Student Nurse Resources and Links

Immunizations

Make sure you are up to date with immunization vaccines, especially for younger children. For both adults and children, learn more at http://www.cdc.gov/vaccines/recs/schedules/default.htm. For children only, learn more at http://www.aap.org/healthtopics/immunizations.cfm.

Blood Tests

Some physicians recommend annual blood tests especially for cholesterol, blood sugar, lead, and others. The American Academy of Pediatrics has an excellent chart of all the recommended tests and examinations for children. See http://practice.aap.org/content.aspx?aid=1599.

Vision

It would be wonderful to find out about any vision issues before it affects your child's learning.

Diet

I'm a big believer of prevention. Ask your doctor to discuss diet with you and your children; make sure your children are within a healthy range for their height-to-weight ratio, especially since habits start young and it's easier to shed a few pounds then tens of pounds if necessary.

Dental

Dental health can impact many other areas of your overall health. And it's never too young for a dental check-up, even at age two.

For more information about communicating with your pediatrician, visit the AAP's website http://www.medicalhomeinfo.org/tools/communication%20families.html.

Swine Flu

H1N1, referred to as "swine flu," is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. This virus spreads from person-to-person the same way that regular seasonal influenza viruses spread.

The following are some of the steps that have been implemented and emphasized at school at ALL times and not only during a flu pandemic:

• Follow good hand hygiene practices. Wash hands with soap and water for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used and have been made available.
• Cover mouth and nose when coughing or sneezing by using either a napkin or the elbow, not hands.
• Clean surfaces and items most likely to have frequent hand contact, such as desks, doorknobs, keyboards, etc., with cleaning agents.
• Keep an eye out for sick students and send them to the school Nurse for further evaluation.
• Send sick students home and advise them and their families that ill people should stay at home until at least 24 hours after they no longer have a fever or signs of a fever (without the use of fever-reducing medicine).
• Move students to a separate room if they become sick at school until they can be sent home.
• Added new additional paper towel holders in the bathrooms
• Added more soap dispensers in the bathrooms
• Added new hand sanitizer dispensers mounted to the walls in classrooms and lunchroom.

For more information and updates please visit: http://www.capenet.org

Defibrillator on Campus!

HHHA receives its first ever AED (Automatic External Defibrillator)!

HHHA has just taken possession of its first automatic external defibrillator, or "AED", a life-saving device that automatically diagnoses then delivers an electric shock to heart attack victims. We introduce the device to all the staff and students so they recognize what it looks like and does. Currently, all staff members are trained and certified regularly in CPR and first aid. A number of our staff members are trained in the use and operation of the AED and can access it from its dedicated, marked cabinet in my office. My goal is to provide AED training to all staff members.

I am grateful to the City of Beverly Hills for the device and to Rabbi Sufrin, shlit'a, for his leadership, support, encouragement, and efforts in pursuing this opportunity and making HHHA one of the first Jewish schools to acquire an AED.

Scarlet fever

Scarlet fever is not very common these days and is the result of streptococcal infection.

Symptoms:

• Sore or red throat
• Chills and fever
• Headaches
• Vomiting
• Strawberry collard tongue
• Swollen glands in the neck
• Rapid Pulse
• Red rash in the face, neck, chest, abdomen or entire body

Diagnosis:

Scarlet fever can be diagnosed by your physician. A throat culture will be positive for a certain type of strep bacteria. The rash usually stars on the second day of the illness and lasts 4-10 days.

Treatment:

Scarlet fever will respond to a course of antibiotics.

Scoliosis

Scoliosis is a spinal condition that is becoming more and more common, especially in girls. Scoliosis can be detected around age nine.

Scoliosis is a condition which affects the spines of many children, teenagers and adults. The human spine features many natural curvatures which help our bodies to move and be flexible.

Symptoms

There are several different "warning signs" to look for to help determine if you or someone you love has scoliosis. Should you notice any one or more of these signs, you should schedule an exam with a doctor.

