Head Lice Treatments

The most common symptom of children infected with head lice is itching, although some children might not complain of itching if they have a light infestation.

Adult lice are reddish-brown and 1/16 of an inch long. They move very fast and are most commonly seen at the back of the neck and behind the ears. Lice can only survive for two to three days when off of the human body. Nits are eggs from the adult lice and are whitish and are firmly attached to hairs. The eggs hatch in 8-9 days and it then takes another 9-12 days for the lice to mature and be able to reproduce themselves, completing the lice life cycle.

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Although many schools and day care centers have no-nit policies, just because your child has nits doesn't necessarily mean that he has a lice infestation. Even after nits hatch, the empty egg casing can stay on the hair for a long time and it is hard to tell the difference between a nit with a live louse embryo in it, which can be infectious, and an empty one. Nits are more likely to contain a live embryo if they are close to the scalp.

So what do you do if you see nits? First, do a thorough check of your child's hair and scalp to look for live lice. If you don't see any, then you may be able to just remove the nits and continue to look for live lice. Since most of the anti-lice medications are not ovicidal, meaning they don't kill the eggs, treating a child with just nits may not be helpful.

A prescription shampoo, such as Ovide (malathion) or Lindane, may be needed for resistant lice. Ovide is lathered into dry hair and left on overnight. It should not be used in newborns or infants, and be careful, because it is flammable!

Ulesfia (Benzyl alcohol 5%) is the latest treatment that has been approved to treat lice. Unlike most other lice treatments, Ulesfia is not a pestacide, and instead works by smothering head lice. It can be used to treat children as young as six months of age.

Use a regular comb or brush and hair clips to remove tangles and separate your child's hair into sections. Now use your lice comb and go through each section of hair from the scalp to the end of the hair, removing all of the lice and their nits (lice eggs). After finishing each section, search again for any lice that you may have missed and remove them.

It is important that you now check your child's hair every night until all of the lice and nits have been removed. Sit your child in the bathtub and comb their hair out with a regular comb. Check the scalp thoroughly and remove all lice (alive or dead) that you find. Next, use your lice comb again and go through each section of hair until all nits have been removed.

For lice in eyelashes, apply Vaseline to the eyelashes twice a day for a week to kill them.

• Wash all bedding and recently worn clothing in hot water (130º) and dry in a hot dryer.
• Soak combs/brushes in hot water for 10 minutes.
• Vacuum to remove all lice and hairs with attached nits from furniture, rugs, stuffed animals and car seats. Place items that can not be washed or vacuumed into plastic bags for two weeks.
• Change your child's sheets and pillowcases every night for a week and wash in hot water.

Keep in mind that the American Academy of Pediatrics now states that 'only items that have been in contact with the head of the person with infestation in the 24 to 48 hours before treatment should be considered for cleaning' and that bagging items that you can't clean is 'rarely necessary.'

See the site www.headlice.org for more info.

Some physicians are using oral therapies to deal with resistant lice, including the drug ivermetim (a one time dose) and the antibiotic Bactrim (3 day course). Off label use of other medications, such as Elimite and Eurax, are other lice treatments that some pediatricians try.

After treatment, if you continue to see nits, but no live lice, then that may not really be a treatment failure. Nits, even when empty, can stay attached to the hair for a long time. Continue checking your child's hair and scalp daily to remove nits until they are all gone.

• Be patient. This is a frustrating problem, but isn't dangerous. Lice don't transmit any diseases.
• Check your children for head lice regularly and teach them to not share combs, brushes or hats.
• Avoid using head lice sprays, pesticides, gasoline or other non-approved products on your child. These can be deadly!
• Call your pediatrician if your child's lice infestation has not resolved in 1-2 weeks or if his scalp has a rash that is infected with pus or honey colored scabs.
• The American Academy of Pediatrics, in their latest clinical report about head lice, states that 'no healthy child should be excluded from or allowed to miss school time because of head lice.'
  

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