They're tiny, wingless, parasitic insects that live on the scalp and suck blood, causing severe itching. The good news is that head lice are more of a nuisance than a real threat to your child's health.

There's a good chance a preschool teacher or elementary-school nurse will call with the bad news. But you can watch your child for frequent scratching, often the first sign of infestation. If your child scratches a lot, especially around the back of the head or the ears, check for lice immediately.

Lice aren't easy to see: the bugs take on the color of the hair they're hiding in. In fact, you may never see a louse. It's common to discover an infestation of head lice based on lice eggs (nits) alone. Nits are also tiny -- about the size of sesame seeds -- and creamy off-white or pearly white in color. It's easy to confuse nits with dandruff, but nits are attached to the hair shaft with a cement-like glue, not loose like dandruff.

Probably from a classmate or a friend or from shared clothes, such as a cap or a baseball helmet. It's a myth that lice are a product of poor hygiene or poverty. In fact, head lice are remarkably egalitarian and can spread and flourish even in the wealthiest communities.

Because lice travel easily from one head to another, getting rid of lice and nits right away prevents them from spreading to other family members, allows your child to go back to school quickly, and put your family routine back on track. Many schools have a "no nits" policy, requiring children to stay home if they have nits.

Most people turn immediately to commercially available lice, or pediculicide, shampoos. The treatment of choice is an over-the-counter lice shampoo with permethrin or pyrethrin. Doctors usually recommend a product containing permethrin (called Nix). Permethrin is a synthetic form of pyrethrin, which is derived from chrysanthemums. Other commonly used brands contain pyrethrin in combination with piperonyl butoxide; brand names include A200, Pronto, and Rid.

Avoid products containing lindane for children under 3. This highly toxic insecticide has been linked, in rare cases, to convulsions and brain damage in children; lice are often resistant to lindane as well. For these reasons, most experts recommend over-the-counter lice shampoos containing permethrin or pyrethrin.

Although lice shampoos used to offer desperate parents ready relief, an increasing number of parents say lice are no longer responding. The National Pediculosis Association fields as many as 50 calls a day reporting that shampoos have had no effect, and recent studies appear to document a rise in pesticide-tolerant lice. Over-the-counter shampoos, which contain only 1 percent permethrin, may no longer be strong enough. Some experts recommend asking your doctor to prescribe a 5 percent dose of permethrin, since permethrin still works at higher concentrations.

Keep in mind that shampooing alone is unlikely to rid your child of lice. In fact, recently the Federal Trade Commission censured the makers of several commercial lice shampoos for false and misleading advertising. The companies claimed their shampoos were 100-percent effective with only one application. To ensure your child remains free of lice and nits, you must remove ALL the nits and follow up with a second shampoo treatment seven to ten days after the first.

Here are the three basic steps:

1. Shampoo your child's hair with a fairly strong shampoo, such as Prell, to remove oil and styling products that might be coating the hair before using the lice remedy. Don't use conditioner, it also coats hair and protects the pests.

2. Let hair dry, then apply the lice shampoo. The instructions on the label will tell you how long to leave it in. Some doctors and school nurses recommend leaving the shampoo in for several hours or even overnight, but experts say there's no evidence that longer exposure makes lice shampoos more effective. It's important to remember that these shampoos contain pesticides and should be used sparingly.

3. Rinse out the lice shampoo and towel-dry hair. Again, avoid using a conditioner, especially after shampooing with Nix. (It has some residual action, and conditioners interfere with that.)

Some are okay, but never use a home remedy that calls for putting gasoline or malathion in your child's hair; both are extremely dangerous. If you want to avoid the insecticides in commercial lice shampoos, many experts recommend treating lice with an overnight application of Vaseline, which is said to suffocate the pesky bugs.

That sounds hideously messy and it is. But in areas where lice are reported to be pesticide-resistant, the "Schachner Shampoo" (named after the doctor who first recommended it) is said to be very effective.

To use this method, carefully coat all your child's hair with Vaseline. Have your child sleep in a swim cap.