• Shoulders are different heights – one shoulder blade is more prominent than the other
• Head is not centered directly above the pelvis
• Appearance of a raised, prominent hip
• Rib cages are at different heights
• Uneven waist
• Changes in look or texture of skin overlying the spine (dimples, hairy patches, color changes)
• Leaning of entire body to one side

Once suspected, scoliosis is usually confirmed with an x-ray, spinal radiograph, CT scan, MRI or bone scan of the spine.

Treatment Options

Once it has been determined that a patient has scoliosis, there are several things to take into consideration when discussing treatment options:

• Spinal maturity – is the patient's spine still growing and changing?
• Degree and extent of curvature – how severe is the curve and how does it affect the patient's lifestyle?
• Location of curve – according to the Scoliosis Research Society, thoracic (upper spine) curves are more likely to progress than thoracolumbar (middle spine) or lumbar (lower spine) curves.
• Potential for progression – patients who have large curves prior to their adolescent growth spurts are more likely to experience curve progression.

After this complex set of variables is analyzed, treatment options are discussed. There are three basic types of treatments for scoliosis: (1) observation, (2) orthopaedic bracing, or (3) surgery.

As you read this please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, bowel or bladder problems, are some of the potential adverse risks. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.

Head Lice

What are head lice, and how do they differ from other lice? Head lice (Pediculus capitis) are small parasitic insects exquisitely adapted to living mainly on the scalp and neck hairs of their human host. Their six impressive legs are elegantly evolved to grasp hair shafts and provide a striking example of biological specialization. Long associated with people, head lice have been recovered from prehistoric mummies. Head lice are equal opportunity parasites; they do not respect socio-economic class distinctions. Their presence does not connote a lack of hygiene or sanitation practiced by their host. Head lice are mainly acquired by direct head-to-head contact with an infested person's hair, but may infrequently be transferred with shared combs, hats and other hair accessories. They may also remain on bedding or upholstered furniture for a brief period. In North America and Europe, children are more frequently infested than are adults, and Caucasians more frequently than other ethnic groups. Neither able to fly nor jump, lice are also unlikely to wander far from their preferred habitat. Lice and their eggs are unable to burrow into the scalp. Lice are sometimes referred to as cooties, eggs as nits and infested people as lousy. The infestation by head or body lice is termed pediculiasis, and the associated "disease" pediculosis. Delousing (more properly termed lousing) consists of any method for eliminating an infestation. Chemical treatments directed against lice are pediculicides. Those that kill adult and nymphal lice are sometimes called lousicides; those that kill the developing embryo within the egg are ovicides. This discussion relates to head lice unless specific mention is made of other types of lice.

Head lice derive nutrient by blood-feeding once or more often each day, and cannot survive for more than a day or so at room temperature without ready access to a person's blood. A nymphal louse hatches from its egg after about 8 days of development, and begins to feed, grow and develop until it attains the adult stage about 9-12 days after hatching. A female louse may deposit more than 100 eggs at a rate of about six eggs each day. Only those eggs deposited by inseminated female lice will hatch. Generally, an infested person has fewer than a dozen active lice on the scalp at any time, but may have hundreds of viable, dead and hatched eggs. With adequate magnification, the developing nymph can be seen within the egg; hatched eggs are nearly transparent.

Do head lice cause harm?

Head lice rarely (if ever) cause direct harm, and they are not known to transmit infectious agents from person-to-person. Thus, they should not be considered as a medical or a public health problem. These lice may occasionally be burdensome because of annoyance; their presence may cause itching and loss of sleep. The louse's saliva and feces may sensitize people to their bites, thereby exacerbating the irritation and increasing the chance of secondary infection from excessive scratching.

The greatest harm associated with head lice results from the well-intentioned but misguided use of caustic or toxic substances to eliminate the lice. A few lice on the head should not cause alarm; rather, they present an opportunity for parents to spend the needed time with their children in order to find and remove the offending insects. Grooming can be an effective method to remove lice, and engenders several associated physiological and behavioral benefits as well. Because of unfounded fears, some parents have suggested that children refrain from sharing protective batting or biking helmets. The miniscule risk of acquiring lice from such devices pales in comparison to the hazards averted by helmets.

Why were my children sent home from school (the No Nits policies)?

The no-nits policies variously drafted and adopted by school administrations aim to reduce the transmission of lice by excluding infested children from school. . School nurses are generally amongst the most capable to spot signs of infestation.

