Doctors’ Notes


Lice, Scabies, & Pinworms

You ugly, creeping, blasted wonder, Detested, shunned by saint and sinner

 – Robert Burns, “To A Louse”

Creepy crawly critters are a parent’s worst nightmare. Lice, scabies, and pinworms can be unwelcome guests in anyone’s household. The good news is that all of these conditions are pretty common, they’re all very treatable, and they won’t cause any severe illness. With that in mind, let’s take a brief look at three of the most common…


Head lice are small, grayish-white insects that live on the scalp and feed on blood, causing itchy spots where they bite. Lice eggs (nits) are small and white, and are found on the hair shafts, usually close to the scalp. Lice can’t jump, fly, or hitch rides on pets, but they can be spread from direct contact, or through clothing, bedding, helmets, hats, and the like.

Does My Child Have Lice?

Using a good light source, take a fine-toothed comb (or nit comb) and touch it to your child’s scalp. Comb slowly, all the way from the scalp to the ends of the hair. After each comb stroke, look for nits or live lice. Comb through the hair completely at least twice. If any nits or live lice are found, it’s time for treatment.

How are Lice Treated?

The best, first line over-the-counter treatment is permethrin 1% (Rid, Nix) or pyethrin (A-200, Pronto). Follow the manufacturer’s instructions directly. It’s a good idea to repeat this process in 1 week, to kill any remaining lice that might’ve hatched since the first treatment. If this doesn’t work, there are other methods that can be tried, including prescription strength medications and Cetaphil treatment. (Call the office for more details.) By the way, contrary to popular myth, Vaseline, olive oil, and mayonnaise don’t work!

What About Home and School?

Clean-up at home should include washing your child’s sheets, towels, and clothing in hot water, then drying on the hot setting. Vacuum furniture, carpets, and carseats your child has been around. Stuffed animals and other fluffy toys can be put in a plastic bag for 2 weeks (until any remaining living lice die off). Some schools have a no-nit policy, with which the American Academy of Pediatrics disagrees with. Generally, children should be able to return to school after their first combing and lice treatment. If schools require a doctor’s note or examination prior to going back to school, just call our office.

If you’d like more information on Lice, stay tuned. Dr. Pai will have an in-depth Doctor’s Note on them coming later this summer.


Scabies are tiny mites that burrow into the skin and cause one of the itchiest rashes that ever itched. It’s spread by direct contact with other people with an infestation. The mites themselves are too small to see, but they leave behind small red bumps where they start their tunnels.  The bumps come on slowly (not overnight), and can be located anywhere, but are often clustered in the skin folds (between fingers/toes, groin, armpits, waist).

Does My Child Have Scabies?

An office visit and exam are the best way for a diagnosis of scabies. Sometimes it can be difficult to distinguish from other itchy rashes like hives or other bug bites.

How is Scabies Treated?

If scabies is diagnosed, we will usually prescribe permethrin lotion. It’s applied once at night from neck to feet, then washed off the next day.  One treatment is usually all you need.

What About Home and School?

Other close contacts and family members should likely be treated as well. Wash all clothing and bedding in hot water and dry on the hot setting. Children should be able to go back to school 1 day after treatment.


Pinworms are tiny… well… worms that live in the intestines and live off the food we eat. They’re spread from person to person through their eggs, which are ingested, then hatch in the intestines. Female worms crawl out of the bum and lay eggs, usually at night. This causes lots of anal itching, which in turn gets eggs on kids’ fingers, which spreads the eggs to other people.

Does My Child Have Pinworms?

Sometimes pinworms can be seen around the anus, especially at nighttime when they’re most active. They look like very small white strings or threads, and are usually ¼ to ½ inches long. Worms and eggs don’t usually pass in the stool. In many cases, nothing can be seen. If you see worms, or your child has a very itchy bottom at night, call our office for an appointment.

How are Pinworms Treated?

An oral prescription medication is used to wipe out pinworms, usually a chewable tablet given once, then another time 2 weeks later. This treatment has close to a 100% cure rate.

What About Home and School?

Often, everyone in the household is treated for pinworms to reduce the risk for reinfection. As with the other infections, washing all clothing and bedding in hot water and drying on the hot setting is important. Trimming fingernails can keep eggs from getting stuck there and passed to other people. Encouraging hand washing can also help prevent spread.

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Dr. Todd Sanderson was a Kids Plus Doc from 2011 to 2013.