Head Lice: 11 Tips That Parents Are Itching To Know
Medically reviewed on Jun 12, 2018 by L. Anderson, PharmD
Head Lice At School: Don't Panic
Did you get a notice that there is a outbreak of head lice in your child's school?
5 Facts You Should Know:
- Head lice are found worldwide. In fact, anyone can get infected.
- Preschool and elementary children seem to be the primary targets of head lice, with 6 to 12 million infestations each year.
- Head lice do NOT transmit diseases. Luckily, head lice are more of a nuisance than a serious health concern.
- It's a widespread myth that head lice only affect those with poor hygiene, or disadvantaged or low-income groups.
- There's a stigma that having head lice means that person is “dirty” or lives in poor conditions, but this is a not true.
But How Did My Child Get Head Lice?
The head louse, also known as Pediculus humanus capitis, is a parasite that can be found in human hair, eyebrows, and eyelashes. Head lice are spread by direct contact with the hair of an infested person; they don't fly or hop around. Once on the scalp, they feed on blood and can lead to bothersome itching. Their egg sacs, or nits, attach firmly to hair strands. Here's a drawing of how head lice and nits attach to hair.
The American Academy of Pediatrics recommends that children should not be restricted from attending school because of head lice or nits (eggs). Experts also state that contact with clothing or personal items (such as a hat, hairbrush, or coat) is an uncommon way to transmit lice, but it’s probably a good idea not to share personal items.
What Are The First Signs of Head Lice?
The first sign of head lice, known as pediculosis capitis, may be excessive itching around the neck and behind the ear. To check for lice, part your child’s hair and look at the scalp for small white or yellow-brown specks attached to the hair shafts. These are nits - lice eggs in their shell casings. Adult lice are more difficult to spot because they are small and will move quickly away when exposed to light.
Check with the school nurse to see if there have been any infestations reported. If indeed you do find head lice on your child, alert the school so families can be notified, and children can be monitored and treated, if needed. Don't worry, your child's identity will be kept strictly confidential.
OTC Head Lice Treatments
Over-the-counter (OTC) treatments (called pediculicides) come in a variety of shampoos and cream rinses. OTC products available for lice treatment include:
- Pyrethroids, such as piperonyl butoxide/ pyrethrins topical (brand names include: A-200, Pronto, R&C, RID Shampoo, Triple X, others)
- Permethrin 1% (brand names include: Nix Cream Rinse, Nix Ultra, others)
Very long hair may require a second bottle for full coverage. A repeat treatment may be needed after 7 to 9 days to kill any newly hatched lice (follow directions and timing on the individual product). Use a metal nit (lice egg) comb instead of plastic one, if possible.
Tips for Using OTC Head Lice Products
Parents: Please note age differences for product use below.
- Use only if 2 YEARS of age and older
- Side effects: skin irritation. Pyrethrins are pyrethroid extracts from the chrysanthemum.
- Per the CDC, pyrethrins kill only live lice, not the eggs. A second treatment is recommended 9 to 10 days after the first treatment to kill any newly hatched lice before they can produce new eggs.
- In general, don't use pyrethrins if you're allergic to chrysanthemums or ragweed and speak with your doctor about other options.
- Use only if 2 MONTHS of age and older
- Side effects: skin irritation. Permethrin is a synthetic pyrethroid similar to naturally occurring pyrethrins.
- Per the CDC, permethrin kills live lice but not unhatched eggs. Permethrin may continue to kill newly hatched lice for several days after treatment. However, a second treatment often is necessary on day 9 to kill any newly hatched lice before they can produce new eggs.
What If OTC Products Don't Work for Head Lice?
Keep in mind that head lice are developing resistance to the common over-the-counter (OTC) treatments like permethrin, which means they may not fully work to kill all lice. Prescription products may be needed for resistant cases. If lice are still present the day after the final treatment with an OTC product, contact your doctor.
Prescription products, such as:
- Ulesfia (benzyl alcohol topical)
- Sklice (ivermectin topical) - oral product available as well
- Ovide (malathion topical)
- Natroba (spinosad topical)
Follow the above links for dosing, precautions, and side effects.
The American Academy of Pediatrics NO longer recommends lindane to treat head lice.
Tips for Using Prescription Head Lice Products
- Malathion (Ovide): Malathion is intended for use on persons 6 years of age and older. Repeat use in 7 to 9 days if live lice still seen. Side effects: bad odor, highly flammable due to alcohol content (do not smoke or use electrical heat sources, including hair dryers, curlers, and curling or flat irons, when applying malathion lotion and while the hair is wet), skin irritation.
- Benzyl alcohol 5% (Ulesfia): Approved for use in 6 months to 60 years of age (do not use in neonates); must repeat in 7 days. Side effects: skin irritation and numbness, eye irritation.