Although lice and their eggs may be seen without the help of magnifying devices, the viability of the eggs cannot be judged without magnification and a degree of training.

From whom did my child acquire head lice?

Head lice are acquired from other infested people. Upon learning of their child's infestation, parents frequently seek to ascribe blame. This 'knee-jerk' reaction is understandable but unproductive. The offending lice came from some other person, but it is not currently possible to determine the identity of the donor. Parents are encouraged to focus their energies on education and treatment rather than on unsuccessful witch-hunts. Rather than accusing the school administrators or other parents for not preventing spread of head lice, parents are likely to benefit more by ensuring all children and adults in the home are inspected and treated as appropriate.

What is the origin of head lice?

Human lice likely co-evolved with people. Our primate relatives harbor their own species of lice. Lice are quite host specific; human lice, for instance, will not feed upon other animals, and lice of other animals would rarely feed upon a person.

How many people are infested by head lice?

Few useful statistics are available for estimating the prevalence of infestation. Far fewer people seemed infested than the general public or the medical community might believe. Reports of "epidemics" of head lice may generally be attributed to incorrect identifications and misdiagnoses. The apparent annual and seasonal "increases" in prevalence may be real or due to peculiarities in monitoring activities. The perception that lice are more prevalent today then in past decades may, perhaps, reflect societal changes in candor in discussing such issues

What methods can I use to treat the infestation?

Mechanical removal

Mechanically removing lice and nits can be an effective but time-consuming method. Because most eggs will be non-viable, their removal is often impractical and unjustified. An infestation may be eliminated by combing each day to remove the live lice (including those that have hatched since the previous day). Comb daily until no live lice are discovered for about two weeks. Use illumination, magnification and a good louse or nit comb to locate and remove the offending insects. Although the hair may appear 'peppered' with eggs, there generally are fewer than a dozen active lice on the head at any time. Adult female lice usually cement each egg to the base of a hair shaft near the skin. As the hair grows (from the base), these attached eggs are transported away from the scalp. Eggs more than one-half of one inch away from the scalp are nearly always hatched and do not, by themselves, indicate an active infestation.

Louse or nit combs can be useful in removing lice and eggs. Diverse types of fine-toothed combs may be included within packages of pediculicides or they may be purchased from virtually any drug store, pet supply store (often at a discount) or via the web. Some louse combs are better than others; their effectiveness depends on a) their composition (metal vs. plastic) and construction (length and spacing of the comb teeth), b) the texture of the hair to be combed, c) the technique used to comb, and d) the time and care expended in the effort. Whereas straight hair is usually readily combed, tight curls may present an impossible and impractical challenge. Hair should be cleaned and well-combed or brushed to remove tangles before attempting to use a louse comb. Clean the louse comb frequently to remove any caught lice or eggs. It may require several hours each night for several nights to tackle the problem. An entertaining video may help keep the child occupied during this exercise. Sit behind the child, and use a suitably bright light (and magnification if available), to inspect and comb through the hair, one small section at a time. Repeat until no more active lice are observed. Some parents report that water, vegetable oils or hair conditioners help lubricate the hair and ease the combing process; others report that these lubricants make it more difficult to see the eggs.

"Electronic" louse combs that resemble small bug "zappers", or those with oscillating teeth would seem to offer little advantage, if any, over a well-designed traditional louse comb. Teeth of these devices may not effectively reach to the scalp and may not kill or remove eggs.

Pyrethroid insecticides

Infestations may be treated with shampoos containing permethrin or pyrethrins specifically labeled for use on people. Some formulations also contain a synergist, a chemical that may enhance the activity of the insecticide. As with any insecticide or drug, read and follow the label directions. Because these products seem to have limited ovicidal (egg-killing) activity, a second treatment is often necessary about 10 days later to target lice that hatch after the initial treatment. Susceptible lice do not fall from the hair or die immediately upon treatment with pyrethroids; one should wait until the next morning to determine the fate of treated lice. As is true of any pediculicide, pyrethroids do not remove the eggs from the hair.

