Head Lice Treatments for Kids

Head Lice Basics

Combing for head lice
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Head lice are a common, controversial and frustrating problem for parents. But the controversy isn't only about how they got infected with head lice, but also revolves around how they are going to get rid of the head lice.

On one side of the debate are the people who believe that head lice have developed resistance to regular lice treatments so that they no longer work. Other experts believe that lice resistance is not a big problem, and head lice treatment failures are because parents don't remove the nits or that the child was misdiagnosed in the first place.

Head Lice

Once a child gets head lice, the mature or adult head lice can lay up to 10 eggs or nits each day. These nits, or lice eggs, hatch in about 7 to 12 days. Baby lice or nymphs are about the size of a pinhead when they hatch and quickly mature into adult lice in about a 9 to 12 days.

In just a few days, adult lice are ready to mate, starting this lice life cycle all over again during their 3 to 4-week lifespan.

Lice Symptoms

The main lice symptoms and signs are an itchy scalp and a rash on your child's neck from the bites of the lice.

These bites can become infected, and may appear red or crusty, and may lead to your child developing swollen lymph glands in his neck.

Head lice don't spread any diseases and don't usually cause any other symptoms.

Head Lice Diagnosis

In addition to having the lice symptoms listed above, children with head lice will have gray or reddish brown live head lice scurrying around their scalp.

Lice are small, about the size of a sesame seed, and although they don't fly or hop, they can crawl very fast, making them hard to spot.

Another sign that can help you make the diagnosis of head lice is finding nits, or lice eggs, attached to your child's hair. Nits are small, oval shaped, are usually a yellowish-white color, and are firmly attached to the side of hair shafts.

If you confirm that your child does have live lice or nits, it is important that you don't panic about your child's lice.

Head Lice Treatments

The main treatments for head lice usually involve using a head lice shampoo, like Rid or Nix, and then remove nits with a lice comb. Be sure to follow the manufacturer's instructions for whatever products you choose to use, which typically includes a second treatment 7 to 10 days after the first head lice treatment.

You should also check other family members to make sure that they don't have head lice too, although the AAP recommends that 'those with live lice or nits within 1 cm of the scalp should be treated.'

For light infestations or if you are uncomfortable using an anti-lice shampoo, you can try to simply remove the live lice and nits manually.

As there are often a lot of nits on a child and they can be hard to find and remove, you may continue to find nits for days after treatment. This doesn't mean that the treatment didn't work. If you continue to find live lice or new nits close to your child's scalp after treating with an anti-lice shampoo, then that likely does mean that it didn't work or your child was reinfected.

Also, be sure to wash your child's clothing and bedding in hot water and vacuum to remove lice and nits from furniture, carpets, stuffed animals, car seats, etc.

According to the American Academy of Pediatrics, you really only have to clean "items that have been in contact with the head of the person with an infestation in the 24 to 48 hours before treatment," and not everything in your house, though. And you can put anything that you can't wash in a large plastic bag for a few weeks if you are really concerned that it is infested, although this is rarely necessary.

Head Lice Treatments - What You Need To Know

  • Don't Panic About Head Lice - Unfortunately, the first reaction for many parents in dealing with head lice is to panic. Panicking is not going to kill the head lice though and will likely lead to over-treatment and anxiety in your child who may be concerned that they have "bugs" in their hair.
  • Nits hatch in 7 to 10 days and develop into an adult in another 7 to 10 days which can then lay more eggs. So it is important to remove all of the nits to break this cycle. Also, since anti-lice shampoos don't usually kill nits, you have to usually retreat the child in 7 to 10 days to kill any newly hatched head lice. Many experts now recommend doing your second head lice treatment on day 9 though.
  • Children are often misdiagnosed with head lice because they have hair casts that resemble nits, or they have dead or empty nits that are far away from the scalp. If you think your child has lice but you don't actually see any live head lice, see your pediatrician to confirm the diagnosis.
  • You shouldn't usually have to shave your child's head to get rid of head lice.
  • Be careful before trying 'alternative' treatments, like mayonnaise, Vaseline, olive oil or Tea tree oil. Although they are 'natural' treatments, they are untested, and products like mayonnaise can be hard to get out of a child's hair (dishwashing liquid is supposed to make it easier, though).
  • Alternative medications for resistant lice can include Ovide (malathion, an insecticide) and Lindane. Although not approved by the FDA as lice treatments, Elimite, a stronger version of Nix which is usually used to treat scabies, Crotamiton (Eurax), Ivermectin, and the antibiotic Bactrim (which kills symbiotic bacteria inside the lice), are sometimes used to treat resistant lice.
  • Ulesfia (Benzyl Alcohol Lotion 5%) is approved to treat children over six months of age with head lice. Unlike other head lice shampoos which are mostly pesticides, Ulesfia is a water-soluble gel that works to suffocate head lice.
  • The AAP now advises that 'no healthy child should be excluded from or allowed to miss school time because of head lice' and of course, they are still against no-nit policies that keep kids out of school because they simply have nits in their hair.
  • Do your homework or see your pediatrician before treating your child with multiple remedies.


American Academy of Pediatrics Clinical Report. Head Lice. PEDIATRICS Vol. 126 No. 2 August 2010, pp. 392-403

Learning more about head lice is your best ammunition to fight infestations and avoid unnecessary treatments.

Head Lice

American Academy of Pediatrics Clinical Report. Head Lice. Pediatrics 2002 110: 638-643.

A clinical report from the AAP that 'attempts to clarify issues of diagnosis and treatment of head lice and makes recommendations for dealing with head lice in the school setting.'

It recommends that 'permethrin 1% (Nix) is currently the recommended treatment for head lice, with retreatment in 7 to 10 days if live lice are seen' and that 'treatment failure does not equate with resistance, and most instances of such failure represent misdiagnosis/misidentification or noncompliance with the treatment regimen.'

Overdiagnosis and consequent mismanagement of head louse infestations in North America
Pollack RJ - Pediatr Infect Dis J - 01-AUG-2000; 19(8): 689-93; discussion 694

In this study, health care providers and parents submitted samples of what they thought were nits and eggs. Interestingly, 35% of specimens contained simple debris, such as 'dandruff, fibers, dirt, scabs, epidermal matter' and did not contain lice or nits. 59% of specimens did contain 'louse-derived specimens,' but only about 1/2 of them 'included a louse or an egg containing an apparently viable embryo.' So only 31% of the specimens indicated a real lice infestation that required treatment and the other kids were misdiagnosed and overtreated.

Supringly, doctors were more likely than parents or teachers to misdiagnose lice infestations.

Lice , Nits, and School Policy
Williams LK - Pediatrics - 01-MAY-2001; 107(5): 1011-5

Found that 'most children with nits alone did not become infested. Policies requiring exclusion from school and treatment for all children with nits alone are likely excessive.

Instead, these children may benefit from repeated examination to exclude the presence of crawling lice.'

This was a good study because if found that only 18% of kids with nits actually developed an active lice infestation. So just because you have nits, either before or after treatment, doesn't mean that your child is still infested with lice.

Head Lice Infestation: Single Drug Versus Combination Therapy With One Percent Permethrin and Trimethoprim/Sulfamethoxazole
Hipolito RB - Pediatrics - 01-MAR-2001; 107(3): E30

This study found that 'a combination of 1% PER {Nix} and TMP/SMX {Bactrim} is an effective alternative therapy for HLI. We recommend that the dual therapy with 1 %PER and oral TMP/SMX be used and reserved in cases of multiple treatment failures or suspected cases of lice-related resistance to therapy. '

Bactrim is thought to kill the intestinal bacteria inside the lice, which they need to survive.

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