How can I get rid of my child's lice?

Suzanne Berman, M.D.
How did my child get this? I keep her really clean!

Any child may get lice: rich or poor, short hair or long hair, old or young. It does not mean the child is dirty or bad!

Human lice live only on human hair and scalps. If your child has lice, he got it from another individual with whom he was in close contact. Any circumstance where a child's hair comes close to another child's hair can do it: sleepovers, long bus trips and field trips, etc. Also, sharing combs, brushes, hats, helmets, headbands, scarves, etc. can spread lice.

Regular daily baths and shampoos alone don't get rid of head lice -- so even very clean children can, and do, get head lice. Don't let your child feel self-conscious or ashamed about this very common pediatric problem.

How can I be sure my child has lice or nits?

Lice (tiny, grey-brown wingless insects) and nits (tiny white eggs, the size of a pinhead) are very common in children, but often misdiagnosed. The most common symptom is persistent scratching of an itchy head. Dandruff, dust, dirt, dried hair spray or gel, insects blown into the hair from outside, or eczema can all mimic lice or nits. Look very carefully. Brush your child's hair out vigorously while the child stands with his head over a white piece of cardboard or a white towel; live lice should come out easily.

If you still suspect that your child might have lice lurking in his or her hair, apply about 1 cup of isopropyl (rubbing) alcohol to your child's hair and work it in thoroughly. Then rub your child's hair vigorously with a white towel for about 30 seconds. The alcohol will make the lice "drunk" and cause them to come off the hair.

If you are not sure, let us check your child's hair.

How can I get rid of lice?.

The problem isn't getting rid of the live lice -- it's getting rid of the nits. Most children have only 5-6 live lice on the scalp at a time, which can be combed or picked out easily. Unfortunately, the live lice lay eggs (nits), which are glued firmly to the hair shaft. Children may have dozens of eggs at a time in their hair. After a week, the eggs hatch, the lice mate, and even more eggs are laid. Special "nit killing" shampoos kill live lice and the eggs, and loosen the "glue" that sticks nits to the hair shaft.

To get rid of lice, first treat the hair of everyone in the house over the age of 2 with a special nit shampoo:

Next, you'll need to pull out or comb out nits from everyone's hair next: Next, tackle the bedrooms: Go through the rest of the house and car: 7-10 days later, repeat all of the above.

Treated persons should be checked for lice and nits daily for 2-3 weeks after treatment.

Treatments don't always kill eggs completely, even when done correctly. Therefore, infested patients should be treated twice.

The interval between treatments should approximate the incubation period for nits (7-10 days) so that the second application will kill any newly hatched parasites.

Should I cut my child's hair short?
We don't usually recommend this for two reasons:
  1. Cutting the hair short doesn't protect against reinfestations. Boys with very short crew cuts can still get lice from sharing baseball caps, etc.
  2. Cutting the child's hair is a very permanent action for a temporary problem. A little girl who has always been proud of her beautiful, long hair may feel like the lice are her fault if her hair is suddenly "chopped off." It can also have kind of a "concentration camp" feel.

If your son has always wanted a buzz cut, fine; this is a good time to do it. Otherwise, don't make a radical change in your child's hairstyle just because of lice.

What if my child is no better after the second treatment?

Sometimes lice can become resistant to the chemicals in the hair treatments. If this is the case, we might need to try a different product. In most instances, the lice in the hair were killed, but the child re-infested himself from something in the house that was harboring lice: a hat, a teddy bear, etc.

Note: Just because a child is still itchy after a treatment doesn't mean that the lice have come back. The chemicals in the hair treatments can dry out and irritate the scalp, which causes itchiness. If your child picks at her dry, irritated scalp, flakes of dandruff can result - which may look like nits at first glance. Look very closely! (In a 2000 study conducted by the Harvard School of Public Health, doctors and parents were asked to submit specimens of lice and nits. When viewed under the microscope, only 59% of the "specimens" were really lice or nits.


© Plateau Pediatrics, PLC. Last modified 06/08/09