As parents, many of us have been there. You’re going about your day and BAM…fear and anxiety start creeping in as soon as you read the email, that perhaps again, there’s an outbreak of lice. Someone in your child’s school has lice and your child may have been exposed…blah, blah, blah. Nothing about this ever feels benign, even though it always is. Lice just feels a gross inconvenience. This post details the lice life cycle, the ways lice spread, and ways you can treat lice with both OTC or prescription medicines.

Lice infestation is common for US children and has nothing to do with cleanliness. The Centers For Disease Control (CDC) estimate 6-12 million lice infestations a year in the United States, but something you cross your fingers doesn’t make its way into your home or hair.

How Lice Live And How Lice Spread

Head lice feed on tiny amounts of blood from the scalp and if they are not on a person’s scalp, they can usually only survive about a day. This is good news for remembering that lice won’t crawl around your home for days — ever. They just can’t. Lice lay their eggs close to the scalp and when on the head can live about 28 days. They can multiply quickly, laying up to 10 eggs a day. It only takes about 12 days for newly hatched eggs to reach adulthood. This cycle can repeat itself every 3 weeks if head lice are left untreated.

Remember that head lice usually only survive for less than 1 day away from the scalp at room temperature. Their eggs cannot hatch at room temperature lower than that near the scalp. So once they fall off a child’s head, lice pose very little threat. You don’t have to vacuum the carpet, sterilize the toys, wash the house top to bottom after your child has lice. I mean you can, but don’t do it for the lice :-).

Lice is typically passed through close person-to-person contact.  Lice crawl, they can’t hop or fly (phew!). Lice mainly move from head-to-head and less commonly move from one person to another on a hairbrush or hat or costume.

Lice At School – Why Kids Don’t Get Sent Home Anymore

The American Academy of Pediatrics and CDC have fought hard against “no nit” policies in schools, in the interest of reducing the school absence associated with head lice. When recurrent infestations occur this can be frustrating but no child really ever needs to miss school for lice. Schools are increasingly unlikely to exclude children for nits, but still, in some schools, the policies persist. The rationale for not sending kids home:

  • Many nits are more than ¼ inch from the scalp. Such nits are usually not viable and very unlikely to hatch to become crawling lice, or may in fact be empty shells, also known as ‘casings’.
  • Nits are cemented to hair shafts and are very unlikely to be transferred successfully to other people.
  • The burden of unnecessary absenteeism to the students, families and communities far outweighs the risks associated with head lice.
  • Misdiagnosis of nits is very common during nit checks conducted by non-medical personnel.

 

Over The Counter Lice Products


Most of the time the very best bet for lice are OTC, easy-to-use treatments. The FDA has approved over-the-counter (OTC) lice products as safe and effective when used according to the Drug Facts label instructions. There are 3 main ingredients used to treat lice: Permethrin, most commonly found in the OTC product Nix or Piperonyl Butoxide and Pyrethrum Extract, most commonly found in Pronto or Rid. Each product has different and specific treatment instructions, like if hair needs to be shampooed first or if dry hair is needed, the age a child has to be for these products to be used on their scalp and if and when a second treatment is recommended. If the thought of dealing with lice makes you light-headed, there are lice-removal services available. They’re not cheap (starting around $100 in the Seattle area), but some parents may find the expense well worth the piece of mind of getting rid of lice manually by professionals.

Super Lice That May Be Difficult To Treat

Perhaps even worse than lice….”super lice.” Ewwwww. Although please know that their name exceeds their actual scariness. These lice are only different (aka “Super”) in that they have developed gene mutations that indicate they are developing resistance to a common class of over-the-counter treatments (permethrin). A 2016 study in The Journal of Entomology that got a bunch of media coverage found resistant lice all over the United States. The study was funded in part by the pharmaceutical company that makes one of the prescriptions, but nonetheless did find that lice are becoming harder to treat, coast to coast with the typical OTC medicines. If you’re concerned about difficult-to-treat lice in your family, talk with your pediatrician.

Does your family have “super lice?” Maybe. If you’ve treated your child several times exactly according to directions and aren’t having success, you should explore prescription medications that treat a resistant bug. But, REMEMBER though that sometimes you child is just getting re-infested from someone at school.  It is sometimes hard to decipher if the OTC medication is ineffective, or if your child has been re-exposed.

10 Tips To Remove Lice

  1. Follow the directions on the package exactly as written. If re-treatment is recommended you need to do so because of eggs that can hatch later.
  2. Never let children apply the medicine. Medicine should be applied by an adult.
  3. Do not use medicine on a child 2 years or younger without first checking with your child’s doctor (although most medicines can be used on babies over 6 months of age).
  4. Do not use or apply medicine to children if you are pregnant or breastfeeding without first checking with your doctor.
  5. Always rinse the medicine off over a sink and not during a shower or bath, so the medicine doesn’t run off the head onto other areas of skin. Place your child’s head over a sink and rinse the medicine off with warm water (not hot water).
  6. Never place a plastic bag on a child’s head. This is a no-duh, but just a little reminder not to try to suffocate the lice like that.
  7. Do not leave a child alone with medicine in his or her hair.
  8. Store medicine in a locked cabinet, out of sight and reach of children.
  9. Check with your child’s doctor before beginning a second or third treatment. Your child may need repeat treatment 7 to 9 or 9 to 10 days after the first treatment depending on the medicine. Each medicine varies a bit.
  10. Ask your child’s doctor if you have any questions or if treatments you have tried have not gotten rid of lice.

5-13 know your OTCs

This post was written in partnership with KnowYourOTCs.org. In exchange for our ongoing partnership helping families understand how to use OTC (over-the-counter) meds safely they have made a contribution to Digital Health at Seattle Children’s for our work in innovation. I adore the OTC Safety tagline, “Treat yourself and your family with care all year long.” Follow @KnowYourOTCs # KnowYourOTCs for more info on health and wellness.