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How should I treat my daughter's lice?

Asked by Carol, Dunwoody, Georgia

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My 10-year-old daughter was just treated for lice for the third time this school year. What's the best way to get rid of them, and how can I make sure she doesn't get it again?

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Living Well Expert Dr. Jennifer Shu Pediatrician,
Children's Medical Group

Expert answer

Thanks for your question. Head lice is very common in children, especially between 3 and 12 years of age. The insects can be found crawling around the hairline and lay their eggs on the hair shafts close to a person's scalp. Lice do not carry infectious diseases and are not a sign of a person's cleanliness, but they are a nuisance and can be difficult to treat.

Lice are transmitted from one person to another by direct contact (lice must crawl from one head to another; they do not jump or fly), and can spread during sleepovers or when working or playing closely together. The insects may also move from one person to another if objects such as hats or hairbrushes are shared.

The key to getting rid of lice is to remove all live lice and prevent eggs that are attached to the hair from hatching. There are many possible treatments, ranging from physically removing the bugs and their eggs from the hair to using medicated products to kill the lice and/or their eggs. If the eggs are not removed, they may hatch after a week or two, and the process to get rid of the live lice would then need to be repeated.

• Picking or combing. Both lice and eggs may be removed by painstakingly picking out or finely combing all parts of the hair. This process may need to be repeated for several days or even a few weeks to make sure everything has been removed.

• Home remedies. Many people have tried smothering lice by leaving household products such as mayonnaise, vinegar, or petroleum jelly on the hair overnight and then washing it out the next morning. Cetaphil cleanser has also been reported to treat lice. It should go without saying that one should not use potentially toxic products such as gasoline or kerosene -- although they may kill the lice, they are also hazardous to children. Bottom line: If the home remedy is not harmful, it may be worth a try.

• Dry heat. A special machine called the LouseBuster delivers a controlled amount of heated air to dry hair with the goal of killing both lice and their eggs. It is designed for use by trained individuals in settings such as schools, camps, or clinics. Regular hair dryers can cause live lice to become airborne and spread to other people nearby and are therefore not recommended.

• Medicated treatments. Over-the-counter medicated lotions such as permethrin (Nix) and pyrethrin formulations (RID or Pronto) can be very effective in killing live lice. Prescription treatments such as benzyl alcohol (Ulesfia) and malathion (Ovide) may be successful even if the lice are resistant to the over-the-counter preparations. Ask your doctor which one is recommended in your community, and be sure to follow the product directions regarding how much to use, whether to apply to wet or dry hair, and how long to leave it on before washing. These products often need to be repeated within 7 to 10 days.

• Lice removal services. Some caregivers may choose to outsource the lice removal process to companies dedicated to getting rid of head lice. These companies may rely upon a combination of the above therapies.

• Treat the environment. It can be helpful to wash and dry clothing and bedding using hot water and high heat and to vacuum furniture, carpets, and car seats. Consider placing items that are difficult to wash (such as stuffed animals and pillows) in a plastic bag for two weeks to be sure that any remaining eggs will not hatch and survive.

• Avoid contact with lice. Even if you successfully remove all the lice and eggs from your daughter's hair, it's possible to be reinfested by someone else who has not been adequately treated. Teach children to be extra careful to avoid touching heads with one another. It's also a good idea to keep hats, jackets, combs, brushes, towels, and other personal items separated, although once a louse has been removed from its human host, it will die within a day or two unless it finds another warm scalp to live on.

• Extreme measures. While shaving a child's hair can definitely also remove lice and eggs, this drastic step is often not necessary.

Please be sure to contact your child's pediatrician if you have any other questions. Good luck!

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