To remove the Vaseline (no, it isn't easy), use a grease-cutting liquid dishwasher detergent. Don't use talcum powder, baby powder, or any other powder to absorb the Vaseline; it doesn't work and can be dangerous to a child's vision and breathing.

You have to get rid of the nits, too. Why do experts call this the all-important step? It's a simple equation: Each remaining nit will hatch a new round of lice, making it crucial to break that maddening cycle.

There are many remedies -- from commercial products to vinegar -- suggested for dissolving the "glue" that attaches the nit to the hair. You're welcome to try them, but the solution that works best is the most labor-intensive: removing the nits by hand.

Here are some suggestions for making the nit-picking task less daunting:

•Lighten up. Bright sunlight is by far the best for your search; indoors, use a bright light such as a clip-on desk lamp that you can move close to your child's head.

•Magnify the problem. Give your vision a boost with an inexpensive pair of magnifying reading glasses from your local drugstore; they'll double the effectiveness of your check.

•Divide and conquer. Use hairclips to section hair and go through it strand by strand, sliding each nit off with your fingers or using nail scissors to cut the nit-bearing hair close to the scalp. Drop it in a bowl of water. Pour the water down the drain when you're done.

•Use a good comb. Plastic lice combs are less effective than metal, but the tiniest-toothed flea-style combs are painful for all involved. The National Pediculosis Association (NPA) recently began selling a comb called the LiceMeister, designed according to the latest research. With rounded teeth nearly twice as long as other lice combs, it gets all the way through thick hair but doesn't pull as miserably. (You can order one from the NPA by calling (866) 323-5465.)

•Give nits the slip. Studies haven't proved that oils suffocate any leftover lice, but experts say there's little doubt that soaking the hair in olive oil, coconut oil, or an oil-based product makes it much easier to comb the nits out.

•Nit-pick daily. Check for nits and lice daily until your child has passed an all-clear inspection. This may take up to two weeks. The NPA advises using the LiceMeister regularly to screen for lice and nits as a preventive measure. Note: Nits that you find more than two to three inches away from the scalp are usually empty shells.

•Make a clean sweep. Rid your home of any lice that have dropped off your infested child. Each hardy louse, which can live up to 48 hours off a host, can reinfect your child -- or find a new host.

•Vacuum each room thoroughly, and wash all linens, towels, and clothes your child has recently worn in hot water (130 degrees Farenheit for 20 minutes). (Afterwards, return your water heater to 120 degrees; that's the safest way to prevent scalding-water burns in children.) An alternative to washing all your clothes and linens is simply to put them in a large, sealed plastic bag for 10 days; deprived of humans to feast on, the lice will die. Put all combs, brushes, and hair accessories in hot soapy water and let them soak overnight. Don't forget the car: Vacuum your child's seat and headrest. There's no need to use lice sprays; experts say they can expose your child to too much insecticide.

•Be persistent, and beware of stopping treatment too soon. In lice-prone areas, it's common to hear parents say their child has been repeatedly reinfested. In many cases, however, the lice were not completely eradicated the first time around. Remember, just a few overlooked nits can start a new generation of lice. Keep checking your child's head daily until you're sure the pests are gone; then check weekly to make sure your child hasn't picked up more unwanted pests. If your child continues to suffer from lice after repeated treatments, your pediatrician may give your child an oral medication to help eradicate them.

-- Melanie Haiken, M.A., is the former health editor of Parenting magazine. An independent journalist specializing in health, business, and parenting issues, she has served as managing editor of BabyCenter and of San Francisco magazine and as executive editor of an Industry Standard magazine, and has written for Time Inc. Health, The Washington Post, and many other publications.

Further Resources

Robert H. Pantell M.D., James F. Fries M.D., Donald M. Vickery M.D., Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care. Perseus Books Publishing, L.L.C.: 1999.

References

First published July 19, 1999
Last updated June 28, 2007
Copyright © 1999 Consumer Health Interactive

Or Find More On:

Back to top of page