I have a confession to make. I hate making school lunches. As much as I love cooking, somehow I dread putting together school lunches in the morning. I’d rather be drinking my coffee. Reading the paper. Listening to the ocean breeze. You get the picture. A bit of a fantasy, I know, but somehow this morning routine of making lunches is just not my thing. Truthfully, my husband ends up taking on a large share of this responsibility. When we have leftovers or a pre-made lunch like this fabulously simple and delicious Moroccan couscous with toasted chickpeas, my heart sings a little.
This recipe is terrific to make on a Sunday if you have a little (and by that I mean just about 20 to 30 minutes) extra time. It’ll keep in the fridge for a couple of days and depending on the crowd you are feeding, will last for a couple of lunches. I think its hefty enough to be dinner all on its own. This recipe is adapted from one that I got on Rouxbe (see below for more details!).
You might consider making a double batch of these chickpeas and save half to put on salads or to snack on just on their own. They’re that good.
The easiest way to get orange peel is to wash an orange and then use a vegetable peeler to peel off a few pieces.
The red onions add such a nice a flavor and beautiful splash of color. The raisins work with honey to give the dish a hint of sweetness.
Moroccan Couscous with Toasted Chickpeas: A Cure For Your Lunch Box Blues
15 ounce can chickpeas, rinsed, thoroughly drained and dried
1 teaspoon olive oil, plus additional to finish
1 teaspoon cumin seeds
1/2 teaspoon turmeric
1 1/2 teaspoons ground cumin, divided
1 teaspoon salt, divided
1 1/8 cup water
2 pieces of orange peel
1 garlic clove
2 teaspoons honey
freshly ground black pepper
1/4 cup golden raisins
1 cup dried couscous
1/2 small red onion (or 1/4 of a large one), finely diced
1/2 cup chopped parsley
1/2 cup chopped mint
3 tablespoons freshly squeezed lemon juice
chopped cherry tomatoes
Preheat the oven to 450 degrees.
Place the well drained, rinsed and dried chickpeas on a baking sheet. Drizzle with one teaspoon olive oil and add the cumin seeds, turmeric, 1 teaspoon of ground cumin seeds and 1/2 teaspoon of salt. Genlty toss, coating each chickpea lightly with olive oil and spices. Spread evenly and bake for 10 to 15 minutes until chickpeas are nicely toasted but still a little soft. Set aside.
While the chick peas are roasting, pour the water into a medium pot. Add the remaining ground cumin seed, orange peel, peeled garlic clove, honey, 1/2 teaspoon salt, and freshly ground black pepper. Bring to a boil and then simmer for an additional 5 minutes so that the flavors infuse into the water. Remove the orange peel and garlic. With the heat off, place the raisins in the water mixture and let steep for just a minute.
Place the dried couscous in a large bowl. Pour the hot liquid, along with raisins over top and mix to combine. Cover the bowl with plastic wrap and let steam for 10 to 15 minutes. (this is a great time to prep your remaining items if you haven't already!)
Once the couscous is steamed through, remove the plastic wrap and fluff with a fork. Make sure you fluff thoroughly as it will be more difficult to remove large clumps once the additional ingredients are added.
Add the chickpeas, chopped herbs and onion. Mix together. Add the lemon juice and drizzle with a little bit of olive oil. Season to taste with additional salt and pepper. Garnish with your creative touch.
I mentioned in a recent post that I’ve been taking a few classes on plant based nutrition. I’m about a quarter of the way through a terrific online Plant-Based Professional Certification Course offered through Rouxbe. Over the last few years I’ve increasingly become interested in this way of eating not only for personal health but also for the health of our environment. I feel fairly comfortable in the kitchen but am already amazed at the amount that I’m learning. Cooking can be incredibly intimidating. But, like most things in life, it requires practice, patience, the willingness to make mistakes and a good dose of creativity. Short of having a personal chef, the only way to eat for health is to cook for ourselves and our families. As much as we can and in the most forgiving way possible. It does not have to be (nor will it be!) perfect. But, it should be healthful. It should be joyful. And it most definitely should be delicious. I’m hoping to write a lot more about plant based nutrition and cooking. I’d love to hear your questions and of course always welcome your feedback. In the meantime, I hope you’ll enjoy this couscous and that it will, for a brief day or two, serve to relieve you of any lunch box blues, should you have any.