Some physicians treat apparently resistant infestations with a prescription-strength pyrethroid (3 - 5%) preparation normally meant for treating scabies infestations. In our recently published article we report that some head lice in the United States are resistant to permethrin, and those higher doses of this insecticide generally were not more effective. Thus, prescription-strength pyrethroids are not likely to be effective. Although permethrin and pyrethrins differ in chemical structure, their mode of action is quite similar. Thus, we would anticipate that pyrethrins would also be ineffective in killing permethrin-resistant lice.

Non-pyrethroid insecticides

Other insecticides should be avoided unless specifically prescribed by a physician. The organochlorine insecticide lindane, and the organophosphate insecticide malathion are two of the active agents within pediculicides available by prescription. The current susceptibility of these insects to lindane or malathion has not yet been analyzed in the United States. Prescription preparations containing these insecticides may be considered as alternative pediculicides if live lice persist after two treatments with pyrethroid-based pediculicides. Refer to our management flowcharts.

Use caution when dealing with any insecticidal agent, particularly on children. Read and follow label directions. Do not apply any insecticide or other chemical not specifically labeled for use on people. Well-intentioned parents treating their children with toxic or flammable substances have caused several deaths and poisonings.

Essential oils

Numerous "home recipes" and commercial preparations are based on mixtures of essential oils, salts or other "natural" substances. Data is lacking to support the claims of their efficacy. Several formulations include substances that should not be used on the skin, and may not be registered for such use by government regulatory agencies (such as EPA or FDA).

Enzyme treatments The chemical structure of the "cement" that binds the egg to the hair is not well-defined. Nonetheless, it is an exceptionally stable substance that resists degradation by diverse chemicals. Several commercial products are advertised to "dissolve" the eggs or the cement by which the eggs are attached to the hair. We are not convinced of the effectiveness or safety of these products.

Hair soaps, bleaches and dyes Washing the hair each day may dislodge a few active lice; the remaining lice and eggs will be unaffected (but clean). Although hair bleaches and dyes are meant for use on the scalp, they can be caustic. Data is lacking to assess the efficacy of these products against lice. Thus, use of these products in attempts to "treat" lice should probably not be considered. Assertions that dandruff shampoos are effective in removing lice are probably due to misidentification of dandruff as lice.

Do dogs and cats serve to maintain or transfer head lice? Pets are of no significance in maintaining or transmitting human lice, and should not be treated for head lice.

Should I clean my house or car?

Head lice and their eggs soon perish if separated from their human host. Removed lice survive just a day or so, and the eggs generally lose viability within a week. The chances of a live head louse or egg becoming reunited with a person would seem remote exceptionally. Accordingly, Herculean steps to clean lice from the house or car by intensive washing or vacuuming will result in a cleaner space, but are unlikely to significantly facilitate the goal of eliminating the lice from those residing in the home. A child's car seat cover may benefit from vacuuming, as a few errant lice or eggs may temporarily lodge there and survive for a day or so.

What should be cleaned?

Washing and drying (with heat) the pillowcases, sheets, nightclothes, towels and stuffed animals may possibly eliminate lice and eggs that might otherwise reinfest a family member. Combs, brushes, hats and other hair accessories in contact with an infested person should be washed in hot water each day to dislodge any lice and nits. Shared helmets and headphones in schools or recreational settings may rarely and transiently harbor an occasional louse or nit; the effort necessary to effectively inspect and clean these devices, however, is not likely warranted. Shared lockers or coat hooks probably pose even less risk as sources of contamination. Any lice or nits that might detach in a swimming pool would likely be removed by the pool filter or should otherwise perish before they have a chance to contact a person. Closing a swimming pool because of lice is a hysterical overreaction.

Should I use insecticides in the house to rid it of lice?

Insecticidal treatments targeted at lice within the school or home, in vehicles, or to carpets and furniture are generally unwarranted, and unnecessarily expose occupants to insecticidal residues.

Can anything be used to repel lice?

The application of any substance to the hair with an expectation of repelling lice is unwarranted and may neither be safe nor effective. Head lice do not seem to be readily acquired naturally, and they may pose less risk than any "repellent" product.

