By Jennifer Seawell, MD, FAAP
It’s the phone call from the school nurse we all dread. I’m sorry Ms. ____, but little Suzy has head lice. Our hearts drop. Life will never be the same. At least not for the next few days. Our heads spin with the task in front of us. After all, there are about 100,000 hairs on the human head. And depending on how long the infestation has been going on, there could be hundreds to even thousands of tiny little sand-sized nits hiding in that forest of hair. And the idea of bugs in our kids hair is just plain gross. It’s a daunting task for sure.
So that you know
In case your head has already gone to the bad place, let me take this opportunity to set things straight. You are not a bad parent because your child has head lice. You have not failed to instill proper hygiene habits. True, your kid might be gross. But their inherent grossness (or lack thereof) does not make them get lice. Head lice can infect any kid, from any home, in any neighborhood, and at any school. So set the judging of yourself aside, you’re all good.
How do you get head lice?
Head lice are spread by head to head contact. Contrary to popular opinion, they don’t jump. Which is great for those of us imagining the little suckers hopping from head to head at the kitchen table. I tried to talk my artsy teen into drawing us a picture of this imaginary scenario, but she unfortunately declined.
They can spread as our sweet kiddos are bent over a puzzle or game with their heads touching. Or by sharing a pillow at a sleepover. And by bear hugs with an infested friend. Basically, any activity that results in 2 heads touching is a risk factor.
Although you theoretically can get lice from sharing hats or combs and brushes, this is not nearly as common as we all worry about. Luckily for all of us, lice cannot live long without a human host, and only contact with a live louse can cause an infestation.
So change those sheets and wash those blankets. But don’t stress. Even if you don’t fumigate the entire house, you can totally gain control of the situation.
How do you know if your child has head lice?
The best way to tell if your child has head lice is to find live lice in their hair. But this can be trickier than it sounds. An adult louse is the size of a sesame seed. It is super talented at blending into the hair and can move very quickly avoiding light. If you find any live lice in your child’s hair you can be sure they have an active infestation.
If you are unable to find any live lice, you are not necessarily in the clear. Look for tiny nits stuck to the hair shaft close to the scalp. They are usually tan/white and oval. But the big thing is that they are glued to the hair shaft. Unlike dandruff which makes flakes that you can brush out easily, the louse nit is practically super-glued on. Finding nits within 1/4 inch of the scalp indicates an active lice infestation.
Fine, my kid has lice. Now what?
Now that you’ve identified the problem, it’s time to take charge and remedy the situation. There are chemical and non-chemical methods for removing lice.
Non-chemical lice removal
You can effectively end a lice infestation by removing all live lice and nits from your child’s hair. It is tedious for sure, but definitely possible. Invest in a good lice comb and a soft pillow for your rear. If your eyes are not young enough to handle the job, consider purchasing a lighted magnifier lamp. I might have asked my husband to pick one of these up for me recently… They can be found anywhere, but this is the kind I’m talking about..
If you’re not up for the job and you want to try a non-medication approach, there may be a specialty clinic in the area that caters to lice removal. Some places will even travel to your home! These centers tend to be pricey, but can be a good option for those completely weirded out by tiny little 6-legged insects using your child’s head as a jungle gym.
Another option for removing nits is a product by Fairy Tales called Lice Good-Bye. It was originally recommended to me by a friend and I had stashed some away for our eventual downfall. After trying more than one lice comb to no avail, I pulled this out. Worked like a charm. And although I cannot attest to how effective it is for everyone, it worked great for the nits in my fine-haired kid. There are probably many other products that work just as well. Don’t be afraid to experiment at bit.
Chemical lice removal
There are quite a few different medicines designed to kill head lice. They can be divided into non-prescription and prescription options. Different medicines are designed for different ages. Some act just on the lice and others kill the lice and the nits.
Over the Counter
- Permethrin (Nix): This is an over the counter lice treatment that kills live lice. It is safe in all kids older than 2 months old. Downside to permethrin is that it only kills live lice. It does not kill live eggs. Retreating 7-10 days later is necessary.
- Pyrethrum (Rid): This is an over the counter lice treatment that kills live lice. It is safe in kids over 2 years old. Downside to pyrethrum is that it only kills live lice. It does not kill live eggs. Retreating 7-10 days later is necessary.
- Spinosad (Natroba): This is a prescription only lice treatment that kills both live lice AND live nits. Any nits present after treatment are still gross, but are not alive and will not spread to others. Retreating is only necessary if live bugs are still seen 7 days after initial application. It is safe in kiddos over 6 months of age.
- Ivermectin (Sklice): This is a prescription only lice treatment that kills live lice. It does not kill louse eggs, but does kill newly hatched nymphs. It is safe in kids older than 6 months of age. Ivermectin generally only requires one treatment.
- Malathion (Ovide): This is a prescription only lice treatment that kills live lice and some (not all) louse eggs. It can be used in kiddos 6 years and older. Because all the eggs are not killed, retreating is recommended 7-10 days after initial application. Malathion is more likely than others to cause skin irritation.
- Benzyl alcohol (Ulesfia): This is a prescription only lice treatment that kills live lice only. It does not affect louse eggs. It can be used in kiddos 6 months and older. Retreating is necessary 7-10 days after initial application. Benzyl products also can cause skin irritation.
Household control measures
As I alluded to earlier, lice can’t live all that long away from their human host. So disinfecting the entire house is really not necessary. There are however, a few things you need to do to control the situation.
1. Check the rest of the members of your family
If you want to get off this super fun roller coaster, you need to make sure no one else in the family is infested. Siblings are great at spreading lice between each other and it’s not that uncommon for the entire family to be infested. Take this opportunity to inspect everyone and treat who needs to be treated. Much better to have a few rough days than continue on the lice train indefinitely.
2. Let your kid’s parental contacts know
I know it’s not something any of us want to admit, but it’s time to have the talk of shame. Let your kiddo’s teacher know that they’ve had and been treated for lice so the other families can check out their kids. After all, they could have picked it up from school. And you probably don’t want to go through all of this again in a couple of weeks. Do yourself a favor and come clean.
3. Pay attention to frequently used linens
Although you certainly don’t have to disinfect everything, live lice or nits could be hanging out in frequently used pillows and blankets. If these items are machine washable, washing at 130 degrees should kill off any survivors. If machine washing isn’t an option, just bag the offending linens/items to resist temptation and hide them away for 2-3 days. After that time has passed, you can put them back into daily use.
4. Put down the fumigating spray
Lice are gross, but they’re not hanging around everywhere. You do not need to fumigate the house. Treat those infested, hide away or clean the frequently used linens, and let close contacts know and you’ll be fine.
You’ve made it! By the time you reach lice age, you’ve probably already made it thru being peed and pooped on. And by now you’ve probably already caught vomit with your bare hands and used your own sleeve to wipe a snotty nose. This is just one more of the fun parenting milestones. And it too shall pass. You’ve got this.
If you want to read more about lice, check out the following sites..
- American Academy of Dermatology: Overview. This one also has a great picture of adult lice.