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School is back in the session which is a blessing for many of us parents who are happy to see some structure back into the day. As the kids run and play at school, it also provide opportunity for those pesky head lice to party.

I recall all too vividly last year when within weeks of school starting, I looked down by daughters head and saw something moving around. I knew right away it was head lice. Of course my wife totally freaked out. We took care of it right away.

While head lice are annoying, they cause no medical harm. They cross all socioeconomic boundaries. Over the summer, the AAP updated its policy on head lice. The policy states “Head lice are not a health hazard or a sign of poor hygiene and, in contrast to body lice, are not responsible for the spread of any disease”. It also goes on to state that “No healthy child should be excluded from or miss school because of head lice, and no-nit policies for return to school should be abandoned. Informed school nurses can help with diagnosis and suggestions about treatment”. I realize that this second statement may be in stark contrast to school policies currently in place.

A quick recap of treatment from a prior blog.
Permethrin 1% is most commonly used and is over the counter. It is quite effective and safe with a low potential for toxic effects. It continues to work for a few weeks after application although often a second treatment is recommended 7-10 days after the first one. Resistance to it has been documented.

Malathion in another drug used. It is an organophosphate pesticide that is highly effective but has some safety concerns and is not recommended in children younger than 2 years of age.

Lindane is the last drug I will discuss. It is an organochloride. It has some toxicity concerns and is considered a neurotoxin and has the potential for central nervous system toxicity. It should be the last option after everything else has failed.

Suffocation: There are no great evidenced based data to say whether suffocation of lice by applying things such as petroleum jelly, olive oil, mayonnaise is an effective treatment. This is not to say that it does not work, but just no good studies regarding this.

There was an article in the journal Pediatrics years ago regarding treatment with a suffocating agent that ultimately ended up being Cetaphil. Here is the link: http://www.nuvoforheadlice.com.
PEDIATRICS Vol. 114 No. 3 September 2004, pp. e275-e279

When most of us typically think of a typical day in the life of a child we think of fun times like running through the sprinkler or a day at the playground. Life is not always that simple for children. They do experience sadness and death whether we want to shelter them from it or not.

The level of comprehension varies by age and emotional maturity of the child. A very young child may not understand the concept of death. Their thinking tends to be very concrete, short ranged and literal. From their perspective a person is here, then gone and then here again. It may take some time until they really comprehend that they are gone forever.

When it comes to explaining death, it is important to be very direct and honest and avoid using clichés such as “they went to sleep”.  They may also ask the same question again and again as they try to understand what happened.

Older children may be able to express their feelings in words as they have a greater understanding of what has happened and have the capacity for abstract thought.  However, with younger children, they may express their grieving through their behavior. There bodies do the speaking. Regardless of their method of grieving, everyone should be allowed to choose what works best for them. This also includes being given the choice of going to the hospital, viewing the body or attending the funeral.

I have had the misfortune of having two close friends lose a child. Something that no parent ever wants to experience. In talking to them, they both expressed that they want to remember and talk about their child and not act as though they never existed.  I asked them how I could be a better friend to them and better pediatrician to others. Their advice was to continue to talk about their child and the good memories that we all had, as they want to keep those memories alive. This is counter culture to what most people feel comfortable doing for a multitude of reasons. I have followed their advice when I see children in my practice that have lost a parent.

Sometimes creating a special ritual to celebrate the life of a close loved one who has died can be therapeutic to the child and help build on the child’s emotional health.

Well summer is almost over and I am sure there are many of you still planning one last summer vacation before school starts back up and for some, that may involve flying. As any parent can attest to, flying with younger children can be difficult. For us, it was much easier when they were not ambulatory – all that seemed necessary was a little breast milk from mommy and a snuggle with daddy and everything was good.

Once they were mobile, the game changed and it felt as if constant entertainment was necessary. I tell parents that the destination needs to be worth the hassle of the flight as it can be an emotional experience for both the parents and the child. I have seen some parents nearly in tears by the end of a flight. Like most things in life, it is best to be prepared. We always have some kid friendly snacks and some new small toys typically wrapped to pull out of the bag when they start to get antsy. My daughter that is here as I write this says,  “coloring is great and the occasional movie”.

We have had some wonderful travel experiences with our children both domestically and internationally. It has given them a sense of adventure and insight that the world is a much bigger place than Redmond Washington.