What to do when my child has lice?
Quick Answer
When your child has lice, immediately apply an FDA-approved over-the-counter treatment like Nix (permethrin) or Rid (pyrethrin) following package directions, typically leaving it on for 10 minutes, then meticulously comb out nits and lice using a fine-toothed metal nit comb, such as the LiceMeister, every 2-3 days for 2-3 weeks, and retreat with the shampoo 7-10 days after the first application to kill newly hatched lice.
Understanding Head Lice Infestation
Head lice are tiny, wingless insects, about the size of a sesame seed, that live on the human scalp and feed on blood. They are commonly found behind the ears and near the neckline at the back of the head. Adult lice can live for about 30 days on a person's head, and female lice can lay up to 10 eggs, called nits, per day. Nits are firmly attached to individual hair strands, usually within 1/4 inch of the scalp, and are often mistaken for dandruff, but unlike dandruff, they cannot be easily flicked off.
Lice are spread primarily through direct head-to-head contact, which is why they are so prevalent among school-aged children. They do not jump or fly, but crawl quickly from one person's hair to another. While less common, sharing items like hats, scarves, combs, brushes, hair accessories, or headphones can also transmit lice, especially if used shortly after an infested person. The presence of live lice indicates an active infestation, while nits further than 1/4 inch from the scalp usually suggest a past infestation or that the nits are dead, but careful checking is always necessary.
It is crucial to act promptly once lice are identified, as they multiply quickly. Early detection and consistent treatment prevent further spread to other family members or close contacts. A single live louse or a few viable nits can quickly lead to a full re-infestation if not properly addressed, making thoroughness in both treatment and environmental cleaning paramount.
How to Specifically Treat Head Lice in Your Child
First, gather your supplies: an FDA-approved over-the-counter (OTC) lice treatment such as Nix Creme Rinse (permethrin 1%) or Rid Lice Killing Shampoo (pyrethrin and piperonyl butoxide), a high-quality fine-toothed metal nit comb like the LiceMeister or Terminator, a bright light source, hair clips for sectioning, regular hair conditioner, paper towels, and a magnifying glass. Ensure you have enough product for two applications per infested person. Confirm the diagnosis by finding at least one live louse or many nits firmly attached close to the scalp.
Next, apply the chosen OTC treatment precisely according to the package instructions. For most permethrin-based products like Nix, you will apply the solution to towel-dried hair, saturating the scalp and hair, then leave it on for exactly 10 minutes before rinsing thoroughly with warm water. Pyrethrin-based products like Rid are typically applied to dry hair, left for 10 minutes, then rinsed. Always use a timer to ensure correct application time, as leaving it on too long or too short can reduce effectiveness or cause irritation. Do not use regular shampoo immediately after rinsing the treatment.
Third, begin the crucial step of wet-combing to remove nits and remaining lice. After rinsing the treatment, apply a generous amount of regular hair conditioner to the child's wet hair. This helps stun the lice and makes combing easier. Section the hair into small, manageable 1-inch wide parts using hair clips. Starting at the scalp, place the fine-toothed nit comb against the head and systematically comb from the scalp all the way to the end of the hair strand. After each pass, wipe the comb clean on a white paper towel or rinse it thoroughly under running water, inspecting for any removed lice or nits. Continue this meticulous combing for every section of the head until the entire scalp has been combed, which can take 30-60 minutes depending on hair length and thickness.
Fourth, repeat the wet-combing process every 2-3 days for a minimum of 2-3 weeks (e.g., on days 1, 3, 5, 7, 9, 11, 13, 15) to ensure all newly hatched lice are removed before they mature and lay more eggs. This consistent manual removal is key to breaking the life cycle. Fifth, a second application of the chosen OTC treatment is absolutely essential 7-10 days after the first application. This kills any lice that may have hatched from nits that survived the first treatment, as most treatments do not kill 100% of nits.
Sixth, address the environment. Wash all bedding, pillows, towels, hats, scarves, and recently worn clothing (within the last 48 hours) in hot water, at least 130°F (54°C), and dry them in a hot dryer for a minimum of 20 minutes. Items that cannot be washed, such as stuffed animals or headphones, should be sealed in airtight plastic bags for two weeks, as lice cannot survive off a human host for more than 48 hours without a blood meal. Vacuum carpets, rugs, and upholstered furniture thoroughly. Soaking combs and brushes in hot water (at least 130°F) for 5-10 minutes is also recommended.
Finally, regularly check all household members every 2-3 days for at least two weeks after the last louse or nit is found on the initial infested child. Early detection in other family members allows for immediate treatment and prevents re-infestation. Continue these checks for several weeks to ensure complete eradication.
