PAMF Health Blog

Be Well, Be Well Informed

Lice Are Not So Nice!

Posted on Apr 4, 2013


It’s one of those moments all parents dread – the head lice exposure notice has come home in your child’s backpack. Although the thought of your child having head lice can give you the heebie-jeebies, those pesky little critters are a nuisance but not a health hazard or sign of bad hygiene nor do they spread disease. If you discover your child has lice, there are effective, safe and inexpensive ways to treat them. In this blog post Palo Alto Medical Foundation pediatrician Swati Pandya, M.D., answers some of parents’ frequently asked questions about head lice.

How do you get head lice?

Head lice are mainly spread by head-to-head contact and are often a fact of life for preschool and school-age children who huddle together while reading, working on school projects or at circle time. Lice can also be spread during a sleepover or camp where children sleep closely together. Lice cannot jump or fly to another person’s head.

How do you check for head lice?

Head lice can be tricky to see as they are very small, avoid the light and move very quickly. A common symptom of head lice is an itchy scalp but that can also be caused by dandruff, eczema or an allergic reaction to a hair product. Follow these tips to confirm whether or not your child has lice:

  • Have your child sit in a brightly lit room.
  • Part the hair and look at your child’s scalp to find live lice and nits (lice eggs). Nits are tiny white or tan, oval-shaped beads, are firmly attached to the hair about ¼ inch from the scalp and can be seen with the naked eye. It can be easy to confuse nits with other things such as dandruff or specs of dirt. If you can remove the particle easily, it’s probably not a nit.
  • Comb through your child’s hair in small sections to discover and remove lice or nits.

If your child has head lice, check all other family members so they can be treated if necessary.

What’s the best way to get rid of lice?

It’s important to start treatment as soon as possible to limit the lice spreading to others.

Start with an over-the-counter shampoo treatment that contains pyrethrum and piperonlyl butoxide, a naturally occurring chemical from the chrysanthemum flower, (RID or TripleX) or 1-percent permethrin (NIX). These chemical head lice treatments are safe to use and have been approved by the U.S. Food and Drug Administration (FDA) for children two years and older.

While these head lice treatments kill live lice, they may not kill all the eggs (nits). You will need to repeat a treatment 7 to 10 days after the first treatment.

You can also use a nit comb after the hair has been treated to help ensure all the eggs are removed.

Follow theses tips for successful lice elimination:

  • Make sure you carefully follow all the manufacturer’s instructions. One of the main reasons the treatment doesn’t work is because the instructions are not followed correctly.
  • Don’t use more of the product than recommended.
  • Don’t combine different products.
  • Don’t repeat the treatment more than twice if it doesn’t seem to be working.

Speak to your child’s doctor if your child still seems to have lice after the two treatments. Prescription treatments are also available if the over-the-counter treatment has not been successful. These include:

  • Malathion: an organophosphate approved by the FDA for children 6 years and older.
  • Benzyl alcohol: an aromatic alcohol approved for children older than 6 months.

Are there any natural lice removal treatments that are effective?

If your child is very young or you want to avoid all use of chemicals, speak to your doctor who can advise on the use and effectiveness of over-the-counter products that contain occlusive (blocking) agents to suffocate the louse.

Products that have been tested include a petrolatum shampoo. It does have to be followed by diligent shampooing for the next seven to 10 days.

Cetaphil skin lotion is also used; however, it is not approved by the FDA. Some parents try olive oil, mayonnaise or butter but there are no studies to prove their effectiveness.

It’s also possible to remove the lice and nits manually with a fine-toothed nit comb such as the LiceMeister comb. To ensure you remove all the lice and nits you will need to comb out each section of your child’s hair (works best if damp) every day for about two weeks. This method can be effective, but it involves great stamina and staying power from the parent. Products are available that claim to loosen the glue that attaches nits to the hair shaft making the process of removal easier.

There are also companies that will handle lice removal for you. Talk to your child’s doctor about their methods.

What else can I do to limit the spread of lice?

There are some practical steps you can take to stop lice from finding new grazing grounds on family members, your child’s close friends and school mates:

  • Wash your child’s clothes, towels, hats and bed linens in hot water and dry on high heat. This applies to all items your child wore or slept in for the two days before you discovered the infestation.
  • Place and store items that can’t be washed in plastic bags for two weeks. After that time any stray lice will have died.
  • Vacuum the floor and furniture, particularly where your child sat or lay.
  • Don’t spray pesticides or anti-lice sprays in your home as this can expose your family to unnecessary and dangerous chemicals.

Remember that because lice are mainly spread by head-to-head contact, your focus should be on treating the heads of anyone in your family with lice. No need to go on a huge cleaning frenzy.

Can my child go to school if he or she has lice?

Your child should go back to child care, preschool or school after one treatment with an anti-lice shampoo. Although some schools have a “no nits” policy, the American Academy of Pediatrics discourages this as it’s important for children not to miss any school and the presence of nits is not contagious.

Can I stop my child getting lice?

It’s very difficult to stop your child being exposed to lice. If you know one of your child’s friends has lice, make sure your child does not share combs, brushes, hats, scarves or towels. Also, avoid any sleepovers until you know the child is lice-free.

Swati Pandya, M.D., is a board-certified pediatrician at the Palo Alto Medical Foundation’s West Valley Center.