What are head lice, and how do they differ from other lice? Head lice (Pediculus capitis) are small parasitic insects exquisitely adapted to living mainly on the scalp and neck hairs of their human host. Their six impressive legs are elegantly evolved to grasp hair shafts and provide a striking example of biological specialization. Long associated with people, head lice have been recovered from prehistoric mummies. Head lice are equal opportunity parasites; they do not respect socio-economic class distinctions. Their presence does not connote a lack of hygiene or sanitation practiced by their host. Head lice are mainly acquired by direct head-to-head contact with an infested person's hair, but may infrequently be transferred with shared combs, hats and other hair accessories. They may also remain on bedding or upholstered furniture for a brief period. In North America and Europe, children are more frequently infested than are adults, and Caucasians more frequently than other ethnic groups. Neither able to fly nor jump, lice are also unlikely to wander far from their preferred habitat. Lice and their eggs are unable to burrow into the scalp. Lice are sometimes referred to as cooties, eggs as nits and infested people as lousy. The infestation by head or body lice is termed pediculiasis, and the associated "disease" pediculosis. Delousing (more properly termed lousing) consists of any method for eliminating an infestation. Chemical treatments directed against lice are pediculicides. Those that kill adult and nymphal lice are sometimes called lousicides; those that kill the developing embryo within the egg are ovicides. This discussion relates to head lice unless specific mention is made of other types of lice.

Head lice derive nutrient by blood-feeding once or more often each day, and cannot survive for more than a day or so at room temperature without ready access to a person's blood. A nymphal louse hatches from its egg after about 8 days of development, and begins to feed, grow and develop until it attains the adult stage about 9-12 days after hatching. A female louse may deposit more than 100 eggs at a rate of about six eggs each day. Only those eggs deposited by inseminated female lice will hatch. Generally, an infested person has fewer than a dozen active lice on the scalp at any time, but may have hundreds of viable, dead and hatched eggs. With adequate magnification, the developing nymph can be seen within the egg; hatched eggs are nearly transparent.

Do head lice cause harm?

Head lice rarely (if ever) cause direct harm, and they are not known to transmit infectious agents from person-to-person. Thus, they should not be considered as a medical or a public health problem. These lice may occasionally be burdensome because of annoyance; their presence may cause itching and loss of sleep. The louse's saliva and feces may sensitize people to their bites, thereby exacerbating the irritation and increasing the chance of secondary infection from excessive scratching.

The greatest harm associated with head lice results from the well-intentioned but misguided use of caustic or toxic substances to eliminate the lice. A few lice on the head should not cause alarm; rather, they present an opportunity for parents to spend the needed time with their children in order to find and remove the offending insects. Grooming can be an effective method to remove lice, and engenders several associated physiological and behavioral benefits as well. Because of unfounded fears, some parents have suggested that children refrain from sharing protective batting or biking helmets. The miniscule risk of acquiring lice from such devices pales in comparison to the hazards averted by helmets.

Why were my children sent home from school (the No Nits policies)? The no-nits policies variously drafted and adopted by school administrations aim to reduce the transmission of lice by excluding infested children from school. . School nurses are generally amongst the most capable to spot signs of infestation.

Although lice and their eggs may be seen without the help of magnifying devices, the viability of the eggs cannot be judged without magnification and a degree of training.

From whom did my child acquire head lice? Head lice are acquired from other infested people. Upon learning of their child's infestation, parents frequently seek to ascribe blame. This 'knee-jerk' reaction is understandable but unproductive. The offending lice came from some other person, but it is not currently possible to determine the identity of the donor. Parents are encouraged to focus their energies on education and treatment rather than on unsuccessful witch-hunts. Rather than accusing the school administrators or other parents for not preventing spread of head lice, parents are likely to benefit more by ensuring all children and adults in the home are inspected and treated as appropriate.

What is the origin of head lice? Human lice likely co-evolved with people. Our primate relatives harbor their own species of lice. Lice are quite host specific; human lice, for instance, will not feed upon other animals, and lice of other animals would rarely feed upon a person.

