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Head Lice: Q&A with a Pediatrician

Head lice is making the rounds (again). Pediatrician, Dr. Mark Pashayan, offers some advice and answers your questions about the prevention and treatment of head lice.

Q: How common is lice?

A: Lice infestations in the US are estimated to be around twenty to thirty thousand cases a day. You might suspect a problem if your child has an itchy scalp, but often simply see the lice crawling, or the eggs attached to a hair.

Q: How is it treated?

A: Treatment involves killing the live lice and eggs with a special shampoo, and using a very fine-toothed comb to remove the eggs (nits). Start with over-the-counter products, and follow the label directions carefully. Generally this means using sufficient amount of shampoo for the length of hair, leaving in place for appropriate time before rinsing out, and not shampooing again for 1 to 2 days to allow it to work. Repeat the treatment 9 days later. 

You do not need to fumigate your house! Lice and eggs die when they are not in contact with your body heat, so if they are on the furniture or carpet or clothes they will generally die in a few days. After the shampoo treatment, change the sheets and pillowcases for a couple of days and launder clothes and sheets, hats, and scarves in hot water (130 degrees) and use a hot air dryer. Combs and barrettes and hair clips can be soaked in 130 degree water for 10 minutes, or cleaned with pediculocide shampoo. Anything that can’t be machine-washed, can be dry-cleaned. Other things can be sealed in a plastic bag for two weeks to kill everything. 

Many alternative treatments have been suggested over the years. One alternative is safer, easier and less messy than mayonnaise or coating the head in Vaseline overnight. Apply the skin cleanser Cetaphil to the head, comb through, blow dry until hard, sleep on it and shampoo out in the morning. Do this once a week for 3 weeks. In a research study on hard-to-treat lice this worked 95% of the time!

Q: Is it true hair gel or hair spray can prevent you from getting head lice?

A: Lice attach themselves to a hair by grabbing on to the hair shaft. It might make sense that coating the hairs would make them more difficult to cling to. There is definitely a difference in infestation rates based on racial groups. African Americans are less often affected by lice. Daily hair gel or hair spray is not a very practical solution though. Remember, lice are not dangerous. They do not transmit any diseases to humans (unlike ticks, or mosquitos). And transmission occurs by close contact from a person with lice. While hair gel or spray might make infestation less likely, that's a lot to do every day for the rare occurrence when your child might come in contact with lice. 

Q: Will it re-occur?

A: Your child might have another case in several ways. Lice can survive a treatment, eggs can survive and hatch a week later, or infestation from another active case can occur. Don’t be fooled by seeing dandruff flakes in the hair, or dead lice eggs. Any eggs (nits) more than ¼ inch from the scalp are probably dead. Just comb and comb with the nit comb to remove all the pieces. If you see live lice after the treatment, call for advice. Just as bacteria develop resistance when antibiotics are used, lice can develop resistance to any of the over-the-counter and prescription treatments. Changing the treatment or repeating it might be necessary.

Q: Do other family members need to be concerned? Is it contagious?

A: Family treatment is usually recommended because close contact (head to head touching) is the usual method of spread. Although not common, lice can be spread by combs, hats and other clothing.

Q: When do I need to call the doctor/pediatrician?

A: Call the Doctor if your over the counter treatment (with a pediculocide) doesn’t work and you still see live lice after treatment and repeat treatment 9 days later. There are prescription treatments which we can prescribe. This one often kills lice and eggs so a second treatment might not be necessary. 

Dr. Pashayan sees patients at Pediatrics - Clemmons.

More head lice resources

General Head Lice Information

Visual Exam for Lice

Cleaning Lice from Combs, Clothing, and Other Items

Are Head Lice Becoming Resistant to Medications?