There are four letter words every parent dreads hearing. The most horrifying of them all… L I C E! Even typing the word makes me itch. When I drop the “L bomb” parents literally shrink in horror from their kids. And the kids…. their reactions range from terrified shrieks of “DONʼT CUT MY HAIR” to nonchalant shrugs of acceptance.

The idea of creepy crawlies in their kidʼs hair freaks out even the most seasoned parent.

My pronouncement is usually followed by an onslaught of parental questions, “WHAT?!? “HOW?!? “AM I GONNA GET THIS?” “BUT MY KID BATHES!!”

Letʼs face it no one wants LICE and no one wants to be around it. According to the American Academy of Pediatrics there are 6 to 12 million children infested with lice each year. With numbers like these it looks like these pesky critters are here to stay. So, we better figure out how to handle them.

WHAT ARE LICE?

Lice are small insects about the size of a sesame seed that live in the hair and lay eggs near the scalp. They are a grayish color and are best seen at the back of the head.

Female lice lay eggs called nits that stick to the hair shaft by a thick glue substance secreted by the lice. Nits are yellow, white, or brown in color. Nits can look like dandruff.

A good way to tell the difference between a nit and dandruff is to blow on them. Nits will not move.

WHY DO LICE MAKE MY CHILDS HEAD SO ITCHY?

Lice survive by sucking blood from your scalp. Their saliva causes a skin sensitivity that makes your child itch.

CAN LICE MAKE MY CHILD SICK?

No! Lice are not a health hazard. They are not caused by uncleanliness and they do not spread diseases.

HOW DID MY CHILD GET LICE?

Lice cannot jump or fly, they crawl. The only way to get lice is by direct contact with the head of person who has them or indirectly through items that have been in direct contact with an infested persons head like combs, brushes ,hats, towels, or bedding.

If your child has lice you should wash in hot water all bedding and clothing that have been in contact with your child in the 24 to 48 hours prior to treatment and vacuum well around the bed and floor. Items you cannot wash can be tied up in plastic bags for 2 weeks by which time any nits would have hatched and the lice would have died without a food source. I would also recommend vacuuming car seats.

Do not use Pediculicide sprays on these items as these can be harmful to your health Soak all combs, brushes and barrettes in hot water for 15 minutes. Remember lice can only live off humans for 24 hours and nits are not viable away from the warm environment human heads provide.

HOW DO I KiLL THEM!!??!!

This is where it gets tricky. To effectively eradicate the lice you have to kill the live lice and damage the nits so that they will not hatch. There are many ways to treat lice from medicated shampoos (Pediculicides) to homeopathic remedies. Letʼs look at the Pros and Cons.

MEDICATED SHAMPOOS (PEDICULICIDES)

Pyrethrins and Permethrin 1%( better known as RID and NIX) are neurotoxic to lice but have low mammalian toxicity. This means these chemicals work by destroying the lice’s nervous system but will not affect your child’s nervous system.Because newly laid nits do not have nervous systems they are not 100% effective against the nits. Approximately 20-30% remain viable which is why you have to repeat treatment in 7-10 days. (Nix leaves a residue on the hair that is supposed to kill the newly hatched lice from that 20% but they still advise retreatment if visible lice in 7-10 days).

Pros: Pretty effective if used properly with second treatment. These products are over the counter and easy to use.

Cons: Contains neurotoxins. Can get expensive with re-treatments. Some concerns that lice are developing resistance.

NEWER PRESCRIPTION TREATMENTS

Malathion (OVIDE). This is a topical lotion applied to your child’s dry hair. You leave it on 8 hours and then wash his or her hair. It works by killing lice and some nits.

Pros: Extremely active against live lice and nits.

Cons: Expensive and requires a prescription. Has a high alcohol content which makes it extremely flammable. Do not use hair dryer or  curling iron or flat iron around your child when this product is in their  hair and stay away from open flames. This medicine is also dangerous if accidentally ingested as it can stop your child’s breathing.

Ulesfia (Benzoyl alcohol lotion). This is applied topically to dry scalp and hair, left on for 10 minutes and then rinsed off.

Pros: Short duration of treatment. Kills lice.

Cons: Recommend repeat in 7 days as it does not kill nits. Nit combing recommended. Can be irritating to skin.

OCCLUSIVE AGENTS

Yes, Grandma was right, you can use Mayonnaise to get rid of Lice. Other products like Olive oils, petroleum jelly, and Pomades have all been used to essentially smother the lice. They do not kill the nits.

Pros: Inexpensive. No toxicity. Usually on your kitchen or bathroom shelf.

Cons: Messy. Does not always kill all lice and may require multiple treatments. Requires extensive nit combing for removal of nits.

Nuvo method : As described by Dr. Dale Pearlman, involves covering head with Cetaphil face cleanser, blow drying completely, then waiting at least 8 hours before shampooing. Essentially, this shrink wraps the hair and smothers the lice. He recommends repeating weekly for a total of 3 treatments.

 Pros : Over the counter product and inexpensive. If followed weekly is effective.

Cons: Very messy and time consuming. Does not kill nits, so nit combing may be indicated.

DO I HAVE TO TREAT THE WHOLE FAMILY?

No. Only treat family members with visible lice or nits visible within 3/8in of the scalp.

WHAT ABOUT THE NITS? DO I HAVE TO REMOVE THEM? CAN MY CHILD GO TO SCHOOL WITH NITS?

Let’s talk nits! Before you start envisioning yourself as Sigourney Weaver in Aliens surrounded by eggs ready to hatch, remember only LIVE LICE cause an infestation so it is NOT necessary to remove nits AFTER treatments that kill the lice! In fact, the American Academy of Pediatrics and the National Association of School Nurses has discouraged schools from having “No Nit” policies.

So you do not HAVE to remove the nits but many Pediatricians, including myself, encourage nit combing for the following reasons:

  1.  Removing nits that are located within 3/8 inch of the scalp helps minimize the risk of re-infestation.
  2. Nit combing to remove possibly viable nits can decrease the possibility of unnecessary re-treatments.
  3. Removing damaged nits can help minimize confusion regarding reinfection. In other words, when people look at your kiddo and see nits they think she has lice. Removing the nits can help minimize everyoneʼs anxiety.

Some products are available that claim to help loosen nits but according to the American Academy of Pediatrics policy statement on lice these products show “no clinical benefit.”

HOW DO I PREVENT MY CHILD FROM GETTING LICE?

Encourage your child to not share combs, hats, brushes with others. In winter seasons, instruct your kids to store their hats and coats separate from others. Tell them to place their coat or hat in their back pack or school bag if they do not have individual lockers or cubby spaces.

When your kids go to the pool or camp, instruct them to keep their towels separate from their friends towels.

If your kids play a sport where they need helmets, for example batting helmets in baseball, have them wear their own.

If you hear there is a lice outbreak at your childʼs school, STAY CALM! You are now a lice expert and can easily handle this crisis. Remember the parent motto …Never let your kids see you SWEAT…or in this case ITCH!

Sandra C. Peak MD

Sandra Peak, M.D.,  joined Cook Childrens Physician Network in Lewisville in 2004. Dr. Peak enjoys gardening, yoga, and boating and in her spare time can be found at the lake with her husband Jay, stepson Sage and the world’s most amazing Lab, Sugar Mae.

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