Parents face many challenges during their children’s adolescent years, one of them most certainly being the struggle to ensure that their teens are getting adequate sleep. As my oldest is about to turn 13 in a few short weeks, we’ve certainly noticed some changes in her sleep routine and so I thought it would be helpful to review “normal” sleep patterns at this age, some common myths and what we as parents can do to support our teens in establishing and maintaining healthy sleep.
Dr. Mary Carskadon is Professor of Psychiatry and Human Behavior at the Alpert Medical School of Brown University as well as the Director of the Chronobiology and Sleep Research Lab at EP Bradley Hospital. She is an expert on childhood and adolescent sleep and circadian rhythms and has conducted extensive research in the area. She was kind enough to share some of her articles (referenced below) with me and I hope to provide you with an overview of the information.
To start with, a brief review of adolescents and sleep. There are two main things that influence adolescent sleep patterns. The first involves biological changes that occur during puberty and regulate sleep. Contrary to popular belief, adolescents actually need the same (if not more!) sleep than school-aged children. During puberty, most teens undergo a sleep-wake “phase delay” meaning that their internal clocks become wired to stay awake later and want to wake up later as well. This shift can be as much as 2 hours. This is thought to occur because of a delay in nighttime melatonin secretion through adolescence, thus causing a shift in their circadian rhythm. Another contributing factor is a change in the “sleep drive”. The sleep drive is the pressure we feel to fall asleep. During puberty, this pressure accumulates more slowly, ultimately making it more difficult for teens to actually fall asleep. Subsequently, many teens find it challenging to fall asleep before 11 PM. If we understand that their sleep requirements do not decrease during puberty, you can easily see that if your teenager is required to get up much before 8 AM (which is true for almost every family I know!) that it can become quite easy for teens to become sleep deprived.
The second contributing factor that influences teen sleep pattern are psychosocial factors. Teens have an increasing need for independence and autonomy. Bedtime can be one of the areas in which teens choose to exert that autonomy. Throughout the course of adolescence, your child will likely take more control of setting his/her bedtime. (Interestingly, however, even though older kids took more control of setting their own bed time, these same kids actually required a parent or alarm clock to wake them up in the morning compared to younger kids who woke on their own.) Additionally, kids at this age face increasing pressures on their time. Between after school activities, sports and maybe even a part-time job, teens are often completing homework assignments late into the night. Finally, the use of technology and its effects on sleep have been well documented. Carskadon summarized this nicely in her article:
The preponderance of studies report shorter, later, and/or more disrupted sleep, as well as such daytime consequences as sleepiness or disruptive behavior, for children and adolescents as TV watching, computer/Internet/electronic games use, or mobile phone use in the evening before bedtime is greater. These activities are arousing in and of themselves and usually more easily accessed by the older adolescents, taking advantage of increased accessibility of technology and of the changes to the sleep regulatory systems that make it easier to stay away later. Indeed, to the extent that the activities involve light exposure—perhaps particularly blue-spectrum light exposure to which the circadian clock may have greater sensitivity—evening light has the phase-specific effect of delaying circadian rhythms, thus pushing sleep timing later.
All of these factors show how adolescent sleep patterns can be disrupted but why is sleep so important? Other than the obvious, that well rested teens tend to be more pleasant to be around and that they will be more focused and attentive at school, researchers have actually found some other important reasons to encourage you to help your teen get the sleep they need. In addition to improved mood, attention, behavior, grades, and health (overweight and immune problems), sleep has the following associations:
One study showed that teens whose parents set a bedtime of 10 PM or earlier (compared to after midnight) were significantly less likely to suffer form depression or thoughts of suicide.
Another study found that teens who had parents set a bedtime (vs. no bedtime) were more likely to go to bed earlier, get more sleep and reported less daytime fatigue.