Common Mistakes to Avoid
One frequent error is failing to perform the second treatment application 7-10 days after the first. Many people assume one treatment is sufficient because they no longer see live lice. However, most lice treatments are ovicidal (egg-killing) to varying degrees, but none are 100% effective at killing nits. The second treatment is crucial for killing any lice that have hatched since the first application, before they mature and lay new eggs, effectively breaking the life cycle. Without this second step, re-infestation is highly likely.
Another common mistake is not thoroughly wet-combing with a fine-toothed nit comb. Some parents rely solely on the chemical treatment, but these products do not always kill all nits. Meticulous combing, section by section, from scalp to tip, and wiping the comb after each pass, is essential for physically removing nits and any remaining stunned lice. Skipping this step or doing it too quickly leaves viable nits that will hatch and continue the infestation.
Over-treating or using multiple different chemical products simultaneously is a significant mistake. For example, applying a permethrin product and then immediately trying a pyrethrin product if you don't see instant results can lead to scalp irritation or unnecessary chemical exposure, without increasing effectiveness. Stick to one FDA-approved product and follow its specific instructions, including the re-treatment schedule, before considering alternatives or consulting a doctor if the first treatment fails after two full applications.
Neglecting environmental cleaning is another pitfall. While lice primarily spread via head-to-head contact, not washing bedding, towels, and recently worn clothing in hot water (130°F/54°C) and drying on high heat for at least 20 minutes, or not sealing non-washable items for two weeks, can lead to re-infestation from stray lice or nits that have fallen off the head. Though lice survival off the head is short, it's a simple step that provides peace of mind and reduces the slim chance of environmental re-exposure.
Finally, not checking all household members is a common oversight. Lice are highly contagious, and if one child has them, it's very possible other family members, especially siblings, also have an infestation, even if they aren't scratching yet. Failing to check and treat everyone simultaneously means the treated child can easily become re-infested from an untreated family member, creating a frustrating cycle of ongoing infestations.
Expert Tips for Best Results
Always perform wet-combing on hair generously coated with regular conditioner. The conditioner helps to stun the lice, making them less mobile and easier to see and remove with the fine-toothed nit comb. It also provides lubrication, allowing the comb to glide more smoothly through the hair, reducing discomfort for the child and making the meticulous process more effective. This technique significantly increases the number of nits and lice removed manually.
Consider using a prescription-strength topical treatment if over-the-counter options fail after two complete applications, including thorough nit combing. Products like Sklice (ivermectin lotion) or Natroba (spinosad topical suspension) are often more effective against resistant lice strains and require only one application, though nit combing is still highly recommended. Consult your pediatrician or a dermatologist to discuss these options, as they offer a stronger approach for stubborn infestations.
Implement weekly head checks for all school-aged children, especially during peak lice seasons like the beginning of the school year or after school breaks. This proactive measure involves quickly sectioning the hair, particularly behind the ears and at the nape of the neck, and looking for nits close to the scalp. Early detection means smaller infestations, which are much easier and quicker to treat before they spread or become severe.
Educate your child on prevention strategies, such as avoiding head-to-head contact during play, not sharing hats, helmets, combs, brushes, or hair accessories with friends. While not 100% foolproof, these simple practices can significantly reduce the risk of acquiring lice. Some parents also use lice-repelling sprays containing natural essential oils like peppermint or tea tree oil, such as Fairy Tales Lice Repel Spray, as a daily preventative, although their efficacy varies and they should not replace treatment once an infestation is present.
Frequently Asked Questions
How long can head lice live off a human head?
Head lice typically cannot survive for more than 24 to 48 hours off a human head because they need regular blood meals to live. Nits (eggs) require the warmth of the scalp to hatch and usually die within a week if not on a human host.
Do I need to fumigate my house or discard furniture when my child has lice?
No, fumigating your house or discarding furniture is unnecessary and not recommended. Lice do not live on furniture or pets. Focus on washing bedding and recently worn clothes in hot water (130°F/54°C) and drying on high heat for 20 minutes, and sealing non-washable items in plastic bags for two weeks.
What if the first over-the-counter treatment doesn't seem to work?
If the first OTC treatment doesn't work after two complete applications (including the second dose 7-10 days later and thorough nit combing), it might be due to resistance. Consult your pediatrician for advice on using a different type of OTC product or a prescription treatment like Sklice (ivermectin lotion) or Natroba (spinosad topical suspension).
Can pets get head lice from my child?
No, pets cannot get head lice from humans. Head lice are host-specific, meaning human head lice only infest humans. Different species of lice infest animals, so your dog or cat is not at risk and cannot transmit lice to or from your child.
How can I prevent my child from getting lice again after treatment?
To prevent re-infestation, continue weekly head checks, encourage your child to avoid head-to-head contact with others, and advise against sharing personal items like hats, brushes, or hair accessories. Some parents also use daily preventative sprays containing essential oils, though consistent vigilance is the most effective strategy.