A Step-by-Step Guide to Lice
Head lice are tiny little bugs (about the size of a sesame seed) that can cause huge headaches for families — they are common in preschool and elementary school aged children. Dealing with them can be pesky, but please know that they aren’t dangerous — you and your kids can get through it!
what to know
Head lice (singular term: louse) are small little bugs that feed off of blood from our scalp. They lay and attach their eggs to hair on the scalp. These eggs, and their casings, are called ‘nits’. Nits attach to each hair with a sticky substance that holds them in place tight along individual hairs (and they stay attached after the eggs hatch). Nits are tiny — think of a small knot on a thread — and look similar to dandruff.
How do kids get lice? Lice are crawling insects — they can’t fly or jump. Typically, they spread from close and prolonged contact. This is why it’s common in classroom or daycare settings. They can also (though less often) spread by sharing things like brushes, combs, or hats.
what you’ll see
The most common symptoms you’ll notice is your child scratching their scalp. The body starts to itch after our scalp becomes sensitive to lice’s saliva, so this can actually take time — it might be 4-6 weeks after lice get on the scalp. Since it’s a reaction in the body to saliva (not just to the active lice themselves), that itchy feeling can also last for weeks after lice are gone.
Most kids scratch around the back of their neck and behind their ears.
how to check for lice
If you notice these symptoms or hear about an exposure in your child’s care setting, here’s how to check for lice. You’re looking for nits, which are small whitish or yellow specks that will be firmly attached to the hair near the scalp. Live lice are hard to find, because they avoid light and move fast. Focus on the back of the ears and nape of the neck.
Wet your child’s hair. You can apply conditioner to the scalp, which can help you sort through and look for nits more easily.
Make sure you’re in a brightly lit room.
Use a fine tooth comb — this is one that I’ve used a lot and like — and search the scalp section by section. You’re looking for small white dots; if you’re wondering if they are dandruff or nits, remember that nits are firmly attached to the hair, where dandruff falls away easily from the hair.
If you find something, you can also take a photo and share with your care team if you have questions.
what to do
There are a few options for treating head lice - talk with your care team about what makes the most sense for your child and your family. You also want to make sure to confirm that it is lice before considering any treatment. Studies show that the best options for treatment are medications (there are prescriptions and over-the-counter options). Research shows that home remedies like essential oils, mayonnaise, petroleum jellies don’t always work reliably. You can also do the comb-out method (see below) every 2-3 days for the next 2-3 weeks can help to get rid of nits after treatment (It doesn’t always work on its own to get rid of lice, but you can certainly try it and see how it goes if you would like).
Here is a list of the medication options approved for lice treatment:
Permethrin lotion 1% (also called: Nix, Elimite, Acticin). Approved for kids 2 months and older. Over the counter. Kills lice not eggs. You apply it to towel-dried hair after shampooing and rinse off after 10 minutes, and you may need to treat again on days 9-10 if you see live lice again.
Pyrethrin-based shampoo or mousse (also called RID, Triple X, Licide). Approved for kids 2 years and older. Over the counter. Kills lice not eggs. Apply to dry hair and rinse off after 10 minutes. You treat again on days 9-10.
Ivermectin lotion 0.5% (also called Sklice). Approved for kids 6 months and older. Over the counter. Kills lice not eggs but prevents newly hatched lice from living. Apply to dry hair and rinse off after 10 minutes. Apply once. There is an oral formulation of ivermectin in case topical treatments have all failed.
Malathion lotion 0.5% (also called Ovide). Approved for kids 6 years and older. Prescription. Kills lice AND eggs, but has a strong odor and is flammable. Apply to hair and rinse off after 8-12 hours. You treat again on days 7-9 if live lice are seen.
Spinosad topical suspension 0.9% (also called Natroba). Approved for kids 6 months and older. Prescription. Kills lice and lice eggs. Apply to dry hair and rinse off after 10 minutes. Second treatment on day 7 if live lice are seen.
*Always rinse off your child’s hair in a sink (so that the medicine doesn’t run off onto other parts of their body in the bath). Make sure to keep medicine in a safe place, locked away and away from children’s reach.
Here’s how to do the comb-out method: Wet your child’s hair. Using a fine tooth comb, comb through your child’s hair in small sections. After each combing, wipe the comb on a wet paper towel. Look at the scalp, comb, and paper towel carefully for any nits.
Also, make sure that you do these things along with your child’s treatment.
Laundry. If they were used within 2 days before head lice were found, wash your child’s clothes, towels, linens, and hats in hot water. Dry on high heat.
Stuffies/loveys that may have touched your child’s head. If you can wash them in hot water, do that. If you can’t wash them, seal them in a plastic bag for 2 weeks.
Soak hair items (combs, hair bows or ties, etc.) in hot water or throw them away.
Vacuum carpets and upholstered furniture in your home and care, and throw away the cleaner bag.
Check all family/household members for head lice as well every few days.
when to seek help
if your child’s symptoms are getting worse and bothering them, despite the care above
if you still see lice 2 weeks after treatment (some nits may be left behind, but live lice should not)
if there are any signs of infection from scratching — bumps, pus-filled bumps, redness, pain, etc.
with any questions or concerns
Treating lice can feel like a lot, because it takes time and work. But you can do this, you’ll do just great. And your family will get through it!