Wellness: Lice – A Real Head Scratcher

Lice do not reflect lack of cleanliness or hygiene -- they are as happy to live on a sparkly clean scalp as one that hasn't bathed for a week.What should you do if your child comes home with this uninvited guest?
By Julie Davis, M.D.

After a summer of sleepovers, overnight camps and days at the beach, September brings not only the start of school but also — sometimes — the ever dreaded lice outbreaks. If you see evidence of lice on your child, don’t panic! There are good treatments for lice.

Lice are small mites that live on the scalp and cause itching as the child develops sensitivity to them. They lay their eggs (nits) on the hair shafts. Most commonly, they spread from person to person by close contact of heads, sharing hats, hair brushes or hair ties.

Got Lice?

If you suspect that your children have lice because they are scratching their heads or have had contact with others with lice, take a close look at their scalps. Lice are a whitish-grey sesame-seed sized mite that is usually found on the scalp or hair close to the scalp, often behind the ears or at the base of the back of the head. Nits look like little white pieces of sand or sugar but are well attached to the hair and don’t just flake off.

Start at the Top

First, wash the hair with an over-the-counter shampoo that contains permethrin and/or pyrethrins, commonly available as Rid or Nix. When you purchase the shampoo, get a good nit comb, too, ideally metal. Scrub the hair and scalp for 15 minutes or as directed. Remember, lice live on the scalp, so every inch of it must be scrubbed to be well-treated. Because these products may cause skin irritation, rinse the hair in a sink to minimize contact with skin.

A Labor of Love

After rinsing out the shampoo, comb every single strand of hair at least a few times, wiping the nits off on a tissue in between each stroke. A good cream rinse/conditioner will allow the comb to pass easily. It works best to comb one small section of scalp at a time, like when getting a haircut. There are nit cream rinses that help loosen the nits on the hair, but vinegar also works well.

One Day at a Time

Comb again daily for at least 3 or 4 days until there are no nits on the comb and there are no nits or lice seen on the scalp. If you find any live lice, treat with the shampoo again. This process is a labor of love. It could take an hour or more if you are doing it thoroughly, especially if your child has long or thick hair.

Look Around

Consider treating anyone who shares a bed with your child. For other family members, it is okay to just carefully look at their scalps and treat only if lice or nits show up. Wash sheets, towels and clothes in the hottest water possible to kill the lice. Place items that cannot be machine washed in hot water — things like blankets, stuffed animals and headphones — in sealed plastic bags for three weeks. This should kill any nits and lice on these objects. Vacuum floors and furniture where possible to remove lice; permethrin sprays in the house are not necessary.

When to Call the Doctor

Most cases of lice will be cured with this regimen. Occasionally lice are resistant to permethrin shampoos but most of the treatment failures are from not getting all the nits out. If you keep combing out live lice several days after what seems like adequate treatment, call your doctor as there are other prescription lice treatments available.

If you experience this parenting rite of passage, keep in mind that lice do not reflect lack of cleanliness or hygiene — they are as happy to live on a sparkly clean scalp as one that hasn’t bathed for a week.

Lousy Myths
  • Shaving the head has not been shown to get rid of lice; it just makes treatment easier.
  • Children with lice do not need to stay home from school.
  • Oily household products like Vaseline, butter and olive oil have not been shown to suffocate lice.
  • Do not use flammable products like gasoline or kerosene as they are dangerous and not effective.
An Ounce of Prevention
  • Encourage your child not to share hats, helmets, brushes, barrettes, hair bands, or headphones with other kids, especially during known lice outbreaks.
  • Keep long hair tied back or braided to help prevent hair-to-hair contact.

Julie Davis, M.D., is a family physician at White River Family Practice in White River Junction, Vt. She lives in Lyme, N.H., where she enjoys playing outside with her husband and two kids.

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