What are the American Academy of Pediatrics (AAP) guidelines for treating lice in a 10-year-old patient, including medication and dosing, and do I need to treat the family and handle bedding and clothes?

AAP Guidelines for Treatment of Lice in a 10-Year-Old Patient

Permethrin 1% cream rinse is the first-line treatment for head lice in a 10-year-old, applied to damp hair for 10 minutes and repeated 7-10 days later. 1

Diagnosis Confirmation

Before initiating any treatment:

• Confirm diagnosis by finding a live louse on the head (gold standard) 1
• Using a louse comb is more efficient for diagnosis than visual inspection 2
• Never treat based on nits (eggs) alone 1

Medication and Dosing

First-Line Treatment

• Permethrin 1% cream rinse (Nix)
  • Apply to damp hair that has been shampooed with non-conditioning shampoo and towel-dried 2
  • Saturate hair and scalp completely, especially back of head and neck 1
  • Leave on for exactly 10 minutes (not less) 1
  • Rinse thoroughly 2
  • Repeat application in 7-10 days (preferably day 9) to kill newly hatched lice 2, 1

Alternative Treatments (if permethrin fails)

• Malathion 0.5% lotion (Ovide) - for children ≥24 months when resistance to permethrin is documented 2
• Ivermectin (topical or oral) - for children >15kg with persistent cases 1

Family Treatment

• Only treat family members who have evidence of active infestation (live lice) 1
• Examine all household members for live lice 1
• Preventive treatment of family members without active infestation is not recommended 3

Environmental Management

• Machine wash clothing, hats, scarves, and bedding used by the infested person in hot water and dry on high heat for at least 20 minutes 1
• Items that cannot be washed can be dry-cleaned or sealed in plastic bags for 2 weeks 1
• Extensive environmental decontamination is not necessary 1, 3
• Soak combs and brushes in hot water (>130°F) for 5-10 minutes 1

Return to School

• Children can return to school after proper treatment has been initiated 1
• The AAP does not recommend "no-nit" policies for school return 1, 3
• Educate the child to avoid head-to-head contact with other children 2

Common Pitfalls to Avoid

1. Misdiagnosis: Treating without confirming live lice 1
2. Noncompliance: Not following proper application instructions or timing 1
3. Premature retreatment: Retreating too soon or unnecessarily 1
4. Overuse of pediculicides: Leading to potential resistance 4
5. Excessive environmental cleaning: Not necessary and wastes resources 1, 3

Treatment Failure Management

If treatment fails despite proper application:

• Consider resistance to permethrin 2, 4
• Switch to malathion 0.5% for children ≥24 months 2
• For persistent itching after treatment, topical corticosteroids or oral antihistamines may provide relief 1

Remember that head lice infestation is common among school-aged children, affects all socioeconomic groups, and does not reflect poor hygiene 1. Proper education about transmission and treatment is essential for successful management.