Lice

[heatherrmp, ASN, BSN, RN]

I have a student who has been out for two weeks with live lice and nites.They come in to get checked, and we are told the family is treating the house appropriately, as well as treating student, but there is never any change in our assessment when they come to get checked. Do any of you reach out to local pediatricians/family doctors for prescription shampoo? I am at a loss as to how I can help this family further, when we have advised that they reach out to their primary on their own. I feel like we have talked and talked and talked about this with numerous family members and nothing has worked. 

[k1p1ssk, BSN, RN]

You're seeing live lice every time the kiddo comes back to school? Is this family struggling financially? Do they have health insurance? How many children are in the family? Are you sure they have running hot water? 

Negative circumstances in any of these areas could be hindering their access to do the right thing, perpetrating the problem. 

Does your school/district/town have any programs where someone might be able to purchase the treatment and you can help treat the kiddo in school? Our policy is that they cannot be in school with live lice, but may return after treatment. So, if the infestation is found in the morning, I can technically send them home to be treated and then have them return as soon as it's done.

If there is denial/refusal from the family, then your only option might be contacting CPS/DCF and NOT filing, but at the very least, seeing if there are resources available to help the family actually treat the problem.

[nursekoll, BSN, RN]

"Treating appropriately" may mean different things to different people. I've heard all sorts of crazy "treatments" that parents use that are truly not appropriate (mayonaise, salt water, olive oil, perms, hair dye, vinegar, hair straightener, etc) . I would offer to have them come in and go through the treatment process step- by- step. I show them tips and tricks for using the nit comb such as using a headlamp and reading glasses to help to see the tiny nits and nymphs. Explain the reason for treating every 8 days to break the life cycle of the lice. I recommend treating everyone in the home at the same time schedule for recurrent infestations.  I also ask for the empty container of whatever brand product they use to be turned in to me after each treatment. That way I know they've used the whole bottle as recommended each time.  I've found the vamousse brand and other "all natural" products just do not work, so I try to steer them away from these products. Our school has some funding for purchasing lice shampoo if finances are an issue for appropriate treatment. 

[cowboysandangels, BSN]

Our health department will give vouchers for lice treatment kits.  Very helpful due to cost of those kits.  There are also lice salons in some areas that can guarantee the treatment.  Those are very costly but effective.  I have reached out to local community organizations to help pay for the salon treatments when necessary.  

[heatherrmp, ASN, BSN, RN]

k1p1ssk said:

You're seeing live lice every time the kiddo comes back to school? Is this family struggling financially? Do they have health insurance? How many children are in the family? Are you sure they have running hot water? 

Negative circumstances in any of these areas could be hindering their access to do the right thing, perpetrating the problem. 

Does your school/district/town have any programs where someone might be able to purchase the treatment and you can help treat the kiddo in school? Our policy is that they cannot be in school with live lice, but may return after treatment. So, if the infestation is found in the morning, I can technically send them home to be treated and then have them return as soon as it's done.

If there is denial/refusal from the family, then your only option might be contacting CPS/DCF and NOT filing, but at the very least, seeing if there are resources available to help the family actually treat the problem.

Yes. Every other day they would come in (MWF) and every time I or our other nurse would see live lice. This family is struggling financially, I believe mom is the only worker as dad is on disability, but they do have medicaid. We are in a very rural area and the docs in the area all accept medicaid so it's not necessarily an access issue (there are two separate providers in town that are w/in walking distance to students home). I am unsure if they have access to running water, but this is something that has been addressed with DCFS multiple times over the last year and we just found out that parents can prevent DCFS from coming into the house sooooo. Student is the youngest of four, with only one other sibling being school aged. Sibling was treated and then head was shaved. I will try to reach out to our local health department as well, to see if they have other options. The last I had heard before break was that parent was discussing pulling student from school which would be the worst option for them as it does not appear as if student would thrive in an at home schooling setting. 

 

[heatherrmp, ASN, BSN, RN]

nursekoll said:

"Treating appropriately" may mean different things to different people. I've heard all sorts of crazy "treatments" that parents use that are truly not appropriate (mayonaise, salt water, olive oil, perms, hair dye, vinegar, hair straightener, etc) . I would offer to have them come in and go through the treatment process step- by- step. I show them tips and tricks for using the nit comb such as using a headlamp and reading glasses to help to see the tiny nits and nymphs. Explain the reason for treating every 8 days to break the life cycle of the lice. I recommend treating everyone in the home at the same time schedule for recurrent infestations.  I also ask for the empty container of whatever brand product they use to be turned in to me after each treatment. That way I know they've used the whole bottle as recommended each time.  I've found the vamousse brand and other "all natural" products just do not work, so I try to steer them away from these products. Our school has some funding for purchasing lice shampoo if finances are an issue for appropriate treatment. 

I like the idea of having family provide the bottle back to the school! The other nurse and I have talked and talked and talked to sibling, mom, dad. They are just not receptive to the information and are seemingly unwilling to comply. When I would do a check, I would show sibling (who would walk student to school) where the nits were and where I had seen a live bug, but sibling was more interested in using her phone at the time. 

[heatherrmp, ASN, BSN, RN]

cowboysandangels said:

Our health department will give vouchers for lice treatment kits.  Very helpful due to cost of those kits.  There are also lice salons in some areas that can guarantee the treatment.  Those are very costly but effective.  I have reached out to local community organizations to help pay for the salon treatments when necessary.  

This is going to be my next call. I was aware of a prescription shampoo that kills both nits and lice which would be ideal in this situation. There, unfortunately, are no local lice salons (the closest are about an hour away) and this is not a distance that family can drive even if it was paid for. 

[ChaosCoordinator]

Have they tried an oral medication? I know you indicated that resources are limited but oral generic ivermectin is as low as $10 for 4 tablets according to GoodRX. The attached article indicates up to 3 doses may be needed. If parents are agreeable, and you can get resources to help with the cost and permission to administer the medication (so that you know it is done), that could be an option.

https://pubmed.ncbi.nlm.nih.gov/21046698/

[nursekoll, BSN, RN]

Oral ivermectin is not FDA approved for treatment of head lice according to the CDC. Even if prescribed, the child would likely need 2-3 tablets per dose for an appropriate dose depending on weight. This would be considered off-label use, and I will not administer off-label medications at school as per my school policy. (The topical is over $150 per tube.) If you provide parents with this information and they want to go this route, they'd need to do it at home.

If it's a problem of re-infestation from different family members or households, this would likely not be helpful. They need to be checking all contacts and households the student stays with and treating all of them on the same schedule. This has been my experience at least with those recurrent cases.

[ChaosCoordinator]

nursekoll said:

Oral ivermectin is not FDA approved for treatment of head lice according to the CDC.

Shoot! You are correct - I have had families use it at home with great success but since they are handling it at home I didn't think about the FDA approval. Whoops!