Head louse are tiny parasitic insects that live among human hair and they are difficult to get rid of. But now there is a new prescription treatment in the battle against lice, recently approved by the Food and Drug Administration (FDA.)
"We took families that had heavy infestations of head lice and we were clearing these kids, and some adults, with one treatment," says dermatologist Dow Stough, who has a private practice in Hot Springs, Ark., and who performed clinical trials of the new product. "I was like, wow, they really have something."
Clinical studies showed that, Natroba Topical Suspension, got rid of lice after just one treatment. The new prescription hair rinse was approved by the FDA in January and went on sale in August. In clinical trials, 84 percent of participants were lice-free after 14 days. That's compared with 44 percent of people in the study treated with Nix, today's most commonly prescribed head lice product. Lice treated with Natroba ingest the rinse's insecticide, spinosad, and start shaking. They literally shake themselves to death. According to Natroba's website, safety in pediatric patients below the age of 4 years has not been established.
Barbara Frankowski, pediatrician and author of the American Academy of Pediatrics policy statement on lice, says parents shouldn't give up on the popular over-the-counter product- Nix - either. Nix has a proven safety record. "If it works, why drive up the cost of medical care by using something way more expensive?" For families who prefer not to use pesticides, applying petroleum jelly or Cetaphil weekly for three weeks with careful combing works. "Tedious and time consuming, but doable," she says.
If non-prescription techniques do fail, then Frankowski says a pediatrician can prescribe a product such as Ulesfia, Ovide, or Natroba.
Prescription products are more costly than the over-the counter products. Natroba costs the average family about $36 when covered by insurance, or $219 without coverage. Meanwhile, a family pack of Nix lice treatment sells for about $15.
One reason that some over-the-counter products have become less effective is that, over the years, louse have been able to build up a resistance to permethrin-based insecticides. The insects have yet to develop resistance to new treatments like Natroba.
Signs of Head Lice: Although they are very small, you can actually see lice. The lice eggs are called nits. They are tiny yellow, tan, or brown dots before they hatch. Lice lay nits on hair shafts close to the scalp until they hatch. Nits look a little like dandruff but they can't be removed by brushing them off.
Lice eggs hatch within 1 to 2 weeks after they're laid. After hatching, the remaining shell looks white or clear and continues to be firmly attached to the hair shaft. This is the stage when it's easiest to spot them, as the hair is growing longer and the egg-shell is moving further away from the scalp. The adult louse is no bigger than a sesame seed and is grayish-white or tan. Most lice feed on blood several times a day, but they can survive up to 2 days off the scalp.
Lice bite and can cause itching and scratching, but it can take weeks before your kid begins itching. If the scratching becomes excessive, your child may develop a bacterial infection. Your pediatrician can prescribe an oral antibiotic as treatment.
Lice are highly contagious and can spread quickly. If you discover your little one has lice, be sure and notify your child's school.
Kidshealth.org offers these tips for preventing re-infestation. Wash all bed linens and clothing that's been recently worn by anyone in your home who's infested in very hot water (130 F [54.4 C]), then put them in the hot cycle of the dryer for at least 20 minutes. Have bed linens, clothing, and stuffed animals and plush toys that can't be washed dry-cleaned. Or, put them in airtight bags for 2 weeks. Vacuum carpets and any upholstered furniture (in your home or car). Soak hair-care items like combs, barrettes, hair ties or bands, headbands, and brushes in rubbing alcohol or medicated shampoo for 1 hour. You can also wash them in hot water or just throw them away. Because lice are easily passed from person to person in the same house, bedmates and infested family members will also need treatment to prevent the lice from coming back. Also there are some Don't you should be aware of: Don't use a hair dryer on your child's hair after applying any of the currently available scalp treatments because some contain flammable ingredients. Don't use a cream rinse or shampoo/conditioner combination before applying lice medication. Don't wash your child's hair for 1 to 2 days after using a medicated treatment. Don't use sprays or hire a pest control company to try to get rid of the lice, as they can be harmful. Don't use the same medication more than three times on one person. If it doesn't seem to be working, your doctor may recommend another medication. Don't use more than one head lice medication at a time.
Removal by hand: If your child is 2 years old or younger, you should not use medicated lice treatments. You'll need to remove the nits and lice by hand.
To remove lice and nits by hand, use a fine-tooth comb on your child's wet, conditioned hair every 3 to 4 days for 2 weeks after the last live louse was seen. Wetting the hair beforehand is recommended because it temporarily immobilizes the lice and the conditioner makes it easier to get a comb through the hair.
Wet combing is also an alternative to pesticide treatments in older kids. Though petroleum jelly, mayonnaise, or olive oil are sometimes used in an attempt to suffocate head lice, these treatments have not been proven to be effective.
Lice can be persistent, so be sure to follow the directions on any product you use. If the over-the-counter products don't work, you can ask your pediatrician about Natroba Topical Suspension. Clinical results, so far, look excellent for this new treatment.
