Lice Prevention and Removal

Who wants to talk about lice? I know--no one. Until it happens to you. One of my friends just did an extended battle with lice at her daughter's school, and she wrote up this super-comprehensive piece about how to prevent the spread of lice and get rid of them as directly as possible if they happen to you. (She didn't want me to attribute her because she didn't want to be the Lice Hunter forever.)

How to detect lice:
1. The first sign is a child who is scratching his head, especially behind the ears. There may be red bumps on the scalp and neck.  However, not all children are sensitive so an infestation could be asymptomatic.
2. Lice need warmth and prefer the areas behind the ears and at the nape of the neck.  Check for nits regularly [how often, once a week?], especially in these areas.
3. Make sure your child has lice and not dandruff.  Nits are glued onto the hair shaft and will not move when touched. [it would be helpful to refer to a photo on the internet]
4. Nits are visible to the naked eye but are very small.  If you are visually challenged there are binocular magnifiers for about $30 on the internet.

When your child has lice:
1. The chemicals in OTC pediculides (e.g. pyrethrum) have been known to cause acute allergic, anaphylactic and asthmatic reactions.  Furthermore, there is more and more evidence that lice have become resistant to these harmful chemicals.  Less toxic remedies are available, such as enzyme shampoos (Licenders, Lice R Gone). (My recommended shopping list includes: Licenders comb and enzymatic shampoo, baking soda, Pantene conditioner, tea tree oil or citronella oil, witch hazel, and a couple of small spray bottles.  If you don't already have them, you also need plain white paper towels, hair clips for sectioning hair, and olive oil to mix with the essential oils.)
2. A lice killing shampoo will not solve the problem completely because nits will survive even the most potent treatment.  Nits can continue to hatch for 7-10 days after the adult lice have died.  Nits need to be physically removed with a combing process (the high heat that would kill the nit would also damage the hair).  Even when an expert does the comb out, there could still be a nit remaining, so repeated combings everyday for 2 weeks is recommended.
3. The mixture for combing out hair is 1 part white conditioner (such as Pantene) to two parts baking soda.  The color of the paste enables visual identification of the nits and the baking soda provides abrasion for removal of the nits.  The comb must be wiped clean with every swipe onto a plain white paper towel.
4. The technique for combing is to divide the hair into four parts with clips.  Starting at the nape of the neck, separate a small section about the width of the comb. Insert the comb as close to the scalp as possible and comb out four times: once from the top, once underneath, once on the right, and finally on the left.  If no nits are detected, move onto the next small section.  After combing out hair, shampoo as normal and dry hair.  Conduct another visual inspection under bright light.  Pull out any hairs with nits.
5. The choice of louse comb is very important.  The teeth on plastic combs can spread apart and may not remove small nymphs.  On the other hand, the single-piece metal nit comb did nothing but damage and pull hair out.  The best comb is metal with long cylindrical teeth (e.g., Licender, Lice Meister)
6. If a child is found to have lice, everyone in the family must be examined, especially if parents are in contact with the child's bed linens or towels.  (Lying on the same pillow while reading a bedtime story will infect the parent!)
7. Use clean towels every time you wash hair.  Vacuum and use a lint remover to pick up stray hairs.  Scrub combs and hair accessories with lice shampoo and an old toothbrush.  Place brushes in a plastic bag for 2 weeks or buy new ones.
8. A thorough cleaning of the house is necessary after the first treatment: clothing, linens, backpacks, outerwear, hair accessories, headphones, hats, towels, stuffed animals, rugs and any items in contact with the infected individual within the past 48 hours need to be laundered, vacuumed, brushed with a lint roller, or placed in plastic bags.  Afterwards, normal cleaning is sufficient.  Most of the effort should be directed towards keeping your family's heads nit free.

For prevention:
1. Lice can live up to 48 hours without a host.  A nit on a fallen hair could theoretically still hatch. Lice can quickly crawl to a new host via hats, helmets, combs, brushes, barrettes, pillows, rugs, earphones, or towels/jackets/backpacks in shared lockers/closets. Lice/nits need to be physically contained in a plastic bag for 48 hrs. or heat killed in a clothes dryer. I am putting my child's backpack, hats, scarf, and jacket in the dryer for 30 min everyday.
2. It is actually believed that head lice prefer clean hair to dirty hair. Do not wash hair everyday and keep hair oily with olive oil or coconut oil.  Nits cannot easily attach to the hair shaft if it is oily.
3. Lice do not like tea tree oil (insecticide) or citronella oil (insect repellant).  Keep two bottles of repellent spray, one with olive oil and one with witch hazel.  The citronella + olive oil can be added to hair and dabbed on wrists, behind the ears, and at the nape of the neck. The witch hazel + citronella can be sprayed on linens, upholstery, car seats, and other items that cannot be washed or bagged.  Essential oils can also be added to shampoos, laundry detergent, and lotions.
4. Lice can more easily crawl to another head if the hair is loose.  Girls with long hair should keep it up in a bun.
5. Children should be told not to hug each other or touch heads while reading together.