These studies seem to suggest that having a fixed (parent set!) and earlier bedtime not only helps to counter some of the effects of the circadian phase delay seen in adolescence by providing extended amounts of sleep but that, in fact, the benefits of longer sleep periods go beyond being able to stay awake in class.
So, how exactly do we determine how much sleep our teens need? The topic of sleep requirement and the research surrounding it can be quite complicated. Generally speaking, teens need roughly 8.5 to 9.5 hours of sleep a night. As mentioned previously, contrary to popular thinking, sleep requirements DO NOT go down during the teen years. In fact they remain the same (if not increase). Some indicators of insufficient sleep include, excessive daytime sleepiness, difficulty paying attention, irritability, hyperactivity, mood swings, difficulty getting up in the morning and falling grades.
If sleep need does not decline, we know that due to the circadian shift experienced during adolescence, that teens are naturally inclined to sleep later in the day and the start of their day remains fixed (some schools actually have middle and high school students starting the day even earlier) then it’s easy to see how teens can become sleep deprived. In fact, in August of 2014, the American Academy of Pediatrics issued a policy statement in support of delayed (no earlier than 8:30 AM) school start times for middle and high school students for precisely this reason. However, not all families have access to schools with later start times. Though later start times make sense in terms of teens’ biologically mediated sleep patterns, they also pose certain problems for districts and families if they are not implemented in a well thought way. Many families have daycare/childcare restrictions and often older teens are responsible for caring for younger siblings after school.
So what’s a parent to do? In addition to encouraging your district to adopting a later start time for middle and high school students, here are some strategies you can use at home to help your teen get better sleep:
Work together to set a reasonable bedtime and try to be as consistent as possible (even on the weekends!).
Take a look at after school activities and simplify where you can.
Try to maximize light in the morning and minimize it in the evening (this can help with the circadian rhythm shift).
Avoid late afternoon napping (anything past 4 PM).
Avoid caffeine, especially in the afternoon.
Encourage a calming, relaxing pre-sleep routine and avoid overly stimulating, high-energy activities before bed.
Limit screen time before bed and consider removing electronic devices in the bedroom if they continue to be a problem. Some teens have a difficult time regulating these things on their own and may need our help to set limits.
Create an environment where your teen can wake up as late as possible. If their internal clocks are wired to go to bed between 10 and 11 PM, the only way to give them more sleep is to let them sleep in as much as possible. Simple solutions like showering at night, having their clothes picked out the night before and making sure back packs and all necessary items are ready to go could give them more than 1/2 an hour of additional sleep.
The ultimate goal would be to have a smooth bedtime routine that allows for enough sleep that your child can either wake up on their own or with minimal intervention. She should be able to get through the day without feeling overly tired and remain attentive in class. If you find your child sleeping until noon on the weekends, that may signal that she isn’t getting enough shut eye on school nights. One final thought would be to model good behavior around sleep. Adequate sleep is an essential ingredient in a healthy lifestyle. Whether we realize it or not, our children look to us to show them the way.
Carskadon MA. Sleep in adolescents: the perfect storm. Pediatr Clin North Am. 2011; 58(3):637–647
Carskadon MA. Sleep’s effects on cognition and learning in adolescence. In Hans P.A. Van Dongen and Gerard A. Kerkhof, editors: Progress in Brain Research. 2011; 190: 137-143
School Start Times for Adolescents. Pediatrics 2014;134:3 642–649
I was thrilled to collaborate with Your Teen Mag to bring this interview to you. You can check out a briefer version of this interview on their site by clicking here.
Participating in organized youth sports offers many potential benefits for children including physical activity, building self-esteem, leadership and organizational skills. On the flip side, as a parent I’ve often found the whole scene to be quite stressful at times. The shuffling and herding of children from practices and games, the year-round schedule of some sports and the nagging feeling that everyone is just over scheduled. As a pediatrician I’ve often seen young athletes with recurrent concussions and families that find it difficult to keep up with the demands of their children’s sports schedules.
