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How to get rid of lice

When school's in session, you might have to deal with the facts of lice

Published: August 2012

This image shows the actual size of the three lice forms compared to a U.S. penny.
Photo: CDC

For parents, back to school means packing lunches, getting kids out the door in the morning, and countless other tasks big and small. For students, the return to the classroom brings the joy of seeing friends as well as the burdens of homework, class projects, tests, and more.

And for parents and kids alike, back to school can also include one major nuisance in a tiny, sesame-seed-size package: head lice, which are wingless insects usually transmitted by head-to-head contact. If you notice your child scratching his or her scalp a lot, especially behind the ears or at the back of the neck, check for head lice.

There’s a chance that the itching could be caused by eczema, dandruff, or an allergy. But if it is a case of lice, it will not clear up on its own, so treat it right away.

Checking for head lice

Wet-combing your child's hair is much better than a visual inspection for detecting an active head lice infestation, according to a study in the March 2009 Archives of Dermatology. German researchers compared the two methods on 304 students, ages 6 to 12. They found that wet-combing identified infestations in 90 percent of the cases, compared with about 29 percent for visual inspections. "Wet combing is the only useful method if active infestation has to be ruled out," researchers said.

To wet comb, first coat your child's hair and scalp with any regular hair conditioner, then comb it out in small sections with a nit comb, available in most drug stores. After each comb-through, wipe the comb on a wet paper towel and inspect for lice. Repeat this four times, with a three-day break in between each session. If you find that your child has head lice, here are some steps you can take to get rid of them.

Best lice treatments

A nit comb can help you find head lice.

According to our review of the research and advice from medical experts, some treatments are clearly more effective—and safer—than the others:

  • Over-the-counter chemical treatment. A lice cream rinse containing 1 percent permethrin (Nix and generic) has proved quite effective at treating head lice. Follow the package directions carefully. One treatment may not always kill all of the eggs; a second is often necessary 7 to 10 days later. To make sure that the eggs not killed are removed, you can continue to comb out the nits after hair has been treated. To do this, comb hair with water rather than conditioners or detanglers, the American Academy of Pediatrics says, so that the chemical ingredients intended to linger on the hair are not deactivated.
  • Prescription treatment. Most of the prescription options are not usually the first choice for treating head lice. However, because lice in some areas are becoming resistant to permethrin, you may want to check with your doctor for his or her advice.  In 2011 the Food and Drug Administration approved a new drug called spinosad (Natroba), a topical treatment for use in children ages 4 and up, that was found to be more effective than permethrin, according to two manufacturer-sponsored randomized studies. But it is also much more expensive. Benzyl alcohol (Ulesfia), ivermectin (Sklice) and malathion (Ovide), are also topical prescription medicines your doctor may consider if the over-the-counter options have not been effective. But all come with medical cautions.
  • Comb-out treatment.  Some parents may not want to use chemicals on their children and opt for a comb-out method of eliminating lice. Using a fine-toothed comb, damp hair can be combed out every day for two weeks. However, this approach often fails.
  • Home remedies. Coating the hair and scalp with such substances as petroleum jelly, mayonnaise, tub margarine, herbal oils, or olive oil and leaving on overnight in a shower cap has been suggested as a way of “smothering” the adult lice and nits. But those substances have not been scientifically proved to work. Dangerous products like gasoline or kerosene or products that are made for use on animals should never be tried.
  • Natural remedies. Several products are marketed by health-food stores for treatment of head lice and are in wide use, but are not required to meet standards set by the FDA for efficacy and safety.

Household tips

Head lice don't put your child at risk for any serious health problems. But they can spread easily in families and with prolonged direct contact in schools. If your child has head lice, all household members and close contacts should be checked and treated if necessary. Also tell your child's teacher, who can then advise other parents to check their children's hair and treat them if necessary.

You don’t need to spend a lot of time or money on housecleaning since head lice won’t survive long if they fall off a person and cannot feed. Follow these steps recommended by the Centers for Disease Control and Prevention to help avoid re-infestation:

  • Machine wash and dry clothing, bed linens, and other items that your child wore or used during the two days before treatment using hot water (130° F) and high heat. Clothing and items that are not washable can be dry-cleaned or sealed in a plastic bag and stored for two weeks. The American Academy of Pediatrics recommends that pillow cases be laundered before a treated child uses a pillow.
  • Soak combs and brushes in hot water (at least 130° F) for 5 to 10 minutes.
  • Vacuum the floor and furniture, particularly where your child sat or lay.
  • Do not use fumigant sprays; they can be toxic if inhaled or absorbed through the skin.

For more information, see the American Academy of Pediatric’s guidelines for head lice, as well as the CDC’s.


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