Head Lice Management


Headlice is a very common annoyance but it is not a dangerous condition and lice do not spread disease. Lice are tiny insects that lives on hair and feed on very small amounts of blood. When the lice feed, the small bites can cause itching and irritation on the scalp and your child may develop sores that sometimes even become infected from scratching. Sometimes, the first signs are itching and rash on the scalp, the back of the neck or behind the ears. If you look more closely, you may be able to see the lice crawling on the scalp or the nits (eggs) that are cemented onto the hair. The nits may look like small grains of sand or pieces of dandruff but they cannot be moved easily off of the hair where they are attached. They are typically found fairly close to the scalp on the hair shaft.

Lice do not discriminate and any close contact between heads or clothing items from an infected person can be enough to transmit the lice. Lice are not a sign of being dirty or poor hygiene.

There are several treatments to treat lice. Some are medicated and may kill just the lice or the lice and the nits. Any treatment you choose requires that you also comb through your child’s hair and remove any nits that you find so that they do not have the chance to hatch and reinfect your child. They can be removed with a lice comb which has very fine teeth, or they can be picked off by hand but this may take longer and be more difficult. The best way is to use a conditioner/cream to moisten and slick the hair so that the lice are immobilized and you will have an easier time getting the comb through the hair. Older methods of “suffocating” the lice with Vaseline, mayonnaise or olive oil have not been proven to be effective to kill the lice and are difficult to remove from hair once used.

Management of the home can also help to prevent reinfestation. Wash any and all clothing/jackets/scarves/hats as well as bed linens that have been worn in the last few days in hot water and then the run them through the dryer on a hot setting for a minimum of 20-30minutes. Any items that cannot be run through the washer/dryer should be put in plastic bags and tied off for 3-5 days. The lice require a blood meal every few days and cannot survive on non-human items for more than a few days. Vacuuming carpets, sofas, chairs and car seat covers/car upholstery where your child sits can also decrease the risk of reinfection. Any hair care items should also be soaked in rubbing alcohol or medicated shampoo for an hour or more and then rinse thoroughly.

Treatment options: Remember to only use one remedy at a time and if you are not successful, you may need to try a different remedy as some lice can develop resistance to some treatments.

Medicated shampoos/rinses: These include Rid or Nix as the most common over-the-counter treatments that you will find at the pharmacy. Follow the package instructions for treatment but then continue to “nit pick” every morning and evening for the 2 weeks before the second application and again for another week after the second application. This way, the treatment will kill any of the lice and there will be no opportunity for the nits to hatch if they are all removed. Any that happened to hatch during the time between treatments are killed during the second application and in the meantime the remaining nits will be removed, thus breaking the cycle.

The Cetaphil Method is as follows:

Applying the Cetaphil

1. Purchase a 12 oz. bottle of Cetaphil Gentle Cleanser at a major retailer or drugstore. You also need an 8 oz. clear application bottle with a tip which can be found at a beauty supply store (or see online Resources below). Fill the application bottle with Cetaphil.

2. Drape a towel around the child's shoulders to catch any extra cleanser that drips off the hair. The hair should be dry for this treatment.

3. Begin at the nape of the neck on the left side and apply the cleanser directly to the scalp moving back and forth from the nape of the neck to the front hairline until you reach the right side. This should use 1/4 of the cleanser.

4. Change the direction of the zigzag pattern to criss-cross the first pattern. Now the application bottle should be half empty.

5. Massage the cleanser into the scalp.

6. Repeat Step 3 and 4. Now the application bottle should be empty. Massage the cleanser into the scalp again.

7. Refill the bottle half full if your child has long hair. Squirt the cleanser on the hair strands and massage it in.

Completing the Treatment

8. Wait just 2 minutes and then comb out the cleanser. Wipe the excess cleanser onto another towel. The goal is to remove as much cleanser as possible so it will take less time to blow dry the hair.

9. Remove nits with a lice comb. Place the lice comb at the scalp and slowly comb through. Swish the comb in a bowl of water to see if anything comes out. A white bowl works best to spot the nits. Flush the water down the toilet when done.

10. Blow dry the hair so that the scalp, roots, and strands are completely dry. This is very important so the cleanser adheres to the lice and cannot be rubbed off on a pillow. Expect blow drying to take three times longer than it normally does. Do not apply any other hair care products—they may be flammable!

11. Leave the dried cleanser on the hair overnight or for at least 8 hours.

12. Wash hair with your normal shampoo. You can rinse hair with a 50/50 mixture of vinegar and warm water and then comb again with the lice comb before shampooing. The vinegar helps to loosen the nits.

13. Check daily for live lice and nits. Remove nits immediately. Retreat with Cetaphil if you see live lice or contact your pediatrician for advice.

14. Repeat this treatment after seven days and again seven days after that to kill any newly hatched lice before they become adults and lay eggs. This is a crucial step to break the lice life cycle.

Other Non-Pesticide Methods: There are many other over the counter remedies for head lice (Lice MD). Some have a high salt concentration which dries out and kills both the lice and the nits but we would still recommend nit picking every morning and evening for 2 weeks and then retreating. There are also alcohol based treatments which also kill lice and nits but these are flammable—do NOT use with a hairdryer!

Heat Method:

There are recent studies that show that treatment of lice with heat can be quite effective in killing head lice. Products such as Lousebuster are very effective but even a home hairdryer can successfully treat lice. DO NOT USE HAIRDRYER WITH MEDICATED TREATMENTS OR TREATMENTS THAT CONTAIN ALCOHOL--THESE PRODUCTS CAN CAUSE FIRE AND SEVERE BURNS TO YOUR CHILD!

It is recommended that your child’s hair is separated into 10-20 sections held by hair clips. Each section should be heated with hot air for 3 minutes concentrating on the area closest to the scalp where lice and nits are generally found. The hair dryer should be gradually moved around (WAVE BACK AND FORTH OVER THAT SECTION OF HAIR) during the treatment of each section to avoid burning the scalp. Gradually move the hair clip up each bunch of hair and then move to the next section. This may be a good method to use in addition to nit-picking on the days in between the first and second application of a medicated lice shampoo.