How to get rid of lice: a primer

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Head lice look like this.Credit: University of Massachusetts
Head lice look like this.Credit: University of Massachusetts

Head lice look like this.Credit: University of Massachusetts

There’s a story circulating about super lice. If it comes to your house, here’s my lice guide that published a few years ago:

Lice. You read that right. Bet your head is itching right now.

Any parent who has discovered a child has lice wants to crawl up into a hole and die. There’s the stigma and the instant shame: If your child has lice, your family must be unclean. You must be an unfit parent. Not true.

And parents struggle with information overload about what to do.

We asked doctors and a school heath official and followed the Centers for Disease Control and Prevention guidelines to offer you this guide on what to do when lice throw a party on your child’s head.

What are lice?

Lice are parasitic insects that want to suck your blood. They are not an infectious disease.

An estimated 6 million to 12 million lice infestations occur each year in the U.S. in children ages 3 to 11, the most common age group to get them. Lice know no racial or socioeconomic boundaries. They can be more common in girls and are less common in African Americans.

Lice have three forms:

Nits – the eggs, which are about 0.8 mm to 0.3 mm white or clear ovals. They attach close to the scalp on one side of the strand of the hair. Nits that are more than a quarter-inch away from the scalp are empty egg casings or dead. It usually takes about eight to nine days for eggs to hatch.

Nymphs – the childhood stage of lice. They are small, quick-moving and hard to spot.

Adults – At 2 mm to 3 mm, they are the size of a sesame seed. The female is slightly larger than the male and can lay about six eggs a day. They can live about 30 days on a person’s head, but only about one to two days off the head.

How do I know if my child has lice?

The symptoms are itchy head, crawling sensation, sores on the head from scratching, irritability and difficulty sleeping (lice like to party at night.) However, your child could have lice and not be itchy at all. By the time an adult louse is spotted, a child has had lice for four to six weeks.

Lice are hard to diagnose and are often mistaken for dandruff, extra conditioner or food remnants from that morning’s breakfast. Even doctors and nurses can misdiagnose lice.

Look for small ovals attached to a single strand of hair on one side close to the shaft. Unlike dandruff, nits don’t just flake away.

You also might want to invest in a fine-toothed nit comb. When lice is suspected, comb through the hair a section at a time, particularly behind the ears and neck, to see what you pull off the hair.

It’s lice. Now what?

Most of the doctors we talked to recommend starting with an over-the-counter medication such as Rid or Lice MD. If your child is younger than 2, the grocery store products are not for you. Consult your doctor.

Read the directions carefully. Applying to dry hair is really important. Most of these medications have a time element to them. Stick to that. Some doctors might recommend using the medication longer; some will say that can be harmful because these medications are insecticides. Avoid washing hair for the specified time period, usually a day or two, after the lice shampoo has been applied.

Most of the over-the-counter products only kill the nymphs and adults, so removing the nits with a lice comb is just as important as applying the shampoo. For a child with long hair, combing section by section could take an hour and a half to two hours. Put on a DVD or give them a good book.

Recheck the head nightly for lice. Using a flashlight and a magnifying glass can help. Recomb with the nit comb.

The most important step is often overlooked: Reapply the shampoo seven to 10 days after the first infestation. That will ensure that any missed nits that hatched and are now nymphs or adults are killed.

Because your child is probably not the only one of his friends with lice, keep rechecking at least once a week for several months afterward.

Can’t someone else do this for me?

Yes, there are services in Austin that take care of lice.

Penny Warner, a registered nurse, started the Texas Lice Squad in 2007 and now has four offices, including one in Austin. Her staff applies an enzyme solution to the hair to break down the glue that holds the nits and then they comb through the hair using the Terminator nit comb. She charges $95 an hour, billed in 15-minute increments. Girls usually take an hour and a half, boys 15 minutes to 30 minutes. She teaches parents how to recheck their children, and if there’s another infestation within 30 days, a return visit is free.

Picky Nicky, aka Nicky Perrotta, does not use a comb or a shampoo. Instead, she comes to your house and uses the Louse Buster, a vacuum that dehydrates the lice and the nits. She charges $175 for the 30-minute treatment and guarantees her work.

Do I have to clean my house?

Lice aren’t really happy living away from your head, but they can survive up to two days without you. Nits might also survive off the head.

People most commonly get lice from head-to-head contact. Some doctors don’t recommend a whole house cleaning, though most recommend washing clothing and bedding in 130-degree water and drying on high temperatures. Bag up stuffed animals or anything that cannot be washed and store it for two weeks. Vacuum floors and furniture. There’s no need to fumigate, and don’t drive yourself crazy cleaning, because your child will most likely become reinfested again from another child or from a missed nit on their head.

What about alternative methods?

Some essential oils like mint or tea tree are said to have repellent qualities, but they don’t kill the lice and don’t always work.

Mayonnaise and olive oil are said to suffocate the lice, but they haven’t been shown to be as effective as the over-the-counter insecticides.

Nothing is working. Now what?

If you’ve followed the directions and the lice are still with you, see your doctor. She will be able to prescribe several medications that have been described as the “gasoline of all lice removal.” They can be expensive, but the lice are not as resistant to these as they are to the over-the-counter products. Some prescription products even kill the nits.

My kid has lice. What do we do about school?

Two years ago, the American Academy of Pediatrics recommended eliminating the no-nit policy for schools, and local school districts, including Austin Independent School District, followed suit.

Because a child who has lice has probably had them four to six weeks, there’s no need to panic. If a kid does have a live louse, AISD’s protocol is to send the kid home at the end of the day after calling the parent. You’ll need to treat it that night to return to school.

If it is just nits, a parent will be contacted to see whether lice treatment has been done in the past seven to 10 days. If not, information will go home about how to treat, and treatment must be done to return to school.

AISD tries to maintain privacy because of the social stigma, so when there is a case or two, there won’t be a letter home. A classroom-wide or grade-level-wide infestation might cause a letter to go out.

As a parent, you might want to contact your child’s teacher. You can give the teacher permission to notify the class parents or you can notify parents yourself.


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