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So, this 2 year old complained that his leg hurt. Enough pain that he limped and woke up at night crying that his thigh hurt. He had no history of trauma and also was otherwise well, in other words no fever, vomiting, cold symptoms etc.
After several days of watching him without resolution of his pain the mother noticed 3 little spots on his thigh, which she thought might be a bite. The little boy was seen and the diagnosis of herpes zoster (shingles) was considered. In children the differential diagnosis of localized leg pain in the absence of a rash would not normally include shingles.
According to the pedi dermatologist (that I consulted) shingles in children occurs more frequently on their lower extremities (not for adults) and may involve the back on the same side. Unlike adults, most cases of zoster in children are only mildly painful and resolve fairly quickly.
Well, this little boy didn't read the book and his rash continued to get worse and spread, and was quite painful for days. Prior to this, he was a perfectly healthy little boy and had received his first varicella vaccine when he was 1.
Since the widespread use of the varicella vaccine (chickenpox vaccine, see old post), the incidence of chickenpox has decreased dramatically, and vaccination should also reduce the risk of developing shingles later in life. In otherwise healthy children shingles (zoster) tends to develop at a younger age among vaccinated children than in those who have had a natural chickenpox infection. When shingles occurs after vaccination it represents either a new infection with wild-type virus (an exposure to chickenpox or shingles) or reactivation of the vaccine virus.
Once a child has received 2 doses of varicella vaccine as recommended, the immunity is boosted and should further reduce the risk of developing shingles. Varicella zoster virus can be transmitted via contact with skin lesions of those who have either chickenpox or shingles. Infection is less likely after exposure to shingles. Transmission of the virus occurs until all lesions have crusted over. In this case, the little boy was ultimately started on an oral anti-viral therapy with slow resolution of his rash and pain and a return to normal around his house.
Note to self, weird pain may precede the rash in herpes zoster by several days. Even though unusual, herpes zoster may occur in a healthy child who no history of varicella exposure and who has received all or part of their chickenpox vaccine.
That's your daily dose for today. We'll chat again tomorrow.
Millions of people watch YouTube and other social media videos. There's everything from music to medical procedures, comedy clips and cooking shows you name it and there's a video for it.
There are also videos showing teens and pre-teens choking each other and beating each other to a bloody pulp. These are videos that encourage dangerous and sometimes deadly games. It appears the more outrageous you can be, the bigger audience you'll have. Unfortunately a lot of kids end up in emergency rooms or worse, dead.
Last week a 15-year-old boy died while copying a YouTube video he and his friends had seen. While standing, he passed out, and fell forward crashing into an empty drinking glass. His collarbone broke the glass and a shard sliced through his interior and exterior jugular vein. He died shortly after arriving at the hospital. It's called the choking game.
The asphyxiation-to- get-high videos are popular with young adults, teens and even preteens.
Other popular games include jumping off a moving vehicle, salt and ice, extreme fighting, the cinnamon challenge and hitting someone over the head with a folding chair.
Dr. Thomas Abramo, the chief of pediatric emergency medicine at Vanderbilt University Medical Center, said he sees all of it in his ER. Although teens have acted on risky behavior fads throughout his 30-year career, he said he's seeing trends catch on faster than ever before, and he thinks it's because of YouTube and social media.
"If you get one kid doing it, you tend to see more kids doing it," said Abramo, who said two of his patients have died playing the choking game. "The spread of the event is definitely faster."
One challenge that scares Abramo involves being hit on the head with a bench or a folding chair to "see if you can take it," he said. A lot of the time, they can't.
"Fractures, concussions, lacerations," Abramo said. "Just the things you would think would happen."
"Once you see some of these videos, you go, 'Oh my God,'" the doctor said. The "Darwin award" videos, which involve varying dangerous challenges, are the worst he's seen. "Survival of the stupidest. I can't believe it happens. It defies logic," Abramo said.
YouTube says its guidelines prohibit videos that encourage dangerous behaviors, but they depend on viewers to flag objectionable posts before they are removed.
"We count on our users to flag content they believe violates the rules," a YouTube spokesman said. "We review flagged videos around the clock and remove all those that violate our policies."
That policy doesn't seem to be working very well because there are plenty of these videos to watch.
Dr. Alan Hilfer, a child psychologist at Maimonides Medical Center, said he thinks the existing videos validate risky behavior for teens and give them a way to get notoriety if they post a video. He said he hears a lot about YouTube's amateur ultimate fighting videos, which show teen fights with are no rules -- just bare knuckles.
Videos of kids self-mutilating and encouraging eating disorders are also being posted on social media sites.
However, Dr. Carol Bernstein, a psychiatry professor at New York University's Langone Medical Center, said she doesn't think YouTube alone is to blame for teens engaging in challenges that could seriously injure them because many factors are involved. She said other environmental factors, physiology, and temperament contribute to a child's decision to emulate a video.