In his book, Changing the Game, John O’Sullivan writes passionately about helping parents and coaches create more positive and rewarding experiences for kids participating in youth sports. Sadly, he states that more than 70% of young athletes drop out of organized sports before reaching high school, largely because kids lose their enthusiasm to participate and it no longer is fun. The corporatization of youth sports and the myth that sports will provide scholarship opportunities or entry into elite universities has created a culture of sports where kids are being pushed to “be on the travel teams by age 7, have a private coach by 8, and be committed to a single sport by age 10”. In addition to providing a summary of the state of youth sports and outlining a framework for athlete education and development, his book provides action steps to help parents make positive changes in their child’s athletic experiences. I spoke with him recently about his book and the role of parents in helping their children successfully navigate the world of youth sports.
You outline this very nicely in your book but could you briefly describe the best way for parents to introduce their kids to sports?
Early on, it’s important to introduce our kids to the ABCs – agility, balance and co-ordination as soon as possible. That doesn’t mean signing them up for soccer at 1½ years of age but rather spending time with them at the playground and teaching them how to run and jump. There’s a myth out there that kids are either born athletes or they’re not. But agility, balance and co-ordination are learned. Some kids pick them up quickly and others take more time. It’s just like saying if your 5 year old was struggling with reading – you wouldn’t say “let’s just forget about reading and move on” you’d say that reading is an important life skill. So if your 5 year old is getting the athletic movements down, enroll them in tumbling, martial arts or something where they are learning the basic movements or just kick a soccer ball around with them. As kids are progressing onto team sports, it’s important to keep them in a good learning environment with little competitive pressure for as long as possible.
Speaking of low competitive pressure and not making early participation about keeping score or winning, what do you do when the kids are actually the ones that are keeping score?
It’s fine if the kids keep score because the thing about 6 or 7 year olds is that one minute after that game, the only thing they care about is what the snack is. It’s usually the parents that are really caught up in the fact that “we lost 6-0”. Keeping score isn’t intrinsically good or bad; it’s just important to know what the purpose of keeping that score is. If we want to make sports enjoyable for as many children as possible and teach them athletic skills, then cutting kids, making all-star teams and emphasizing winning at these early ages doesn’t make any sense. In fact if you look at all-star teams at these early ages, it has more to do with what calendar month the kids are born in rather than actual skill level. It’s ends up being more about who is older because at those young ages, a few months make a big difference.
So how do parents decide when, if at all, their kids should specialize in a particular sport?
It’s important for parents to determine what the values and goal of any program are for their child. Playing travel soccer at 9 or 10 isn’t a bad thing; it’s just important to recognize it for what it is and try to maintain some balance. So, maybe play travel soccer in the fall and then rec basketball in the winter and either take some time off or make time for other things. It’s also important to recognize that while parents may try to avoid having their child be a single sport specialist that they often become a “multi-sport specialist” where they are playing multiple travel sports at the same time. In a way we’ve lost that middle ground where a multi-sport athlete can find a good level of play; everyone gets funneled into “the rec league that doesn’t care” or the ultra competitive teams. We end up losing a lot of athletes.
What if the push for early specialization comes from your child? Should you allow early specialization or try to “hold them back”?
When your child is the one that’s really driving it, then it’s ok to follow their lead but with the caveat that parents need to find a balanced approach that provides adequate rest and time for other interests.
There is already an existing infrastructure existing in youth sports that prevents kids from being able to participate in organized sports at the high school level if they haven’t specialized early. How do parents navigate around the current system so that their children are still having fun without limiting future participation opportunities?
Going to a high school with 3000 vs. 1000 kids, there’s a big difference in terms of the level of competition for sports. Having said that, regardless of your situation, it doesn’t change the science of how to best develop an athlete. From a physician’s perspective, the science says DO NOT specialize early unless you are a female gymnast or figure skater because you are very likely to get injured and suffer overuse injuries. From a psychologist’s perspective, the science says that early specialization will more likely lead to burnout and maladaptive behaviors. From an athlete development viewpoint, playing multiple sports at young ages develops better all-around athleticism, which in the end usually trumps early specialization. So, you’re better off having a child who plays lots of sports, finds the one that’s the best fit and then during the middle school / high school years, putting a lot into that sport.
