Head lice are wingless insects that live on the human scalp-especially the scalps of young children. The do not carry disease, but they can be unsightly, itchy, and upsetting. Getting lice can happen to any child, and is not a reason for panic or embarrassment. When teachers or school nurses find signs of lice of lice eggs, they usually send a child home with instructions not to return until signs of the infestation are gone. If this should happen to your child, you will naturally be concerned. This guide will help you sort fact from fiction and make an effective response.

Few childhood ailments have accumulated as much lore as lice infestation, some of it true and much of it fantasies. Here are the facts:

• Lice infestation is not rare. Six to 12 million persons in the United States get lice every year, and most of them are school children.
• Children do not get head lice because they are dirty, neglected, or poor, and meticulous hygiene will not prevent an infestation. They probably don’t pick up lice by sharing combs or hats. They do get lice from direct, head-to-head contact with other children who have lice, usually their close friends.
• Lice don’t prefer children with long hair, although they do seem to prefer girls-probably because girls are more likely than boys to play close to their best friends.
• Lice are more common in white that in black children. This is probably because it is easier for lice to cling to the round hair shafts typical of black children.
• Lice have no wings, so they can’t fly from one head to another, and they don’t hop. They can scurry, however.
• Infested children are not likely to have great swarms of lice in their hair: many have only one or two.

Quite possibly, none. Children with lice may have itchy scalps, but about half of them do not. Sometimes, when children scratch louse bites vigorously, the sites get infected. If you see redness or swelling on your child’s scalp, or notice swollen lymph glands in the neck, bring your child to the office so that we can prescribe treatment.

If you have been informed of lice infestations in your child’s class at school or among their friends, it would be prudent to check your child’s scalp. Lice are not easy to find because when you shine a light on the scalp or comb the hair, they hide. The female louse is either black or reddish-brown and the size of a sesame seed. Eggs and nits are found firmly attached to the hair shaft near the skin and unlike dandruff will not shake off the hair shaft. The favorite areas of lice are the back of the neck and behind the ears, but can be found on other areas of the scalp. Lifting the hair gently, under a strong light will help you find lice easier. Eggs or nits are not always a sign of active infestation but some schools will not allow children to attend until the nits are gone. If you or the school nurse find lice on your child’s head, you can treat at home with shampoos or rinses from the local pharmacy. Among the recommended treatments include: Nix crème rinse A-200, Pronto or Ovide (which requires a prescription). The directions include shampooing the child’s head with regular shampoo, rinse and towel dry. Then apply the treatment and leave on for approximately 10 minutes and rinse. Comb hair thoroughly to remove eggs and nits, which takes time, but is crucial. If any eggs are left behind, they may hatch and begin a new infestation. Repeat the treatment in 7-12 days to be sure all the eggs have been killed. Inspect the scalp 24-48 hours after the treatment to see if lice remain. Also, you may call our office for further suggestions. Sterilizing the infested child’s clothes or possessions is beneficial by drying at a high heat setting, or seal items in plastic bags for two weeks because lice do not live long away from the scalp. If your child complains of itching even after the lice are gone, call us. This may be due to an allergic reaction to the dead lice and eggs. There is medication to help with this.

How to protect and teach your children about strangers.

Your child misses considerable school because of vague physical symptoms. When he is not in school, he is at home; that is, he is not a truant. Tile symptoms are usually the type that people get when they are upset or worried, such as stomachaches, headaches, nausea, vomiting, diarrhea, tiredness, or dizziness. These physical symptoms occur mainly in the morning and often worsen at the time of departure for school. Otherwise, your child seems healthy and vigorous. School phobia is a very common problem that affects at least 5% of elementary school children and 2% of middle school students. The symptoms often begin in the fall.

A school-phobic child is usually afraid of leaving home in general, rather than afraid of anything in particular at school. For example, he may experience homesickness when staying at a friend's house. Often the first test of a child's independence comes when he must attend school daily. Aside from poor attendance, these children usually are good students and well behaved at school. The parents are typically good parents who are conscientious and loving. Such parents are sometimes overly protective and close, and the child finds it difficult to separate from them. He may lack the self-confidence that comes from handling life's normal stresses without his parents' help.

Sometimes a change of schools, a strict teacher, hard tests, a learning problem, or a bully are seen as causes of fear of going to school. Such factors may be only part of the problem, however, and your child should still go to school while these difficulties are being resolved.

If you insist oil daily school attendance, school phobia should improve dramatically in one or two weeks. If you do not require your child to attend school every day, however, the physical symptoms and desires to stay home will become more frequent. The longer your child stays home, the harder it will be for him to return. Your child's future social life and education may be at stake.

therapy for school phobia is to be in school every day. Fears are overcome by facing them as soon as possible. Daily school attendance will cause your child's physical symptoms to improve. As they become less severe and occur less often, your child will eventually enjoy school again. At first, however, he will test your determination to send him every day. You must make school attendance a nonnegotiable, ironclad rule. Be optimistic with your child; reassure him that he'll feel better after he gets to school.

You should probably keep your child home from school when she has any of the following symptoms: · fever over 100.4°F

· vomiting more than once · frequent diarrhea · frequent cough · widespread rash · earache

· toothache.

Children with a sore throat, moderate cough, runny nose, or other cold symptoms but no fever can go to class. Don't keep a child home for "looking sick," "poor color," "circles under the eyes," or "tiredness" in the absence of other symptoms.

· School phobia does not resolve in two weeks using this approach.

· School phobia recurs.

· You think the cause of the symptoms may be physical rather than emotional.

· Your child continues to have other fears or separation problems.

· Yom' child is withdrawn in general or seems depressed.

· You have other questions or concerns.

Adapted from Schmitt BD: You; Child's Health. New York. Bantam Books. Inc., 1987.

T his parent information aid on school phobia may be photocopied and distributed to parents without permission of the publisher.

DR. SCHMITT is director of consullative services, The

Children's Hospital, Denver, and professor of pediatrics         ,

University of Colorado 'School of Medicine.

42 CONTEMPORARY PEDIATRICS