Moxie here again: Aaaahhhhhh! I had no idea. If we get lice, I think the boys and I are all getting our heads shaved. Or at least they will. I'm putting my hair up in a bun as we speak.

Thoughts? Comments? Commiseration?

Comments

[Slim]

Shave heads now, before the lice can get to you.
Buy a load of cheapo conditioning caps, goop children and self up, sleep that way. Use lice comb in AM and start laundry fest.
Keep combing, every day for two weeks. Pour boiling water over combs.

[lynn]

Been there, done that. Completely horrifying at first, but not as bad as it sounds once you start dealing with it. Or maybe we just noticed it quickly enough (dd scratching her head a lot). I used the pesticide shampoo even though I had misgivings. Then I combed, combed, combed. I used a good metal lice comb, and thick conditioner. Every night, at first, I combed each kid for 1/2 an hour (each!) while they watched Where in the World is Carmen Sandiego DVDs on our portable player (so that they could sit in the dining room where the light was brightest). Also laundered the bedding a lot though I've since heard that isn't such an issue.

After a week I got a friendly hairstylist to cut both kids hair short (some won't want to risk you coming in to the salon with lice in the hair), and kept combing every few days for a few weeks to be sure they were all gone. Wasn't too traumatic, DD kept saying afterwards that she thought she still had some lice, so could she please watch more Carmen Sandiego?

[Johanna]

Wow, I'm so glad that you posted this. If I need it someday, I will be even more thrilled it's here.

[anna]

comb regularly. seriously. lice are not that big a deal.

[SarcastiCarrie]

Can someone who has been there/done that tell the rest of us how long you are booted from school/day care? I'm just curious.

[Kate]

We live in a country where lice are endemic and not as big a deal as they were in the US.

That being said, a friend recommended natural prevention tips: shampoo/conditioner with rosemary oil (wash hair only 3-4 days/week, unless they get dirt/sand in it), combing regularly (weekly?) with a lice comb (we use the Assy 2000), and using a spray every morning before school on the "problem areas" (behind ears/nape of neck)--it's essential oils of rosemary, tea tree, lavender, and geranium in sunflower oil. It's strong smelling, but the point is that the lice don't like the smell of the rosemary.

My daughter has thick, curly hair--it's always in a ponytail or braids unless she's about to be photographed :)

But if (when?) she gets lice I am 100% going to pay someone else to deal with it. Yes, you can do that here. It's crazy enough to do the half assed combing once a week on her hair. There isn't enough TV in the world, I think, if she actually were infested.

[lisak]

My boys are ten and twelve. Despite day care since six weeks each we've only dealt with a very light infestation once. And once was enough. Lots of washing and vacuuming. Treatment with something that seemed toxic--combing of hair that was already pretty short. Since then they use a tea tree oil shampoo regularly, since there always seems to be lice somewhere in the school. I don't know if it really helps or not, but since we've only had one bout I think perhaps it does. Shampoo is available at Whole Foods.

[abby]

Moxie, you are not alone, I'm the mother of 3 boys, and I've alredy said, if someone gets lice we all get shaved. I figure I can do the other stuff (cleaning, washing, etc.) but I cannot deal with the combing and the checking.

figure, it's only for a few weeks until it starts to grow back in

[Jill in Atlanta]

I will remember that you have this posting, just in case, but I can't read it. I will spend the rest of the day itching my head. Plus, if I don't think about it, it can't happen to my kids... right?

[electriclady]

Oh dear God. This is overwhelming but I will be glad to have it later if I need it.

On the other hand, we had a confirmed case of bedbugs in my apartment building recently and compared to that (DO NOT google bedbugs if you want to keep your sanity) dealing with lice seems like a breeze.

[Slim]

You only need to stay out of daycare/school until your child is de-loused, and you need to keep up with the combing. But there's no reason to keep a child whose hair, clothing, and bedding have been de-loused out of school.

[hush]

Better lice than mice!! Well, no not really. Unfortch, we have had the latter... eek!!!!

[Nick]

Tip: For things you can't wash, such as many beloved stuffed animals, wrap them in plastic and throw them in your deep freeze for a couple of days. We were told 48 hours and it worked.

[Erica]

Suddenly very itchy. Thank you for the post, and I hope to never, ever refer back to it.

[Lee]

Moxie - I once read a New Yorker column about an Orthodox Jewish woman in NYC who specialized in combing out nits. Keep that idea in your back pocket!

[alisha]

We all had it when I was little, but I forgot about the possibility for my child. Another plague for the little bean to catch at day care, while I toil in the petri dish that is my middle school. At least it's curable.

And what category exactly will this go under in the archives? Experts? Gear? (comb, DVD player for kid, shampoo?)

[susan]

Use Fairy Tales Lice Good-Bye and Terminator comb - uses enzymes and you get like 4 uses out of 1 bottle. www.fairytaleshaircare.com

[Jenny]

We just had lice with my daughter. The day care said she couldn't come back until she was nit free, which as you can see can be up to 2 weeks! Only live lice transmit infestation, and by the time your kid is itchy they've probably had lice for weeks, so the AAP says that there is no reason a healthy, deloused child should miss any school at all. You'd better believe we combed like our salvation depended on it.