As parents, how do we prepare our kids so that they are able to reach whatever goals they set for themselves (like being on the varsity tennis team) without overcommitting them and ourselves?
The kids who are going to make it at the high school level are very likely going to be the best athletes. So despite playing year round baseball from age 9, if your kid is not a great athlete, it’s unlikely they will make the varsity baseball team. You cannot get around that.
So how do we capture those kids back into the world of sports? So many opportunities to play sports are lost by the time kids reach high school. If a parent has a child who enjoys sports but doesn’t make the high school team, how can they encourage their child to continue to be involved?
My personal thinking has been changing on this and it’s been influenced a lot by a book called Spark by Harvard psychologist, John Ratey. He talks about the influence of exercise on brain and learning. For the vast majority of kids, by the time they have finished high school, their physical fitness pursuits will be an individual pursuit. They will be a cyclist, a runner or a swimmer and they are pretty much done with team sports. So if you have a child that is funneled off a team by 13 or 14, have them run cross-country, do track or swim. These are the individual sports they will likely pursue when they are older, so why not give them a good basis to start from?
That’s a great point. Is there a role for our school’s physical education programs to take a lead with this sort of thing and encourage kids to continue to stay active even if they are no longer on a team?
I would encourage everyone to look at the PBS special on the Naperville School District in Illinois. They changed their whole focus in their school district away from team sports to individual sports. They got heart rate monitors, treadmills and climbing walls. The obesity rate in the Naperville School District is 3%. It’s unbelievable what they have done. There’s been some criticism that it’s a wealthy school district and that it’s not reproducible but that program has been replicated in non-wealthy districts. Additionally, when they’ve done this, academic performance has actually gone up. Another problem is with the grading system for gym. Of course all of the elite athletes are going to get the best grades. One of the things that came from Naperville was looking at heart rate monitors to grade based on individual effort. So that if you have a fourteen year old girl who seems not be running that fast and might get a C grade – if you look at her heart rate and see that her heart rate is actually at 90 bpm, you can see that she’s really giving all her effort and you can give her a grade based on her effort. It’s pretty powerful – you change the message you give that fourteen-year-old girl from “you’re the slowest runner in the class” to “you are really working hard” and change her perception of herself as an athlete.
In your book you talk about how parents are “chasing the scholarship myth” and often have unrealistic expectations that lead them to push their kids to specialize early with the hope of acquiring a college scholarship. Do you think parents are buying into that myth?
I’ve seen surveys where 30-50% of parents think that their kid is going to get a scholarship. In reality, the numbers are 1-2% or even less. I think there is a lot misunderstanding around the prevalence of athletic scholarships out there, especially when you consider the fact that most schools, such as Division 3 and Ivy League schools, don’t even offer athletic scholarships.
Here’s a reader question: how do you handle all the “drama” on kid’s sports team — as in parents complaining, everyone wanting their kid to be the star, all the “fun” things that go along with being a part of a competitive sport”?
My best advice is to begin with the end in mind. What do you want sports to mean in your kid’s life? If you want sports to be something that teaches your child to work hard, to be confident, to have integrity, work well with others, to be a leader – as long as you keep your eye on the prize I think things like the politics and the drama — you just work past them. Becoming an athlete is not a sprint, it’s a marathon. So every experience is a teachable moment and if you’re on a team with a lot of drama, you need to make the decision of is this the best group to continue on with. If the answer is no, then find a group with less drama. Or, better yet, be an agent of change within your group and introduce my book or the work of groups like positive coaching alliance and work to change the environment on the team because the drama may serve the parents but it doesn’t serve the kids.
How are you working to spread your messages about youth sports?
I founded this organization called the Changing The Game Project in 2012 to get the message out and the book was just a part of it. I travel and speak at schools, clubs and conferences to get the message out about how do we create a player first environment in youth sports? Because when we do and we serve the needs, values and priorities of our kids, that’s when our kids not only stick with it and enjoy it but that is actually the path to raising elite athletes. I have a blog at changingthegameproject.com that is growing everyday with over 2 million views. So it’s a message that is really growing and resonating with parents and coaches.
