Ask the Pediatrician: Lice & Pink Eye

Q: Now that schools are back in session, children are sharing all sorts of new things. Two things that keep kids out of school, and cause a lot of problems for parents, are head lice and pink eye. What are the facts?

A: Let’s start with head lice. The American Academy of Pediatrics has guidelines which has generated some controversy. These guidelines suggest that children do not need to be excluded from school when lice are discovered, or to be free of nits, the eggs of lice, to return to school. This is because it has been shown that lice carry no illness, and that often kids have the lice in class for weeks before it is evident.

Q: Are there any new treatments for lice?

A: The remedies that have been around for awhile over-the counter, like RID and Nix, applied to the hair and scalp has generally been quite effective in getting rid of lice on an individual head. Head lice that are resistant to our usual treatments are relatively rare. These natural insect poisons are very safe for people, available without prescription and all need two applications one week apart. The disadvantage is cost- if you have to treat two or three kids and their cousins a couple of times, the cash outlay can be a burden. The insurers are putting big co-payments on the prescription treatments, which have their own disadvantages as well. There is a newly approved treatment, ivermectin applied to the hair, which has been around for awhile as a medicine for a tropical parasitic infection, but has become available as lice medicine this summer. Unfortunately, it is a more expensive co-pay, so should generally only be used if other treatments fail.

Q: Pinkeye is an illness that every child gets sooner or later. Do children need to miss school for this?

A: The lining of the eye socket and the outermost clear covering of the eye itself are called the conjunctiva. If something causes this lining to become irritated, then there is conjunctivitis. There are multiple causes of irritation, including allergies, soap in the eye, smoke, but infectious causes- both viruses and bacteria -are the cause of what most people call pinkeye. [ Graphic#1] The major symptoms are redness, discharge and itchy or painful eyes. Both viral and bacterial conjunctivitis are very contagious and can spread through a preschool and elementary school, but are not terribly dangerous. Bacterial conjunctivitis is treated with antibiotic eyedrops or ointment which treats the infection and decreases spread. Because it is difficult to tell quickly and conveniently whether a particular pink eye is caused by a virus or by bacteria, doctors often treat pinkeye on the basis of clinical judgement. So although it’s not a serious health risk, pink eye can lead to a great deal of inconvenience for schools and parents.

Q: Anything to watch for, that would indicate something more than simple pinkeye?

A: Unusual swelling of the eye, fever, and severe pain can be markers of a complicating situation, but not consistently. Any vision changes should be reported to your pediatrician.

Helpful links:
The AAP information for parents on lice: http://www.healthychildren.org/English/tips-tools/Symptom-Checker/Pages/Lice-Head.aspx

Pink Eye:
http://www.keepkidshealthy.com/symptoms/pink_eye.html