Lice
If you or your child has never had lice consider yourself lucky. Each year millions of children get lice. And while lice does not cause serious illness or disease it can be a challenge to get rid of.
What is lice?
Lice are tiny bugs, about the size of a sesame seed, that attach to the hair. They feed on blood from the scalp. Their saliva irritates our skin to cause itching and sometimes a rash. Lice can occur anywhere we have hair but in children we see this mostly on the scalp. Lice can not fly or jump. They are passed to others by close head to head contact. However lice reproduce quickly.
What are nits?
Lice lay eggs on the hair. These eggs are called nits. Nits are small, white or yellow in color and so sticky that they stick to the hair shaft. They do not typically comb or brush out with standard brushes or combs. They do not usually wash out with regular shampoo. Nits hatch into lice after about a week. It then takes 9-11 days to become adult lice that can lay eggs. So lice can produce more lice quickly if left untreated.
How do I know if my child has lice?
If your child has been scratching their scalp or back of the neck go through the hair section by section and look for nits attached to the hair shafts and crawling dark lice. Sometimes nits are mistaken for dandruff. Dandruff will shake out while nits will not. Remember that not all itchy scalp is due to lice. Dandruff, eczema, irritation from shampoo and other hair product can all cause itchy scalp. If you aren’t sure reach out to your pediatrician to have the scalp examined.
How can I get rid of lice?
Comb-through method: this involves using a specialized fine tooth comb every day, going through the hair in small sections and combing out the nits and live lice. This should be done daily until all of the lice and nits are removed. The more thorough the combing the better because you want to make sure you have removed all of the lice before they have reproduced. Otherwise you will be combing out the hair for what seems like forever. This is the preferred method of removing lice in babies 2 months and younger.
Medications: many topical medications for lice are available over the counter.
1. Permethrin (Nix, Elemite)- can be used in children 2 months and older. It is a topical that is applied to the hair for 10 minutes and rinsed out. Do not leave it on longer than the package recommends. This kills live lice but may not kill the nits. So use this treatment again in 9 days to ensure you get all of the new lice that hatched since the last treatment. If you wait longer than 9 days to retreat then all of the newly hatched lice are now old enough to reproduce and you will have to retreat in another 9 days to get the lice from the newly laid eggs. You will still want to comb out the lice and nits daily during the treatment period.
2. Pyrethrin (RID)- can be used in children older than 2 years old. This topical is applied to the hair and kills lice but not the nits. So this treatment needs to be used again after 9 days to ensure you get all of the new lice that hatched since the last treatment. Again, if you wait longer than 9 days to retreat then all of the newly hatched lice are now old enough to reproduce and you will have to retreat in another 9 days to get the lice from the newly laid eggs.
3. Ivermectin (Sklice)- this is a topical that used to be prescription only but is now over the counter. This kills lice and while it does not kill the eggs it helps prevent the eggs from hatching or prevents the juvenile lice from surviving into reproductive stage. This means that only 1 treatment is usually needed.
4. “Pesticide-free” topicals- these usually have dimethicone in them which is a silicone oil. It works by coating the lice causing them to suffocate and dehydrate. These topicals do not kill nits so re-treatment in 7-10 days is needed. These can typically be used in children of any age but check your specific package for age of use restrictions since every brand contains different ingredients.
5. Cetaphil method- Some people recommend this method as an alternative to the above treatments. While one study showed this to be effective other studies attempting to replicate their findings have been less successful. The process is detailed and specific and if steps are not followed exactly it may not be an effective method. The FDA has not approved of Cetaphil for this use.
How do I treat bedding, towels, stuffed animals, etc.?
Wash the bedding, towels, clothes, jackets in hot water and dry on high heat to help kill the lice.
Live lice can only live 1-2 days off of a host. Nits can survive for a week off of a host but usually these nits do not hatch and if they do the juvenile lice typically can not survive off of a host. So for things that can not be washed and dried on hot settings, like stuffed animals, you can seal these up in plastic bags for 2-3 weeks. This will ensure that all of the lice will die.
Also make sure to check everyone else at home for lice to prevent transfer of lice back and forth among family members.
What about the home remedies that friends and family members have suggested? Should I try those?
Lots of people will tell you about a variety of home remedies for lice treatment such as mayonnaise, olive oil, butter or margarine. But these have been proven to NOT be effective. I can’t believe I have to say this, but I continue to talk to people who considered putting gasoline or kerosine on their child’s head to treat lice when family or friends recommended it. DO NOT DO THIS. In addition to being flammable and dangerous it does NOT work.
Ok, but rosemary or tea tree or eucalyptus are different, right? My friends swear that will work.
Rosemary, tea tree oil and eucalyptus does not kill lice or nits. There is no clinical evidence to suggest that it does. It is not FDA approved for lice treatment. Some small studies suggest that these act as a repellent, and may help keep lice away but do not rely on this for treatment of lice.
I used the over the counter treatments and we still have lice. What now?
Not to worry. If you have used an over the counter treatment listed above and treated your home as noted above and you are still seeing lice please reach out to your pediatrician for help. Remember lice does not cause serious or long term illness but it is a nuisance.