Steps

Rationale/Points of Emphasis

1 Interview the child and the family about potential or known exposure to lice or scabies. Determine the symptoms, length of time of the infestation, possible exposure route, and the treatment already initiated.

Lice and scabies are transmitted through close contact with the individuals already infested. Pubic lice or scabies infestation in the young child should raise suspicion of sexual abuse.

caREminder

Pruritus is the primary symptom in children affected by head lice, pubic lice, or scabies.

2 Perform hand hygiene. Don nonsterile gloves. Don gown (as needed).

Reduces transmission of microorganisms and potential contact with lice or scabies.

3a Assessing for lice (nit): Separate the hair into sections and carefully inspect the scalp and hair for the presence of lice or nits. A nit comb may be used to assist with hair separation and inspection. A magnifying glass may be used to assist in visualization of the nits.

Determines whether lice or nits are present. Keeping yourself positioned away from the child will prevent your body and clothing from coming into contact with lice or nits.

caREminder

caREminder

Nits appear as yellowish or white, oval-shaped eggs stuck on the hair shaft. Head lice are clear in color after they have hatched. They may change in color to reddish or black with feeding. Pubic lice are brown or black colored after they are hatched, and their body appears more rounded.

In the school setting, the nurse would not be assessing for pediculosis in the child’s pubic area. Referral to the child’s healthcare prescriber should be made for this assessment.

3b Assessing for scabies (mite): Examine the child’s skin at locations of pruritus as well as skin areas where scabies are most commonly found, such as web areas between fingers and toes and inner aspect of elbows, axilla, wrist, groin, and waistband area.

Determines whether scabies are present. Scabies are attracted to warm areas of the body.

caREminder

Scabies mites are too small to be seen without magnification. The mites cause small, itchy bumps and blisters due to how they burrow into the top layer of human skin to lay their eggs. The burrows sometimes appear as short, wavy, reddish, or darkened lines on the skin’s surface, especially around the wrists and between the fingers. A child who has contracted scabies can also develop a bumpy red rash. Burrows are difficult to detect in areas of excoriation of simultaneous infection, such as impetigo.

4 Remove gloves and gown, and perform hand hygiene.

Reduces transmission of microorganisms or pediculosis.

5 Review findings of examination with the child and the family and answer any questions. Advise about the treatment, if necessary.

Imparts information about the child’s condition and provides opportunity for teaching.

Steps

Rationale/Points of Emphasis

1 Perform hand hygiene. Don nonsterile gloves and gown.

Reduces transmission of microorganisms and potential contact with pediculi.

2 Undress the child and place clothes in secured plastic bag. Give bag to a family member and provide instructions for cleaning the clothes (see Community Care).

Reduces transmission of lice.

3a Bathe the child with soap and water. Shampoo hair and pubic area with regular shampoo.

Cleanses body and hair of superficial dirt in preparation for the application of pediculicide.

caREminder

Do not use conditioner or combination shampoo/conditioner because the oils in conditioners may enhance absorption of chemicals.

3b Towel-dry the child’s hair with clean towel.

Removes excess water.

The practice of “wet combing” (combing the wet hair without use of any antilice treatment applied to hair) to treat head-lice infestations has not been demonstrated to be effective.

4 Place the used towels in appropriate receptacle.

Reduces the risk of transmission of lice to others.

5a Apply antilice shampoo or treatment per package instructions or per order of a healthcare prescriber. Massage the product into the base of the hair shafts where live lice and nits occur. Coat the entire scalp, including the back of the head and behind the ears.

Kills lice. The majority of head lice die of starvation unless they have access to a human blood meal at least every 48 hours. Head lice are host specific; they do not live on live pets and do not jump or fly.

KidKare While applying the treatment, avoid contact with child’s eyes and mucous membranes by protecting the eyes with a towel or washcloth.

5b Never leave the product in child’s hair longer than directed. Do not use shower cap. Do not mix the products or follow one treatment with another.

Leaving antilice treatments in a child’s hair no longer than directed prevents unnecessary exposure to toxins. Misuse or overuse of some antilice products has been reported to cause neurotoxic effects. Caution must be used, especially in the treatment of children younger than 2 years. Because of the risk of neurotoxic effects, antilice products are not often used on small children. Use of a nit comb can remove nits and lice from the fine hair of young children. Benzyl alcohol lotion 5% (BAL 5%) is the only Food and Drug Administration (FDA)-approved pediculicide tested and found safe in children as young as 6 months of age and is not contraindicated in pregnant women. The product works by asphyxiating lice.

Lindane (Kwell) is no longer recommended as a pediculicide by the FDA and has been banned from use in many countries and certain states. Lindane has a tendency to accumulate in lipid tissue and has a propensity for the lipid matter of the brain, thus leading to neurotoxicity manifested as generalized seizures and bone marrow suppression.

6 Rinse hair thoroughly until the water runs clear.

Removes all chemical products from the skin to limit unnecessary exposure to chemicals.

7a Remove the child from bath, and dry the body and hair with clean, dry towels. Place the used towels in appropriate receptacle.

Reduces risk of transmission of lice to others.

7b Dress the child in freshly laundered clothing.

Provides comfort to the child and helps prevent reinfestation.

8 Comb tangles out of hair with regular comb.

Later use of nit comb will be easier in untangled hair.

9 Part the hair into small, easy-to-handle sections. Using the nit comb, comb each section of hair to remove nits, starting at the scalp and working down in a meticulous fashion and with special attention to the nape of the neck and behind the ears, rinsing comb frequently in water.

Some antilice treatments do not kill the eggs, so removal of the nits helps prevent reinfestation. Small, close teeth in a nit comb allow more effective removal of nits and nit shells.

10 Remove gloves and gown and perform hand hygiene.

Reduces transmission of microorganisms or pediculosis.