“Head lice? In MY child?” Yes. Here’s What To Do.

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Now that school is back in session, your child is picking up all kinds of new things: reading skills, vocabulary words, friendships, playground games…and head lice.

“Head lice? How can that be? We wash her 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, despite their family’s “cleanliness,” have contracted head lice. In fact, 6-12 million kids in the U.S. get lice every year, so if it happens to your child, you’re not alone.

Lauren Adler

Lauren Adler, MD, FAAP

Since lice are typically spread through direct head-to-head contact—which happens all the time in school, sleepovers, camp and any other situation where people have close physical contact with each other—kids are common targets. However, head lice is not a “kid” thing, it’s a “close contact” thing. Kids are prone to catching lice because they tend to be in close quarters with each other and often share personal items.

Lice myth busters

  1. FALSE: Having head lice is a sign of dirtiness, poor hygiene or low income.
    Kids of all cleanliness and socioeconomic levels get lice, no matter how often or seldom they wash their hair or bathe. (In fact, lice prefer clean hair.)
  2. FALSE: Lice like long hair.
    It doesn’t matter how long or short your child’s hair is.
  3. FALSE: You can get lice from using someone’s brush or hat.
    The spread of lice through brushes, combs, hats, etc. is fairly rare, although yes, it can happen.
  4. FALSE: You can get lice from pets.
    No, this is false.

Can you see lice with the naked eye? Yes.

Although they are very small, you can spot lice in your child’s hair, especially the eggs clinging to dark hair. Here’s what to look for:

  1. Lice eggs (called nits). These look like tiny white, yellow, tan or brown dots before they hatch, similar to dandruff, except they can’t be removed by brushing your child’s hair or shaking his/her head.
  2. 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 hatching process repeats itself about every 3 weeks.
  3. Lice bites cause itching and scratching. This does not always start right away and often 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.
  4. 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.

10 best ways to eradicate head lice

From our years of experience dealing with head lice at Westchester Health Pediatrics, we’ve put together our 10 best ways to get rid of them. But before you do anything else, the first thing we recommend is to wash any items that have come in contact with your child’s head—bedding, hats, clothing, scarves, toys, towels, car seat/stroller head rests—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. Then, check everyone else in your family for lice as well.

Here are our Top 10 remedies:

  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 (get one at a drugstore) to remove lice and nits. After a comb-through, use a magnification light to find and pick out any strays.

  2. Rid, a 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. 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.

  4. 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.

  5. Petroleum jelly (Vaseline)

    Like olive oil, many parents 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. 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 it is completely dry (this may take longer than usual). Leave product in for at least 8 hours, then wash hair as usual. This process should be repeated 7 and 14 days later.

  7. 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.)

  8. Benzyl alcohol lotion 5%

    This prescription lotion (Ulesfia) works by paralyzing a louse’s breathing apparatus. Ulesfia can be prescribed for patients 6 months and older; 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.

  9. 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.

  10. Hire a nit-picking service

    There are actually de-lousing services that specialize in removing head lice. Ask us for recommendations for a reliable service in your area, or consult the National Association of Lice Treatment Professionals.

Lice should not keep your child from going to school

If children are found to have live lice while at school, they might be sent home (depending on school policy) where they need to be treated appropriately (as recommended by the American Association of Pediatrics and the National Association of School Nurses). Then they should be allowed to return to school.

Proper treatment will kill the live lice, though nits can hang onto the hair for longer. Nits are not as contagious because they are cemented to the hair, which is why children with nits but not live lice should be permitted to attend school.

If you are notified that a student in your child’s school has been found to have head lice, this doesn’t mean your child will necessarily contract lice, too. Check your child’s hair over the next few days and be aware of any scalp itching or scratching. If your child does develop head lice, follow the guidelines above.

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

If your child is showing signs of head lice and you want to know the best ways to get rid of them, or if he/she has developed a scalp infection from scratching, please make an appointment at Westchester Health Pediatrics to see one of our pediatricians. We’ll examine your child, determine if he/she does in fact have head lice, and if so, give you advice and guidance on the best, fastest way to eradicate them so you and your family can rest easy. Whenever, wherever you need us, we’re here for you.

Make an appt

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

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About the Author: ML Ball