What’s your final take home message for parents?
Always come back to this: if I were the one playing, what would I like in this situation? How would I like to be coached? How would I like to be cheered for? How would I like to be supported? If you’re ever in doubt of the answer, ask your son or ask your daughter what they want from you and help them find situations to allow them to get what they want from sports.
Last week I was fortunate enough to attend the Edible Schoolyard’s public tour at Martin Luther King, Jr. Middle School in Berkeley, CA. It was a truly inspirational* morning.
For those of you who haven’t heard about this wonderful organization, the Edible Schoolyard Project was established by Alice Waters, founder of Chez Panisse Restaurant and Café in Berkeley, California. Nearly 20 years ago, Alice Waters along with the principal at the time, Neil Smith, worked together to transform an acre of asphalt into a thriving, beautiful garden. It involves students in all aspects of farming the garden and preparing, serving, and eating food as a means of awakening their senses and encouraging awareness and appreciation of the transformative values of nourishment, community, and stewardship of the land. Over the last 2 decades, The Edible Schoolyard has become a model of edible education and inspired countless communities. In addition to linking garden and cooking lessons with science, math and history curricula, through its collaboration with the School Lunch Initiative, the Edible Schoolyard works to improve school lunch and food choices for students. A truly impressive and worthwhile mission.
Our morning began with a tour of the garden. The Director of the Edible Schoolyard, Kyle Cornforth and the Director of Partnerships and Engagement, Liza Siegler shared the stories of failure (one attempt at teaching the children about composting was quickly abandoned when rats were found rummaging through the compost bins!) and ultimate success. As we walked through the garden, it was hard to imagine that this plant filled haven was once a vast asphalt covered parking lot.
A beautifully prepared environment, where deliberate thought has gone into everything from the garden paths to the plates on the tables, communicates to children that we care about them.
I can’t describe the feelings of hope and admiration I felt as I experienced the walk through the garden and witnessed students actively engaged in lessons. The children seemed so at ease in this environment and there was a rhythm and flow as they navigated their way through the garden paths and outdoor classroom. They are involved in all aspects of the care and growth of the garden and no tasks are off limits.
From the garden, we moved on to the kitchen classroom. The kitchen curriculum ties in with humanities lessons. The kids learn basic kitchen skills and work in groups to create recipes. Following meal prep, they share in a communal meal as well as the clean up efforts to return the kitchen in the same state they found it. Sounds daunting. Busy middle- schoolers with knives, boiling pots of water and a flurry of activity. But it works. Watching them set the table and gathering around to share in this experience was just lovely.
Our tour ended in the school cafeteria where we learned more about the School Lunch Initiative. It’s a collaboration between the Berkeley Unified School District, the Center for Ecoliteracy and the Chez Panisse Foundation whose primary purpose is to “change the way children learn about food and what they eat for lunch in school everyday.” In the middle school cafeteria staff make over 10,000 meals per day from scratch to provide breakfast and lunch for all 16 of the BUSD schools under the guidance of executive chef, Bonnie Christensen. She talked about the work involved in preparing so many meals daily, the lessons they have learned and how rewarding the experience has been.
public/private partnership by the Berkeley Unified School District (BUSD), the Center for Ecoliteracy, and the Chez Panisse Foundation, with the primary purpose of changing the way children learn about food and what they eat for lunch in school every day. – See more at: http://edibleschoolyard.org/resource/lunch-matters-how-feed-our-children-better-story-berkeley-school-lunch-initiative#sthash.ke3jUmYQ.dpuf
The morning was informative and inspiring. It made me wonder why this couldn’t happen in more schools. In all schools. If we want our children to have nutritious meals and healthful lives, what better way to show them than by prioritizing it?
Right there, in the middle of every school day, lies time and energy already devoted to the feeding of children. We have the power to turn that daily school lunch from an afterthought into a joyous education, a way of caring for our health, our environment, and our community.