- Spinosad 0.9% (Natroba): Approved for use if 6 months or older; reapply at 7 days only if live lice still seen. Side effects: skin or eye irritation.
- Ivermectin 0.5% (Sklice): Approved for use if 6 months or older; repeat application not needed; do not use for retreatment without talking to your doctor. Side effects: skin or eye irritation.
Do not use a prescription product called lindane, since it can be dangerous. Overuse, misuse, or accidentally swallowing lindane can be toxic to the nervous system and brain.
Should I Treat Other Family Members?
Worried that others in the house may have contracted head lice? All household members should be examined for head lice, and treated at the same time if needed. No need to treat your household pets; dogs or cats cannot transmit human lice.
In fact, lice cannot live off of the scalp for longer than 48 hours, so gather and wash items used in the last two days. To kill lice and eggs from clothes, stuffed animals, and bedsheets, you can use one of 3 methods:
- Use hot, soapy water (at least 130 degrees F or 54.4 degrees C) and the high heat cycle when drying.
- Have items professionally dry cleaned.
- Seal items in a plastic bag for 2 weeks.
Vacuum furniture and floors to remove stray hairs that may contain nits. Soak combs, brushes, and hair accessories in very hot, soapy water for 5 to 10 minutes. Household spraying with insecticides is not recommended.
Wet Combing: A Non-Insecticide Option for Head Lice
The available OTC and prescription pediculicides have been shown to be safe and effective when used according to the directions. However, some people prefer not to use them for a variety of reasons.
A method known as "wet combing" is an alternative for patients too young to use these products or for those who would prefer to avoid use of insecticides. Keep in mind the process can be time consuming and careful and repeated combing is needed over several weeks.
To perform wet combing:
- Lubricate wet hair with a hair conditioner.
- Use a fine-tooth nit comb from the crown, and firmly draw down and examine for lice after each stroke.
- Combing is done until no lice are found for each session (15 to 30 minutes per session is needed).
- The process should be repeated every three to four days for several weeks -- at least two weeks after no more lice are found.
Other Lice Treatments: Use Caution
Some people believe (and questionable Internet sites may promote) that head lice can be "suffocated" by coating the hair in "natural" oily products such as olive oil, mayonnaise, butter, or petroleum jelly. However, head lice are difficult to suffocate, and at least one report states that these methods are not effective.
Plus, extreme methods, like using gasoline or kerosene can be very toxic and highly flammable and should NEVER be used to try to kill head lice.
Shaving the head has not been shown to be effective to kill lice and may be psychologically distressing to a school age child. Avoid this practice.
More Support: Head Lice Treatment
- [Don't panic] if your child, or other family member, comes down with head lice. It sounds awful, but it's really fairly common and easy to treat.
- Remember that head lice cannot transmit disease and are more of a nuisance than anything else.
However, you may still have questions or want to ask other parents for advice.
Finished: Head Lice: 11 Tips That Parents Are Itching To Know
- American Academy of Pediatrics. AAP Updates Treatments for Head Lice. April 27, 2015. Accessed June 12, 2018 at https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Updates-Treatments-for-Head-Lice.aspx
- Koch, E., Clark, J. M., Cohen, B., et al. Management of Head Louse Infestations in the United States—A Literature Review. Pediatr Dermatol 2016;33:466–72. Accessed June 12, 2018 at https://www.onlinelibrary.wiley.com/doi/10.1111/pde.12982/full
- Devore CD, Schutze GE. Council on School Health and Committee on Infectious Diseases, American Academy of Pediatrics. Pediatrics. 2015;135(5):e1355.
- U.S. Centers for Disease Control and Prevention (CDC). Head Lice. Treatment. Accessed June 12, 2018 at https://www.cdc.gov/parasites/lice/head/gen_info/index.html
- U.S. Centers for Disease Control and Prevention (CDC). Head Lice. Treatment. Accessed June 12, 2018 at https://www.cdc.gov/parasites/lice/head/treatment.html
- Cynthia D. Devore, Gordon E. Schutze, The Council on School Helath and Committee on Infectious Diseases. Pediatrics May 2015, 135 (5) e1355-e1365; DOI: 10.1542/peds.2015-0746. Accessed June 12, 2018 at https://pediatrics.aappublications.org/content/135/5/e1355
- Lice in at least 25 states show resistance to common treatments. American Chemical Society. Press Release Aug. 18, 2015. Accessed June 12, 2018 at https://www.acs.org/content/acs/en/pressroom/newsreleases/2015/august/lice.html
- Goldstein AO, et al Patient education: Head lice (Beyond the Basics). UpToDate. Updated July 28, 2017. Accessed June 12, 2018 at https://www.uptodate.com/contents/head-lice-beyond-the-basics.
- Goldstein AO. Pediculosis capitis. UpToDate. Updated Aug 16, 2017. Accessed June 12, 2018 at https://www.uptodate.com/contents/pediculosis-capitis