"Stress here should be on knowing our children, watching behaviors and having conversations with them," Bernstein said. "There's no substitute for parents and teachers who are engaging with their kids in general."
Many parents don't know that their kids are acting out these videos until their child is injured. But not all parents are unaware. A mother in St. Louis was arrested after posting a video of her young children beating each other. You could hear her egging them on in the background. Fortunately she's the exception rather than the rule.
Most parents are concerned about their kids doing drugs or drinking alcohol but they should add dangerous games to the list of topics to talk to their kids about.
"Adolescence is, developmentally, a time when young people experiment with cigarettes and other behaviors that aren't so smart for their health," says John Santelli, MD, MPH, president of the American Society of Adolescent Health and a Columbia University pediatrics professor. "Some of the consequences can be pretty tragic with these dangerous games."
Webmd.com provides a list of the 7 Dangerous Games Parents Must Know About as well as tips for how parents can approach their kids about the subject.
Keep the lines of communication open and talk to your child about what videos he or she and their friends are watching. Ask them what they like about the videos to get a feel for what excites them.
Experts suggest that you know what websites your kids are viewing and discuss stories that feature kids who have gotten hurt carrying out these types of games. Ask them what they think about this kind of behavior and listen carefully to what they say. Their answers may surprise you.
Make it a point to learn about these dangerous games. You can't protect your child from everything that our high-tech society is throwing at them, but understanding what is going on in their teen and pre-teen world can help you be aware of what may be trying to influence them. That's a start.
The best way to attack the problem of bedwetting begins when you and your child have had a discussion about their feelings related to bedwetting. This often happens as they get older and continue to have problems with bedwetting and they are anxious or embarrassed.
If you bring up the subject and they would rather just wear a pull up at night, and go back to playing outside rather than discuss strategies for staying dry, it is not time to tackle the issue. Timing is everything!
As you start to discuss strategies to stop bedwetting, begin with having your child keep a calendar of their dry nights. This gets them involved and gives you an idea of their level of commitment.
Then start setting their alarm clock to awake them in the morning and see if they can get up on their own. If the alarm doesn't wake them up for school it is probably not going to awaken them in the middle of the night.
Remind them to recognize their need to go to the bathroom during the day too, and have them go every several hours to feel the sensation of their bladder filling throughout the day. Many of these kids are infrequent voiders during the day and have actually stretched their bladder wall and hypertrophied the bladder muscle.
Lastly, make sure that they are not constipated and put them on something like Miralax to ensure that they do not have stool that also compresses the bladder (the colon sits right above the bladder and can push on the bladder). Talk about a reward system that they would like to use while working on the problem. It doesn't have to be a major reward, small things work equally well. I think the rewards should be given by the week, rather than the day.
I also give rewards for effort, not just for dry nights. Trying is the whole idea. Sometimes the brain and bladder are just not ready and you do not want your child to feel defeated even though they have tried their hardest.
If all of this is successful it is then time to set up a bedwetting alarm system (numerous ones available over the internet). The alarms consist of a bell and pad. The alarm sounds when the pad senses moisture. The alarms that actually buzz are more effective than those that only vibrate. Remember, your child is already hard to arouse and vibration alone will probably not work.
Once you begin using the alarm and you hear the alarm go off, you will need to go into their rooms and call their name or shake them too, to actually get them awake and to the bathroom. In the beginning it may almost be like sleep walking them to the bathroom. Then rinse off the pad and reset the alarm and put them back to bed.
Over time they should arouse more easily and the time spent awake and going to the bathroom should shorten. As you can see this is disruptive to everyone's sleep so best done over the summer or a long winter break. It often takes at least a month for bedwetting to stop and the alarm system should really be used for several more months to reinforce the process.
There is also a drug call DDAVP that works on the kidneys to reduce the flow of urine. This medication works when given but does not cure the problem. I often use this for children who are worried about a camp or overnight experience, before they have started the alarm system regimen.
It has not been shown to be as effective as the alarm system, but in difficult cases I have used it in conjunction with the alarm system. You might want to discuss the pros and cons of this drug with your pediatrician.
Remember this takes time, motivation and determination on both the parent and child's part. Remain positive and optimistic throughout the training process. It is not a sprint but a longer race, and don't expect overnight success. Remind them of their other childhood accomplishments and that with time and determination they will be successful with bedwetting too.
That's your daily dose, we'll chat again tomorrow.
Send your question to Dr. Sue!
This is the time of year doctors like me worry about heat exhaustion and heat stroke and the importance of maintaining hydration to prevent serious heat related illnesses.
They fly, crawl and can ruin a perfect summer day. Bugs are creeping everywhere this time of year and there is only one way to keep them at bay...insect repellent.
Dr.
Sue Hubbard is an award winning pediatrician and medical editor for
www.kidsdr.com. She is a native of Washington, D.C. who travelled south
to attend the University of Texas at Austin and never left. Read More