Lice Happens. Follow These Treatment & Prevention Tips

Discovering or learning your child’s head has lice can be a horrifying moment for any parent or caregiver. But the truth is, you and your child are in good company. The Centers for Disease Control and Prevention (CDC) estimates that anywhere between 6 million and 12 million children between the ages of 3 and 11 are infected each year. That is a lot of itching and scratching.

Now that we have established lice are nothing to be embarrassed about, let’s get to what to do about it.

The first step in treating head lice is to confirm their presence. You want to carefully inspect your child's scalp and hair for three things: nits, nymphs and adult lice.

Nits are eggs lice attach to the hair shaft close to the scalp. Very tiny in size—think a grain of salt—they’re tan or yellowish white in color and may be mistaken for dandruff. However, if it can’t be easily brushed off the hair shaft, it’s likely a nit.

CAPTION: Lice eggs, also known as nits

Immature lice, or nymphs, are tan or gray in color and about the size of a pinhead. Because they feed on blood, they’re found directly on the scalp.

Adult lice are roughly the size of a sesame seed and tan and gray in color. Armed with six legs, they can move very quickly along the scalp where they feed on blood.

CAPTION: Adult lice

You may find it helpful to use a flashlight to do a thorough inspection. Work slowly and focus on the scalp and hair shaft close to the scalp. Often, it is easier to feel nits than see them so be sure to run your fingers along the hair as you go.

If you spot nits, nymphs or lice, you have several treatment options:

1. Over-the-counter treatments: Drug stores and many grocery stores carry shampoos containing permethrin that are effective at killing lice. Before using, wrap the child’s neck and shoulders in a towel to prevent clothing from becoming wet or stained. Follow the instructions carefully, and do not use more than recommended. If you are working on hair that’s shoulder-length or longer, you may need two packages of shampoo. Again, follow the instructions regarding how long to leave it on the hair, and how to wash it out.
2. Manual removal: Use a fine-toothed nit comb to remove lice and nits. (NOTE: Lice removal combs are readily available online and in many drug stores.) While combing can be time-consuming, it is very effective for removing nits and ending the lice life cycle.
3. Prescription medications: If these treatments are not effective, your doctor may prescribe benzyl alcohol to use on the hair and scalp.  It’s important to note that benzyl alcohol will not kill lice eggs, so it must be used a second time to kill any lice that may hatch from eggs on the hair. In addition, it should not be used on children less than 6 months of age.

While head lice do not survive long if they fall off a person and cannot feed, there are steps you can take to help avoid re–infestation:

1. Machine wash and dry clothes, beddings, and items—including hats, backpacks and car seat covers—used by the infested person in the two days before treatment. Use hot water for washing and high heat drying. If that is not an option, seal items in a plastic bag for two weeks.
2. Soak any combs and brushes used for treatment or by the infested person in the two days preceding treatment in hot water (at least 130°F) for 10 minutes.
3. Vacuum upholstered furniture and floors frequented by the infested person.  

To avoid reliving the joy of head lice in the future, teach your child the following lice-safe practices:

• Don’t share clothing such as hats, helmets, hair ribbons, scrunchies, barrettes, scarves, hoodies, coats, or sports uniforms
• Don’t share combs, brushes, or towels
• Don’t share pillows or bedding at sleepovers
• Avoid hair-to-hair contact during play

Again, millions of kids get head lice every year. But with prompt treatment and prevention measures, you can manage and prevent head lice infestations. 

Emily Rice M,S. PA-C is a physician assistant that works at Southwestern Vermont Medical Center in the Pediatrics office.