How many people are infested by head lice? Few useful statistics are available for estimating the prevalence of infestation. Far fewer people seemed infested than the general public or the medical community might believe. Reports of "epidemics" of head lice may generally be attributed to incorrect identifications and misdiagnoses. The apparent annual and seasonal "increases" in prevalence may be real or due to peculiarities in monitoring activities. The perception that lice are more prevalent today then in past decades may, perhaps, reflect societal changes in candor in discussing such issues

What methods can I use to treat the infestation

Mechanical removal Mechanically removing lice and nits can be an effective but time-consuming method. Because most eggs will be non-viable, their removal is often impractical and unjustified. An infestation may be eliminated by combing each day to remove the live lice (including those that have hatched since the previous day). Comb daily until no live lice are discovered for about two weeks. Use illumination, magnification and a good louse or nit comb to locate and remove the offending insects. Although the hair may appear 'peppered' with eggs, there generally are fewer than a dozen active lice on the head at any time. Adult female lice usually cement each egg to the base of a hair shaft near the skin. As the hair grows (from the base), these attached eggs are transported away from the scalp. Eggs more than one-half of one inch away from the scalp are nearly always hatched and do not, by themselves, indicate an active infestation.

Louse or nit combs can be useful in removing lice and eggs. Diverse types of fine-toothed combs may be included within packages of pediculicides or they may be purchased from virtually any drug store, pet supply store (often at a discount) or via the web. Some louse combs are better than others; their effectiveness depends on a) their composition (metal vs. plastic) and construction (length and spacing of the comb teeth), b) the texture of the hair to be combed, c) the technique used to comb, and d) the time and care expended in the effort. Whereas straight hair is usually readily combed, tight curls may present an impossible and impractical challenge. Hair should be cleaned and well-combed or brushed to remove tangles before attempting to use a louse comb. Clean the louse comb frequently to remove any caught lice or eggs. It may require several hours each night for several nights to tackle the problem. An entertaining video may help keep the child occupied during this exercise. Sit behind the child, and use a suitably bright light (and magnification if available), to inspect and comb through the hair, one small section at a time. Repeat until no more active lice are observed. Some parents report that water, vegetable oils or hair conditioners help lubricate the hair and ease the combing process; others report that these lubricants make it more difficult to see the eggs.

"Electronic" louse combs that resemble small bug "zappers", or those with oscillating teeth would seem to offer little advantage, if any, over a well-designed traditional louse comb. Teeth of these devices may not effectively reach to the scalp and may not kill or remove eggs.

Pyrethroid insecticides Infestations may be treated with shampoos containing permethrin or pyrethrins specifically labeled for use on people. Some formulations also contain a synergist, a chemical that may enhance the activity of the insecticide. As with any insecticide or drug, read and follow the label directions. Because these products seem to have limited ovicidal (egg-killing) activity, a second treatment is often necessary about 10 days later to target lice that hatch after the initial treatment. Susceptible lice do not fall from the hair or die immediately upon treatment with pyrethroids; one should wait until the next morning to determine the fate of treated lice. As is true of any pediculicide, pyrethroids do not remove the eggs from the hair.

Some physicians treat apparently resistant infestations with a prescription-strength pyrethroid (3 - 5%) preparation normally meant for treating scabies infestations. In our recently published article we report that some head lice in the United States are resistant to permethrin, and those higher doses of this insecticide generally were not more effective. Thus, prescription-strength pyrethroids are not likely to be effective. Although permethrin and pyrethrins differ in chemical structure, their mode of action is quite similar. Thus, we would anticipate that pyrethrins would also be ineffective in killing permethrin-resistant lice.

Non-pyrethroid insecticides Other insecticides should be avoided unless specifically prescribed by a physician. The organochlorine insecticide lindane, and the organophosphate insecticide malathion are two of the active agents within pediculicides available by prescription. The current susceptibility of these insects to lindane or malathion has not yet been analyzed in the United States. Prescription preparations containing these insecticides may be considered as alternative pediculicides if live lice persist after two treatments with pyrethroid-based pediculicides. Refer to our management flowcharts.

Use caution when dealing with any insecticidal agent, particularly on children. Read and follow label directions. Do not apply any insecticide or other chemical not specifically labeled for use on people. Well-intentioned parents treating their children with toxic or flammable substances have caused several deaths and poisonings.

