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Nursery nasties - things you don't want your toddler to bring home... by Kate Brian

The chances are that sometime during their years at playgroup, nursery and primary school, your child will get nits, worms or scabies. Parents - and often children too - can find it very upsetting, but these are common parasites and are easily passed from one child to another. Parents sometimes wonder whether they may be to blame, but no amount of washing of your child, his hair, his clothes or your home are going to protect you entirely from these parasites. What is important is to recognise the symptoms and to know what to do when you spot them.

Head lice

They may be unpleasant, but they're a really common problem for young children, particularly girls who often have longer hair and spend more time huddled up to one another. Head lice are very contagious and spread quickly between children. It has been estimated that as many as one in five children have them at any given time. Although the idea of them living on your child's head may be upsettting, they aren't dangerous and won't cause disease. We tend to have an idea that they are unhygienic, but frequent hair washing doesn't make any difference to the chances of your child getting head lice.

Head lice only live on humans, and cannot be caught from pets. They don't live for long once they're away from a human head, and although you may read that you will need to specially wash or fumigate hats, clothes, towels or bedding if your child has head lice, this isn't necessary.

The symptoms

The first sign you may notice is that your child starts scratching his head, or complaining that it feels itchy or tickly. If you look through his hair, you may be able to see the eggs, known as nits. They look like pieces of dandruff, but they are attached to a shaft of hair and don't come loose if you ruffle the hair. They are often found behind your child's ears or at the nape of the neck.
These egg cases remain stuck to the hair after the head louse has hatched out, which usually takes a week to ten days. You may not be able to spot any lice in your child's hair even if you see the nits. The lice are small (they grow to about two to four mm in length at most) and they suck blood from the scalp. They are usually brown in colour.

Treatment

Your local pharmacy will probably have a selection of special shampoos and sprays and the pharmacist will be able to advise you on how to use these, but they are insecticides and so should only be used if you have spotted a live louse rather than as a preventative measure. These preparations are often not suitable for use on babies, if you are pregnant or have any allergies, so do check with your pharmacist. You can buy "green" versions of these shampoos and sprays in health food stores which may contain tea tree oil or neem oil.
However, one of the most effective ways of getting rid of head lice is wet-combing, which is sometimes known as bug busting. You use a special nit comb with extra-fine teeth, which you should be able to buy from any pharmacy. You put normal conditioner onto your child's wet hair and simply comb the lice out of the hair, wiping each side of the comb on a piece of tissue or kitchen towel, or rinsing it, after each sweep. It is quite time consuming, as you need to work your way through all the hair carefully, but it is effective, and means you don't need to use any chemicals. You need to repeat this every few days for at least a fortnight until you are certain all the head lice have gone. There's a useful website with lots of information on bug busting.
Use the wet-combing method on the whole family as head lice are easily passed from one person to another. Head lice can't survive for long away from the human body, so you don't need to worry about them living on bedding or towels.

Preventative measures

Do tell the staff at your child's nursery or school if you find your child has head lice - then they can warn other parents to check their children's hair. Otherwise, you can end up with a constant cycle of children being re-infected because some parents are not aware of the problem. You can continue to go through your child's hair once a week with the nit comb and conditioner method, just to make sure they haven't been infected again. Tying back long hair may also help.

Worms

Threadworms, also known as pinworms, are very common and nearly half of all children will have had them by the time they reach the age of ten. They can live for six weeks inside the human intestine. The female worm lays her eggs at night around the anus, and secretes an itchy substance. If the child scratches the area, the eggs can get under his fingernails and if he then puts his fingers in his mouth, the eggs are swallowed and more worms hatch out in the intestine.
The eggs are tiny and can be passed between children at schools and nurseries. The fact that young children often put their fingers in their mouths or suck their thumbs makes them more susceptible. The eggs can survive on clothes, bedding and furniture for some time so the whole family can be infected.

The symptoms

The most common sign of threadworms is itching, and your child may be restless at night. If the child has had worms for a while, he may start to eat less and there may be some weight loss, You may also find that your child becomes very irritable. Sometimes there are no symptoms at all. If you suspect your child has worms, you may be able to see them around the anus at night when the female comes out to lay eggs. You may also spot what look like tiny pieces of white cotton in your child's stools. If you aren't certain, see your GP.

Treatment

Drug treatment will be available from your local pharmacy - however if you are pregnant, or your child is under the age of two, then you should see your GP first as not all the types of medication will be suitable. There is no need to feel embarrassed about this - they will have seen many other families with the same problem in the past. It is important that the whole family are treated even if you don't think you have all been infected. The medication only gets rid of the worms, not the eggs, so you have to follow strict hygiene measures to prevent re-infestation.

Preventative measures

You don't need to keep your child away from playgroup, nursery or school, but you should make sure that they are following proper hygiene measures as this will mean that your child is less likely to be re-infected. You should follow the precautions listed below for about six weeks, as that is the length of the threadworm's lifecycle.
  • The whole family should bath or shower every morning to get rid of any eggs.
  • Keep your fingernails short, and try to make sure your children don't suck their fingers or their thumbs or bite their nails.
  • Wash hands and scrub nails after going to the loo and before eating
  • Don't share towels or flannels
  • Wear tight-fitting underwear at night to prevent scratching
  • Thoroughly wash all bed linen, towels and cuddly toys
  • Dust surfaces with a damp duster, rinsing frequently.
  • Vacuum daily.

Scabies

Scabies sounds awful and we sometimes associate it with poverty and poor hygiene, but in fact anyone can get scabies and it can spread amongst groups of small children who are in close physical contact with one another.
Scabies mites are tiny creatures which burrow under the skin, and lay their eggs. They like warm places, and are often found in the folds of skin between the fingers but can be elsewhere on the body.

The symptoms

The main symptom of scabies is itching, which can be very intense and is often worse at night, or after a bath or shower. You may see little red bumps, which are often found between the fingers, on the inside of the wrist, on the inside of elbows and knees, under the arms or groin. You may also see short wiggly lines that are usually grey in colour which are the burrows.

Treatment

Scabies can be simply treated with a cream or liquid which you can buy directly from a pharmacy, but you must seek medical advice about treating children, or if you are pregnant, as not all scabies treatments are suitable. In fact, even for adults it is advisable to see your GP first, as you could have some other skin condition with similar symptoms. Be careful to avoid close contact with others until you have been treated.
The itching sometimes carries on for as long as two weeks after treatment, so don't assume the medication hasn't worked if you are still experiencing some itching. If you are concerned, go back to your GP as sometimes the treatment may need to be repeated.

Preventative measures

It is important to treat the whole family as you may not know that you have been infected. You should also make sure all clothes, bedding and towels are washed and dried in a hot dryer, and that the house is thoroughly vacuumed and cleaned. Your child should not go to nursery, playgroup or school until he has been treated, and you should inform the staff as other children may have undiagnosed scabies already.

And finally

Many parents are really upset when they discover that their child has lice, worms or scabies. Remember that these are common problems for children, and try not to pass on your anxiety to your child. Although it may be distressing at the time, these conditions are all easily treated and experiencing one or more of them may just be one of the less pleasant aspects of being a parent!
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