What to Expect the Toddler Years (163 page)

Head lice
(pediculosis).
What is it?
An infestation of the hair by lice.
Who is susceptible?
Despite the stigma associated with head lice, they are not choosy; they will settle comfortably on most any head of hair, clean or dirty, long or short, rich or poor. Lice are more common among children who are in day care or group care situations simply because they’re more likely to be exposed.
Signs and symptoms:
Head-scratching or scratch marks behind the child’s ears or near the hairline, at the forehead or neck (though many toddlers hardly notice the little visitors and don’t scratch at all); sightings of lice or nits in the hair, near the scalp.
Causes:
Infestation by head lice (
Pediculus humanus capitis
), parasites who survive by sucking small amounts of blood from their host’s scalp and reproduce by laying eggs (nits) in the host’s hair.
Treatment:
Use of a lice-killing product as recommended by your child’s doctor; package directions should be followed very carefully. If you have questions about a product, call the manufacturer (most have websites or toll-free numbers on their package inserts). Shampoo over the sink, rather than in shower or tub, to avoid getting the chemical on your child’s body. After the treatment, it’s necessary to painstakingly remove any remaining lice, as well as each and every little nit or empty nit case, using a special fine-tooth comb (one may be included with the lice-killing product) or your fingernails. A cream product used following the shampoo makes removing the nits easier.
Preventing spread and reinfection:
Prohibit sharing of brushes, combs, towels, pillows or other bedding, clothing, hats, and earphones. Destroy nits or lice that may have ended up in bed linens, towels, clothing, or stuffed animals an infected child has been using by washing the item in hot water (at least 130°F) or tumbling them in the dryer at “high” for at least twenty minutes. Items that cannot be exposed to such heat should be dry-cleaned or stored in air-tight plastic bags for two weeks to allow a full breeding cycle to pass before they are used again. (Remember, lice can live for
up to forty-eight hours on clothing, furniture, and so on.) Upholstered furniture, carpets, mattresses, car seats, and such, should be thoroughly vacuumed. (Spraying with an insecticide is probably not necessary.) Hair brushes and combs should be washed in liquid disinfectant, bleach, or the lice-killing product used on the child’s hair. Treating family members who are not infected is controversial; check with your child’s doctor for advice. But be sure to check all household heads for lice or nits daily for two weeks following the last treatment. Because lice are so easily passed around, children with lice are generally sent home from day care or preschool until they’ve been successfully treated; during an outbreak of lice, teachers may check the children’s scalps periodically for signs of the parasites.

Using a fine-tooth comb to remove each and every nit, as well as empty nit cases, is necessary following treatment for killing of head lice.

Head lice, 2 to 4 mm in diameter (shown magnified many times at the left) generally lay their eggs (nits) very close to the scalp. They can survive for no more than ten days on the host; the nits, which are firmly cemented to the hair shaft, survive for about three weeks.

For telling clues to a toddler’s daily activities, look no further than the fingernails. There you’ll find, among other things, mud (from the morning spent at the park digging), play clay (from that play date), glue (from that collage), remnants of breakfast, lunch, and dinner, and often, even less savory substances.

Unless you protect them with gloves, there’s no way you can keep your toddler’s fingernails clean all the time. But since dirty fingernails can harbor germs along with all the collected grime, you’ll need to try to:

Keep them short.
The shorter the fingernails, the less they can collect. Short is also best for toenails, which left to grow ungroomed, can curl under and become ingrown. See page 182 for clipping tips.

Clean them daily.
Make nail-cleaning part of the regular end-of-the-day routine. Help your child to use a small nail brush in the tub or when washing hands before bedtime. Carefully remove stubborn matter with a rounded wooden toothpick.

You know how precious eyes and vision are—not just in the toddler years, as children learn about the world, but all through life. Crucial to maintaining your child’s eye health and vision are:

Regular checkups.
It’s important to catch vision or eye problems early, so be sure your toddler’s eyes are checked by the doctor on schedule. The eyes are usually examined at birth and at six months, and checked informally at all regular well-child visits. If a child is at high risk for eye problems (was under 3.2 pounds at birth, has a family history of retinoblastoma, congenital glaucoma, cataracts, or diseases associated with eye problems), or if any abnormalities are noted, the child may be referred to an eye specialist, or ophthalmologist, for further evaluation. If your child’s eyes were not checked during the first year, have them checked as soon as possible. Visual acuity is usually screened again between three and three-and-a-half (earlier if a specific concern arises or if there is a family history of eye disease). The next screening usually takes place sometime before a child enters school, around the age of five. These exams, performed either by the child’s doctor or by a pediatric ophthalmologist, are not painful and are rarely upsetting to a toddler. In general, children who were born prematurely are more vulnerable to vision problems, so they need earlier and more frequent eye exams.