Essential oils Numerous "home recipes" and commercial preparations are based on mixtures of essential oils, salts or other "natural" substances. Data is lacking to support the claims of their efficacy. Several formulations include substances that should not be used on the skin, and may not be registered for such use by government regulatory agencies (such as EPA or FDA).

Enzyme treatments The chemical structure of the "cement" that binds the egg to the hair is not well-defined. Nonetheless, it is an exceptionally stable substance that resists degradation by diverse chemicals. Several commercial products are advertised to "dissolve" the eggs or the cement by which the eggs are attached to the hair. We are not convinced of the effectiveness or safety of these products.

Hair soaps, bleaches and dyes Washing the hair each day may dislodge a few active lice; the remaining lice and eggs will be unaffected (but clean). Although hair bleaches and dyes are meant for use on the scalp, they can be caustic. Data is lacking to assess the efficacy of these products against lice. Thus, use of these products in attempts to "treat" lice should probably not be considered. Assertions that dandruff shampoos are effective in removing lice are probably due to misidentification of dandruff as lice.

Do dogs and cats serve to maintain or transfer head lice? Pets are of no significance in maintaining or transmitting human lice, and should not be treated for head lice.

Should I clean my house or car? Head lice and their eggs soon perish if separated from their human host. Removed lice survive just a day or so, and the eggs generally lose viability within a week. The chances of a live head louse or egg becoming reunited with a person would seem remote exceptionally. Accordingly, Herculean steps to clean lice from the house or car by intensive washing or vacuuming will result in a cleaner space, but are unlikely to significantly facilitate the goal of eliminating the lice from those residing in the home. A child's car seat cover may benefit from vacuuming, as a few errant lice or eggs may temporarily lodge there and survive for a day or so.

What should be cleaned? Washing and drying (with heat) the pillowcases, sheets, nightclothes, towels and stuffed animals may possibly eliminate lice and eggs that might otherwise reinfest a family member. Combs, brushes, hats and other hair accessories in contact with an infested person should be washed in hot water each day to dislodge any lice and nits. Shared helmets and headphones in schools or recreational settings may rarely and transiently harbor an occasional louse or nit; the effort necessary to effectively inspect and clean these devices, however, is not likely warranted. Shared lockers or coat hooks probably pose even less risk as sources of contamination. Any lice or nits that might detach in a swimming pool would likely be removed by the pool filter or should otherwise perish before they have a chance to contact a person. Closing a swimming pool because of lice is a hysterical overreaction.

Should I use insecticides in the house to rid it of lice? Insecticidal treatments targeted at lice within the school or home, in vehicles, or to carpets and furniture are generally unwarranted, and unnecessarily expose occupants to insecticidal residues.

Can anything be used to repel lice? The application of any substance to the hair with an expectation of repelling lice is unwarranted and may neither be safe nor effective. Head lice do not seem to be readily acquired naturally, and they may pose less risk than any "repellent" product.

Pinworm

Pinworm is not cause for alarm. While this condition may be upsetting, is not dangerous. Pinworm looks like tiny threads and lives in the bowel. It travels to the rectal area and lays eggs on the outside of the skin, usually at night.

Symptoms:

While most pinworms have no symptoms or signs, some do. Observe your child for itching and/or scratching in the rectal area and restless sleep. If you suspect pinworm, contact your physician.

Contamination:

Infestation results from finger transfer of egg from the rectal area, clothing, bedding and toys on which the ova are picked up by the new host. Airborne eggs may be inhaled and swallowed. Auto-infestation occurs through finger transfer of eggs from the rectal area to the mouth.

Diagnosis:

Pinworm can be diagnosed by finding the female worm in the rectal area. Your doctor will prescribe medication.

Please remember that Pinworm has nothing to do with a lack of cleanliness.

Here are some helpful hints to limit the spread of Pinworm:

• Wash your hand and fingernails with soap during the day, especially before and after using the toilet. Keep fingernails short.
• Wear tight underwear both day and night. Change them daily.
• For several days after treatment, clean the bedroom floor by vacuuming or damp mopping. Avoid dry sweeping that may stir up dust.
• After treatment, wash bed linens and nightclothes (do not shake them).
• Keep the toilet seats clean.
• Encourage good hand washing before eating.