Lice

Signs of lice include:

  • an itchy scalp, often with a rash on the head.
  • nits (white lice eggs) that attach to hair shafts, often near the scalp. Often nits are found on the back of the neck, or on the front of the scalp. Nits that are further from the scalp are more like to be already “hatched” and not risk for infection.
  • Head lice are tiny insects, about 1/16 inch long. They move quickly and can be very hard to see.
lice combHead lice do not carry disease, and are NOT a serious medical problem. Anyone can get lice (no matter how clean the home). There is no reason for panic or embarrassment. Any child exposed to lice at school or daycare may get lice. Spread is by direct contact. If you’ve been informed of lice among your child’s friends or classmates, check the entire family. Treat only those who show signs of lice; treat all at the same time.

What to do

1. Treatment:

Agents approved by the FDA and other authorities include medications similar to RID and NIX. When used exactly according to package directions, these agents have been shown to kill adult lice. Nix has the advantage of being more effective against unhatched nits. Complete nit removal immediately after treatment for lice is the most important step.

Lice shampoo (Nix or Rid)
  • Wash hair with regular shampoo.
  • Towel off excess water (hair should not be soaking wet).
  • Shake bottle of NIX well.
  • Have child lean head over SINK (do NOT treat in bathtub or shower).
  • Apply enough NIX to thoroughly soak hair and cover the scalp, especially well behind ears and at base of neck (may need the full bottle).
  • Leave NIX in hair a full 10 minutes.
  • Rinse thoroughly with warm water.
  • May repeat in one week. Do not use medicine more often than one time per week unless on the advice of your health care provider.
Alternative treatments for lice have not been shown to be as effective as medicated shampoos. Unlike medicated shampoos they are extremely safe and can be used repeatedly without concern of side effects.
  • Oil (olive oil, baby oil, or cooking oil)
  • Work thoroughly into ALL of the hair (especially behind ears and at neck)
  • Cover head with shower cap; KEEP CAP ON for 4-6 hours
  • Wash oil out with liquid dish soap (like Dawn; keep out of eyes)
  • Rinse hair thoroughly with lots of water
An alternative approach that has been shown beneficial in one published medical study is the Nuvo approach using Cetaphil© cleanser. Click here for instructions.

2. Remove all nits

It is EXTREMELY IMPORTANT to remove ALL of the NITS; any nits allowed to remain in the hair can go on to hatch, produce new lice, and the exasperating cycle continues
  • Back-comb with a fine-tooth comb; or pull nits out individually
  • COMBS: (a quality metal comb will make the job easier)
    • LiceMeister comb (888-542-3634) probably the best choice
    • Rake comb that comes with RID
  • Divide hair into sections; work each section individually (check from scalp to end of hair)
  • NIT removal may take 1 to 3 hours, depending on number of nits, length of hair, and kind of comb
  • Clean your fingernails well when finished
  • Check head (wash and comb hair carefully) every day for two weeks after treatment
  • NOTE: itching does NOT disappear immediately after treatment

3. Prevent reinfestation

  • Lice cannot survive more than about 24-36 hours away from a person’s head.
  • Pets (including cats and dogs) do NOT get lice.
  • Soak combs and brushes in HOT (not boiling) soapy water for a full 10 minutes
  • Machine wash all bedding, clothes and towels in contact with infected person for previous 3 days. Use hot water and a hot dryer. (non-washables: dry-clean, tumble dry in HOT clothes dryer for a full 20 minutes, or vacuum)
  • Carefully vacuum all rugs, furniture, mattresses, car seats, and any personal items that cannot be washed that have been in contact with infected person (reason: to pick up lice and nits attached to fallen hairs; this step can eliminate bagging, see below) -Tightly seal and discard vacuum bag
  • Some authorities now advise that bagging is not necessary; however, things you do not wash can be tightly sealed in a plastic bag for at least 3 weeks (for example: stuffed animals, pillows)
  • Do NOT use insecticidal sprays (likely will not help; and may harm family members)
  • Teach children to NOT share combs, hats, coats, scarves, earphones, etc. with others.
  • Do not throw coats into a pile at school. (put coat in backpack or hang up individually)

If you are unable to clear the lice with the above treatments your child should be examined by a healthcare provider to confirm the diagnosis (nits are often confused with other things) and to discuss treatment options.

Call (during regular office hours) if:

  • Child develops rash and/or sores that look infected
  • Scalp rash lasts more than 1 week after treatment
  • Scalp rash clears, then returns again
  • New eggs appear in hair

Resources

National Pediculosis Association (NPA) 1-781-449-6487 - Also available at www.headlice.org (handouts, video, and catalog available).