11 Best Ways to Get Rid of Head Lice

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Mother treating son's hair against lice

“Head lice? In MY child?!? But we wash his hair every night. And we’re really clean people!” I wish I could tell you how many times I’ve heard this from parents of young patients who, one way or another, have contracted head lice.

So let me state here for the record:

Having head lice is not a sign of dirtiness or poor hygiene.

Lauren Adler_02R WEB72

Lauren Adler, MD, FAAP

Kids of all ages and socioeconomic levels get lice, no matter how often they do—or do not—wash their hair or bathe. (In fact, lice prefer clean hair.) It also doesn’t matter how long or short your child’s hair is. In fact, 6-12 million kids in the U.S. get head lice each year, so if the troublesome little pests have found their way into your family, you’re not alone.

Head lice facts

Lice do not jump or fly, they crawl. They are most easily spread through direct head to head contact. In fact, most lice are transmitted in the home during sleepovers and close contact.

Although it can happen, the spread of lice through brushes, hats, etc. is uncommon. Kids are most prone to catching lice because they tend to have close physical contact with each other and often share personal items. However, children are more likely to share germs with each other, like strep or the flu, than they are to spread lice. NOTE: You cannot get lice from pets.

Although they’re very small, lice can be seen by the naked eye.

Here are things to look for:

  • Lice eggs (called nits). These look like tiny yellow, tan or brown dots before they hatch, similar to dandruff, except they can’t be removed by brushing or shaking them off.
  • Adult lice and nymphs (baby lice). The adult louse is no bigger than a sesame seed and is grayish-white or tan. Nymphs are smaller and become adult lice 1-2 weeks after they hatch. If head lice is not treated, this process repeats itself about every 3 weeks.
  • Lice bites cause itching and scratching which does not always start right away (depends on how sensitive your child’s skin is to the lice). Some children complain of something crawling in their scalp or tickling their heads.
  • Small red bumps or sores from scratching. For some children, excessive scratching can lead to a bacterial infection (red, tender skin with crusting and oozing) which needs to be treated with an antibiotic.

11 best ways to eradicate head lice

From our years of experience dealing with head lice at Westchester Health Pediatrics, we’ve put together our 11 best ways to get rid of them so you and your child can get some relief.

  1. Nitpicking and wet combing. You cannot get rid of lice until you’ve picked out all the eggs. This should be done in conjunction with almost all other treatments. Hair should be wet and have a lubricant added to it, such as conditioner. First, comb the hair section by section, starting very close to the scalp with a fined-toothed metal comb (you can buy one at the drugstore) to remove lice and nits. After a comb-through, use a magnification light to find and pick out any strays.
  2. Rid, lice-killing shampoo. Pyrethrum, the active ingredient in Rid and similar OTC products, comes from chrysanthemum flowers that harbor natural insecticides called pyrethrins. Apply to dry, clean hair that has no products applied to it, wait 10 minutes, then add water to form a lather and rinse. Comb for nits. A second application is recommended 7-10 days later to kill any live lice that remain. Watch your child for allergic reactions.
  3. Olive oil. This home remedy smothers and kills lice but it needs to be applied overnight under a shower cap because lice can survive without breathing for hours. You’ll also have to comb your child’s hair afterwards to remove nits, but the olive oil should help loosen them from the hair shafts.
  4. Nix, another lice-killing shampoo. Here is another permethrin-containing product that attacks live lice although some of our parents report that lice seem to have become resistant to it. Allergic reactions are possible. On damp, shampooed (but not conditioned) hair, saturate your child’s head with the lotion. Leave for 10 minutes, rinse and comb out nits. Repeat if live lice appear 7 or more days after the initial treatment.
  5. Petroleum jelly (Vaseline). Like olive oil, many moms swear by this (other options: styling gel or mayonnaise). The thick jelly supposedly suffocates lice by clogging their breathing holes. For best results, coat the hair and scalp, cover it overnight with a shower cap, and wash out the next morning. Comb for nits. Repeat the treatment one week later.
  6. Vinegar. Some parents have found that vinegar dissolves the sticky glue that the female louse uses to attach her eggs to hair shafts. Also, we’ve seen that coating the hair with vinegar after using a lice-killing treatment and before combing for nits works well. (White vinegar is recommended.)
  7. LouseBuster. Resembling a vacuum cleaner, this device directs heated air toward the hair roots and scalp to dry out lice and their eggs. A 2006 study showed that the LouseBuster killed 98% of nits and 80% of live lice. Although safe and quick (a typical treatment takes only 30 minutes), treatments are only available through certified professional operators.
  8. Clean items that have come in contact with your child’s head. To prevent re-infection, wash bedding, hats, scarves and towels in hot water and dry on a hot setting. Soak combs and brushes in very hot, soapy water. Vacuum floors, pillows, upholstered furniture and car seats. Stow items you can’t wash in a sealed bag for 2 weeks. Check all household members for lice as well.
  9. Hire a nit-picking service. There are actually de-lousing services that specialize in removing head lice. Ask friends, neighbors, your school nurse or us for recommendations for a reliable service in your area, or consult the National Association of Lice Treatment Professionals.
  10. Benzyl alcohol lotion 5%. This prescription lotion (brand name Ulesfia) works by paralyzing a louse’s breathing apparatus. Ulesfia can be prescribed for patients 6 months of age and older and at least two applications are needed. (Note: It can cause eye and skin irritation.) To use, saturate dry hair and scalp with the lotion, wait 10 minutes, then rinse. Use a nit comb afterward to help remove nits and dead lice.
  11. Cetaphil Cleanser: Another product that can be used to treat lice via suffocation is Cetaphil Cleanser. This method has been shown to be 96% effective and has no toxicity. Start by coating the scalp and dry hair with a thick layer of Cetaphil. Once the hair has been saturated, wait 2 minutes to allow the product to soak in. Using a fine-toothed comb, remove the excess product. Blow dry the hair until is is completely dry (this may take longer than usual). Leave product in for at least 8 hours, usually overnight. In the morning, wash hair as usual. This process should be repeated 7 and 14 days later.

Lice should not bar children from school

Schoolchildren with live lice should be allowed to stay in school until the end of the day and then treated appropriately at home. Proper treatment will kill live lice, though nits can persist (nits are not as contagious because they are cemented to the hair). The American Association of Pediatrics and the National Association of School Nurses do not recommend a no-nit policy. This means that children should not be excluded from school due to the ongoing presence of nits in their hair.

Furthermore, it is an unnecessary use of school facilities/staff to perform school-wide lice checks because lice do not transmit disease and are not highly contagious. Also, it is an invasion of families’ privacy to have parents perform lice checks in school. Parents should be aware of scalp itching in their children and check their heads at home.

If you think your child has head lice, please come in and see us

If your child is showing signs of head lice, please contact us at Westchester Health Pediatrics to see one of our pediatricians. We’ll examine your child, determine if he/she in fact has head lice, and together, agree on the best plan of action.

By Lauren Adler, MD, FAAP, a pediatrician with Westchester Health Pediatrics.

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About the Author: ML Ball