, and other pets are not vectors. They cannot hop or fly, they have to crawl and this tends to be a common misconception. Let's talk about nits. These are lice eggs and they're tiny, yellow, tan or brown dots. They can be found on the hair shaft close to the scalp where they can stay warm and they can't be removed by brushing or shaking the hair. These eggs are going to hatch 1-2 weeks after they're laid and the shell is going to remain attached to the hair shaft and appear white or clear. It's easier to spot them as the hair grows and the shell moves further away from the scalp. Here is the lice's life cycle. First, the egg is laid on the hair shaft and this is called the nit. Next, the louse is going to emerge after 6-7 days. It's going to molt after hatching 3 times before it's an adult lice. The females and males begin to reproduce and females will lay the first egg 1 or 2 days after mating. The female can lay 3-8 eggs per day for the next 10 days and after about 32-35 days this louse will die. There are some risk factors for head lice. Families with multiple children and children who attend daycare or school, also people who share beds and closets, and girls are more frequently infested than boys. The age population 4-14 is the most frequently infested age group. So, how is lice transmitted? It's transmitted via head-to-head contact with an infested person. This can also be spread with contact from clothing including hats, scarves, and coats or personal items like combs, brushes, or towels although that's much less common. So what are the symptoms of lice? Well, some patients have lice and they are asymptomatic. However, if your patient has symptoms, they may have itching on their scalp, their neck, and their ears. And this is a reaction to the louse's saliva. You may also see lice on their scalp. You may see lice eggs or nits on the hair shaft and these are easiest to spot around the ears and the hairline. The patient may feel a tickling feeling from the movement of their hair and you may notice some small red bumps on their scalp and hairline.

02:48 So, on exam, you're going to collect a full health history and look at your patient's vital signs and these should be normal. Next, you examine the scalp and hair and this can be quite a process. You want to be sure to get the patient into good light and use extra tools if needed.

03:03 You can use a nit comb to search. A regular brush can be used to remove tangles but is not adequate to look for lice. You're going to place your nit comb at the top of the head touching the scalp and pull it through from the roots to the ends and then you're going to examine the comb for lice or eggs. You're going to do this through the entire hair twice. Although lice are not dangerous and they don't transmit disease, treatment is recommended. All household members in close contact should be checked and treat if infested. And where I work when I'm checking a child for lice, I will also check the parents or the guardians and I often find that they're also infested as well and they don't have symptoms so then everyone gets treated.

03:45 You give medications to either kill lice or the eggs and the family needs to launder all bedding used in the 2 days prior to the treatment. You can dry clean or seal items that can't be washed in the bag for 2 weeks and you want to remind them not to share hats, grooming aids, or towels. They will also need to vacuum their furniture and floors to collect hair that can contain the nits. And there are many over-the-counter and prescription medications available.

04:12 And your patient can also invest in a nit comb. So, there are a lot of complications of lice, but these aren't serious. But this causes a lot of emotional distress for families. It's kind of a pain to clean their whole house and vacuum and do their bedding and treat their hair so you want to talk to them about this impact. It can also cause absence from school and work so you want to treat the whole family at once so they can get back to their daily routine. This can cause sleep disturbance and this can be from itching and secondary bacterial infections, again from the itch scratch.