If you are ever in the area, I highly recommend a visit. Public tours are generally offered the first week of every month and you can find out more about them at The Edible Schoolyard Project.
A big thank you to all of the staff at the Edible Schoolyard who made the morning so memorable.
* So inspirational in fact that I didn’t take many pictures! Full disclosure — many of the photos from this post* are from Alice Waters’ book, Edible Schoolyard: A Universal Idea. The book describes the first years of the Edible Schoolyard Project and is filled with photographs, recipes and stories.
Lice. There, I’ve said it. It’s the one note that goes home from school that can instantaneously send parents into a state of deep panic. Not strep throat, not pink eye, not even the note informing of a dreaded outbreak of diarrhea can send as many households running for cover as does lice. Invariably, the beginning of school puts kids who have been away for summer camp and all sorts of adventures back together in close proximity, which can then lead to the spread of this most despised scalp inhabitant. My goal here is to arm you with information, demystify the myths and identify any preventive strategies you can take to avoid it all together. So… take deep breath, stop scratching your head and read on. There’s a lot of information so feel free to jump to my lice action plan at the bottom for my take home recommendations.
A LITTLE BIT OF BACKGROUND:
Head lice (formal name, Pediculosis capitis) have been around for a long time, long before humans even. Lice are tiny wingless insects that measure about 2 to 3 mm in size and feed on human blood. The life cycle includes nits (eggs), nymphs (baby) and lice (adult). The nits are eggs that look like tiny yellowish dots that attach on to the hair shaft close to the scalp (within 1/2 a cm) because they require body heat to incubate. They usually hatch into nymphs (baby lice) within 8 to 9 days leaving behind a small casing or shell (empty nits). Over the next 9 to 12 days they mature into the adult state. Within the next day or two the female can begin to lay eggs and the cycle can continue in this way every 3 weeks. The females live for 3 to 4 weeks and can lay up to 10 eggs per day. Fun right? The “itching” from head lice comes from a sensitization to saliva injected by the lice and can actually take 4 to 6 weeks to develop. Head lice cannot survive for long away from the scalp, typically no more than a day or two.
FACT vs. FICTION:
Lice don’t spread disease. They are gross but don’t cause actual harm. The main toll they take is on our mental well being.
Lice love clean, smooth hair. The notion that people get lice because of poor hygiene is not true. On the contrary, “dirtier” hair is more difficult for the lice to take hold of.
Lice cannot fly or jump! They are mostly spread via direct head to head contact. Remember, lice can only survive off of a human head for about a day. Lice can be spread from sharing combs, brushes, hats, pillows, etc. but it would have to be within that limited time frame.
NITS ≠ LICE. Only a small number of children with nits are infested with live, adult lice. Also, many people confuse dandruff and other debris for nits. Remember nits live within half a centimeter of the scalp and attach pretty firmly. If you see loose white “spots” away from the scalp that come off easily, they are most likely dandruff or debris.
Home remedies may not work. Many people swear by mayonnaise, Vaseline or olive oil to treat lice. The studies are not conclusive as to whether or not they work and I would advise against covering your child’s head in form of a plastic bag overnight.
Pets can’t spread lice. Human are the only host for lice.
Permethrin 1% (NIX): Currently the recommended treatment of choice for head lice. Hair should be shampooed and towel dried. Don’t use conditioner! It can make the medicine less effective. The cream rinse should be left on for 10 minutes and then washed out. It is recommended that you wash it out with cool water over a sink rather than in the shower so you don’t risk irritating the eyes and skin. There is some controversy over the next recommendation but I suggest repeating the treatment in 9 days (remember the eggs hatch in 8 to 9 days so if any eggs were left behind and hatched, this re-treatment is important). Others suggest only repeating the treatment if live lice are seen within 7-10 days. Either way, although there is low toxicity for humans it is recommended that you ONLY use this treatment if live lice are seen. Treating unnecessarily can lead to medication resistance.
