• Treating Head Lice

    IMAGE Preschool and elementary school children and their families are among those at the greatest risk of exposure to head lice. Girls get head lice more often than boys and women more than men. Head lice is most often found on the scalp behind the ears and near the neckline at the back of the neck. The lice hold onto hair with the hook-like claws they have at the ends of each of their six legs.

    The Signs

    How do you know if your child has head lice? These signs are a good indication:
    • Feeling of tickling or crawling in hair
    • Itching or scratching
    • Irritability, especially at night
    • Sores on the head due to scratching
    • Eggs or lice seen in the hair

    Where Do the Little Critters Come From?

    The most common causes of head lice include:
    • Having contact with an already infested person during play at school or home
    • Using infested combs, brushes, or towels
    • Lying on a bed, couch, pillow, carpet, or stuffed animal that has recently been in contact with an infested person

    No School?

    Generally, it is not necessary to miss school since it is not likely to spread in a classroom setting. Each district may have its own policies however, so check with officials before sending your child to school.

    How to Get Rid of the Little Critters

    When you find head lice, spring into action as quickly as you can. Your first priority should be to get rid of lice eggs, called nits, in order to end the life cycle.


    If your doctor recommends a shampoo, follow the directions carefully. Then wash all bedding and clothing in hot water and dry them in a dryer using high heat. Vacuum floors, beds, chairs, car seats, and headrests—any place that the person with lice has been. Soak combs and brushes in hot water for 5-10 minutes.


    It is important to use appropriate products to treat lice.
    Examples of medications used to treat head lice include:
    • Over-the-counter products, such as those containing pyrethrin or permethrin
    • Prescription products, such as lindane and malathione—These may be prescribed because some cases of head lice are resistant to pyrethrin and permethrin.
    Using Caution With Lindane
    The Food and Drug Administration (FDA) includes a warning on prescription shampoos and lotions containing lindane because, in rare cases, it can cause serious side effects, including seizure and death. Those especially at risk include:
    • Infants
    • Young children
    • Elderly
    • People weighing less than 110 pounds
    • People with certain skin conditions


    A fine-toothed comb designed to capture and remove the lice and nits often comes with the medicated shampoo. A lice comb is essential for lice detection and removal. The teeth of the comb should be long and tapered and set so close that combing removes virtually all lice and nits. This comb can be used to check for the presence of the lice after treatment

    Beware Unproven Treatments

    Herbal Remedies

    There are many unproven head lice remedies. The biggest problem with using these herbs is that if they do not work, the head lice population can increase unchecked, worsening the infestation and associated symptoms. Further, they are not regulated by the FDA.
    Some herbal remedies, though, have shown to be effective in clinical trials. An example is a spray that contains coconut oil and anise. If you are unsure of which product to use, talk to your doctor.

    Other Treatments

    Others are experimenting with suffocating the head lice by covering the hair with vasoline, mayonnaise or olive oil and wrapping the head in plastic wrap overnight. There is no evidence that these methods work either. Though the multiple shampooing required to remove the oil from the hair may help with removal it can also irritate an already itchy head.

    Tips for Preventing Head Lice

    There are ways to prevent getting head lice. Some steps you can take include the following:
    • Avoid hair-to-hair contact
    • Do not share clothing or hair accessories
    • Do not share combs, brushes, or towels

    Keep Checking

    Some people report that despite vigilance and treatment, the lice keep coming back. Be sure to continue checking for lice regularly. If the treatment did not work, let your doctor know as another medication may need to be used. As much as no one wants to reveal that they have head lice, it is important to warn friends who may have been exposed. After spending weeks to eliminate the lice, you do not want your child to pick it up all over again.


    Centers for Disease Control and Prevention http://www.cdc.gov

    National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov


    Communicable Disease Control (CDC) NetworkProvince of Manitoba http://www.gov.mb.ca

    Health Canada http://www.hc-sc.gc.ca


    Dodd CS. Interventions for treating head lice. Cochrane Database Syst Rev. 2001;(2):CD001165.

    FDA Public Health Advisory: safety of topical lindane products for the treatment of scabies and lice. Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm110845.htm. Updated April 30, 2009. Accessed February 11, 2015.

    Head lice. Centers for Disease Control and Preventionwebsite. Available at: http://www.cdc.gov/parasites/lice/head/index.html. Last updated September 24, 2013. Accessed February 11, 2015.

    Head lice. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 22, 2014. Accessed February 11, 2013.

    Hensel P. The challenge of choosing a pediculicide. Public Health Nurs. 2000;17(4):300-304.

    Lindane. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 29, 2013. Accessed February 11, 2015.

    Meinking TL, Serrano L, et al. Comparative in vitro pediculicidal efficacy of treatments in a resistant head lice population in the United States. Arch Dermatol. 2002;138(2):220-224.

    Mumcuoglu KY. Prevention and treatment of head lice in children. Paediatr Drugs. 1999;1(3):211-218.

    Richardson M, Elliman D, et al. Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools. Pediatr Infect Dis J. 2001;20(4):380-391.

    12/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Burgess IF, Brunton ER, et al. Clinical trial showing superiority of a coconut and anise spray over permethrin 0.43% lotion for head louse infestation, ISRCTN96469780. Eur J Pediatr. 2010;169(1):55-62.

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