By Dr Sarah Jarvis

September – time of ripening fruits and late summer sun, when thoughts turn to the new school year. Perhaps your first-born is taking his (or her) first tentative steps towards independence, as he starts school or nursery for the first time. Worrying, perhaps, but exciting too. After all, there is so much he has to gain. Literacy, numeracy, musical prowess, social skills, nits, worms …

Ah, yes – those unwelcome presents from his peers. Much as we would like to pretend that our little darlings are immune to itchy, wriggly infestations, they are highly unlikely to escape entirely. Fortunately, however, there are plenty of simple measures you can take to reduce the risks.

Headlice

Head lice are tiny insects which cling to the hair, but feed off skin from the scalp. They tend to stay close to the scalp, which provides a source of both food and warmth. Nits, on the other hand, are the empty shells from which the lice hatch. White, small and oval, they can look like dandruff but cannot be easily removed.

Head lice are not dangerous and, contrary to popular belief, they do not always cause symptoms. In fact, only about 1 in 3 people with head lice get the characteristic itchy scalp.

Another misconception is that head lice spread 'like wildfire' through schools. In fact, they are only spread by close head-to-head contact, and most doctors no longer recommend that children with head lice should be excluded from school. Best friends and close relatives, then, are the most likely recipients – the only known downside of bedtime cuddles!

Unfortunately, there is no really effective way of preventing head lice. However, regular nit combing will allow you to pick up head lice early, and early treatment will reduce the risk of passing them on.

If your child gets head lice, there is no need to see the GP. You can try and get rid of them with the 'bug busting' method: shampoo, conditioner and comb, comb, comb (you can buy a special comb set online at www.nits.net). Alternatively, get a lotion from your pharmacist. There is no point in treating the whole family because one person has lice – eggs take 7-10 days to hatch, and 10 days to mature enough to breed. Head lice treatments do not work on eggs, so wait until you have found a live louse (regular combing with a nit comb) then treat.

Do avoid sharing brushes and combs, and wash before each use. There's no need to fumigate or wash all clothes and/or bedding, though – lice can't survive for long away from a scalp, and are very rarely transmitted this way.

Threadworms

By far the most common form of worm caught by children is the threadworm. Threadworms are 2-10mm long, and look like white cotton threads. They cause itching when the female lays her eggs around the anus. You may see worms in your child's stools, or be alerted by their complaints of an itchy bottom.

The itching may be worse at night, when your child is warmest – they may itch in their sleep, and get threadworm eggs under their fingernails. These can be swallowed again by them or passed on to other children they come into contact with. The only way to reduce the risk of getting threadworms in the first place is to teach your child to be obsessional about handwashing and to discourage them from putting their hands in their mouths without washing them immediately beforehand.

Threadworms, unlike head lice, can also survive for up to 2 weeks away from a human host. That's why, unlike with a head lice infestation, you'll need to wash all clothes and bedding if your child is infected.

Fortunately, simple measures can reduce re-infection. They include:

if your child has threadworms, go to the GP and get a single tablet (or liquid) for the whole family; on the day of treatment, vacuum all carpets and damp-dust all smooth surfaces in the house; wash, wash and wash your (and their) hands again; keep your child's fingernails short; wear underpants in bed and change them in the morning;wash around the anus every morning to get rid of eggs; let the school or nursery know, so that they can check their hygiene.

There is no need to keep your child at home if they use the measures above. Of course, by the time you've read this, you will be convinced that you are totally infested, and won't stop itching for a week - I know I won't! But remember – these tiny visitors may be a bore, but they won't do you, or your children, any harm.