Pyrethrins (RID): This product has rare allergic reactions (for those allergic to chrysanthemums) and has more reported cases of resistance which is why this would be my second choice.
Prescription only medications such as malthion and benzyl alcohol 5% can can have significant side effects and are only recommended for use if there is true treatment failure. If the over the counter remedies don’t work, you need to see your health care provider for more treatment options.
Several “natural” products are available over the counter and have been used for the treatment of lice but are not FDA approved. If you wanted to skip any form of medication, you could also opt for manual removalwith a nit comb. This process, while completely safe and devoid of side effects is extremely labor intensive. Some people choose to use the nit combs in combination with some of the above treatments. If you opt for manual removal, the hair should be thoroughly wet combed with a nit comb every 3 days for 2 weeks or until the lice and nits are gone. More and more professional “nit picking” salons have popped up to handle the entire process of manual removal. They can be quite pricey but are an option for some families who don’t want to deal with the mess of it all.
LICE ACTION PLAN
Here’s my summary of what I recommend. I tend towards the anxious side so you may find my recommendations a bit excessive but I don’t like to mess around.
At the start of the school year (or if the dreaded letter comes home) implement practical measures like avoiding the sharing of combs, brushes, hats, etc. to help prevent the spread of lice. For girls with longer hair, even wearing a braided ponytail can help.
Many over the counter, natural repellent shampoos have gained popularity as well. Some hair care products, such as the Fairy Tales brand, claim to naturally repel head lice with ingredients such as rosemary and other herbs and plant extracts. While there is no conclusive data to show that these products are 100% effective in preventing lice, there is no harm in trying them. For the anxious family, I think it’s fine to use these sorts of products, especially at the start of the school year or when a lice outbreak occurs.
If the dreaded letter comes home or your child has symptoms, do a thorough head check. You may need to purchase a special nit comb and do a wet combing to fully evaluate. If you detect lice, read on…. otherwise continue to check every couple of days for the next 2 weeks.
Everyone in the household should be checked out. Only those family members with lice/nits require treatment.
I recommend starting with the over the counter 1% Permethrin (NIX) unless there has been high resistance in your community. I also recommend retreating in 9 days so that you catch any nits that may have hatched. If you prefer, you can hold off on a second application and only use if you see live lice after treatment. If this product doesn’t seem to be working or you have additional questions, talk to your health care provider for more detailed information.
If they are available to you, you can also consider using a professional “nit picking” salon.
Sheets, towels and clothing (those used in the last 2 days — remember lice can only survive for about a day off the human head) should be washed in hot water and dried in high heat.
If there is a favorite stuffed animal that can’t be washed, you can store it in an airtight bag for two weeks.
Soak combs and brushes for 10 minutes in hot water if you choose not to replace them.
Vacuum rugs and furniture as needed.
There are some varying opinions on this (and I actually disagree with the AAP on this one!) but I believe that if a child has an active lice infestation they should remain at home until they have been adequately treated. Notifying the class will ensure that families stay on the lookout for new cases of lice. Schools however do not need to adopt a “no nit” policy as nits cannot spread infestations — only live lice can. Once the child has been adequately treated, they can return to school.
I also recommend notifying any close contacts. If your child has had a sleepover, play date or any other close contact that you feel would put another child at risk, it’s best to talk to the involved parent(s).
As far as play dates and other social gatherings, use your judgement. I always recommend acting in a way that you would want to be treated. If your child is being treated for lice, I think it’s the right thing to do to inform fellow parents.
There is a lot of shame and embarrassment surrounding lice. It’s really important not to stigmatize children over it. Do the best that you can to stay calm. In my experience parents are more bothered by it than the child. I get it. It’s gross. It’s a hassle. It’s just plain louse-y (Ha!). But, I think that if we communicate a little more openly about it, it will help to remove some of the stigma around it.
I hope you have been able to get through the length of this article without scratching your head too much. It’s the first longer piece I’ve written on a medical topic. I’d love your feedback for future features. Too long? Not enough detail? Too much detail? Let me know!
Frankowski, B. Head Lice (Pediatrics 2010;126:392-403)