[Geek in Rome]

This is a great rundown of what to do.

I thought I would be grossed out and overwhelmed when my kids got lice in Feb., but it was surprisingly doable. After a very light second bout on vacation this summer, I skipped the whole wash and freeze everything and just did beddings and hoodies because I had such luck in the hunt and kill (manual) method.

I basically used the same method I use to catch fleas on my cat: comb the kids and dip the comb in soapy water to drown the victims.

I actually found cutting my son's hair made separating the strands to get to the scalp harder. You either have to shave to the scalp or just keep it as it is. If it is medium length hair, it's easier to pin or hold the hair back as you hunt. The eggs get laid as close to the scalp as possible, so having longer hair doesn't mean you will be giving them more room to lay eggs.

Then when they were asleep, I would spend up to an hour with a camping headlamp on and just go through their hair with my fingers and pull off the eggs and stick the eggs in soapy water. Then any live (nearly transparent) nits on the scalp I would crunch between my nails and lastly I would comb their hair with Listerine. It kills the lice and acts as a repellant.

Since I caught lice from them, too, I could only comb and use Listerine since my hubby was too grossed out to nit-pick and I still got rid of them. I just spent a week doing this on my kids and they were lice-free well before the school would let them back after 10 days.

I wrote a pretty extensive post about it here:

http://geeksinrome.wordpress.com/2009/02/13/nit-pickin-n-grinnin/

[CaliBoo]

There is a protocol on WebMD for using Cetaphil to help de-louse:
http://blogs.webmd.com/healthy-children/2006/02/got-lice.html
(from the Healthy Children Blog)

Seems like it would be worth a try if you're skeptical about using a drugstore lice treatment.

[Claire - Matching Pegs]

All you actually need to treat lice/nits is white conditioner, a nit comb, and some white tissues!

Our State government (Victoria, Australia) prints a leaflet on lice treatment/management, that is sent home with each member of a class whenever any member of that class has lice.

Treatment and detection can follow the same process. ANY cheap WHITE conditioner can be used to coat the whole head (it stuns the lice, so they can't move properly) and then the hair is combed with a nit comb - wiped on a white tissue with each stroke. The conditioner and tissue need to be white, so that you can clearly see the lice and nits.

If lice/nits are present, you will see them, and will have to comb the whole head about 5 times.

If you choose not to use a chemical product, you can repeat the process every two days until no lice/nits are found. If you treat the head with a chemical treatment, you must repeat the process 7 days apart - it is all down to the life cycle of the lice.

You can read more about it here...
http://www.health.vic.gov.au/headlice/about.htm

I have had to deal with lice in the family several times - it is exhausting combing a child over and over when they are not willing, but the process does work.

I have had an itchy head since I started writing this comment :-)

[TheLuckyGal]

Like @Claire, I am in Vic, Australia (relocated from Seattle). The fact sheet that schools send home is great. We have actually done the comb-through-with-conditioner protocol preventatively during severe outbreaks in my DD's class. What I do to prevent her getting them is use an herbal spray (tea tree and other smelly stuff they don't like - could make my own but I just buy a commercial one), put her hair in two plaits / braids and finish with hairspray. Rumor has it they cannot attatch to a laquered head. Oh, and we only wash her hair 1-2 X / week. Teachers and other parents seem pretty good about not letting them share hats, put their heads together, etc. etc. Knock wood - so far so good.

[marci]

my brother had them once, and we sleuthed it to sharing batting helmets at little league. (very small school, there were only 2 or 3 total...)

[Irene]

Don't panic. Lice are icky and itchy but they're NOT a major health threat.

[Jamie]

We dealt with lice at the end of August. I highly recommend the Cetaphil treatment. It was time-consuming to treat all five of my kids, but probably less so than all that nit-combing and without the toxicity issues of shampoos. Also, you don't see these wiggly live things coming up on the nit comb with a bellyful of your child's blood (ICK ICK ICK ICK) -- they get buried in the lather and shrink-wrapped by the blow-dryer instead.

In addition to the link up above, you can get more info on the Cetaphil treatment at http://nuvoforheadlice.com. The doctor who developed this treatment says you don't have to go crazy cleaning your house; he recommends a pretty simple protocol. He does have a peer-reviewed article out there on this approach -- in Pediatrics, I think.

[hedra]

Programs that have parents comb for lice regularly have majorly reduced lice incidence in schools (UK I think has this program, in addition to the advice in Australia). MAJOR reduction in outbreaks.

We had lice here maybe two years back? The week that ep went to a professional-organization sleep-away camp, in fact. So I was dealing with four kids (plus me, whee) with lice by myself. Oh, the suckage.

It took forever for us to realize that was what was going on, so we had a major huge outbreak before I had any clue. Ugh. Washing everything. Bagging what couldn't be washed. Combing and combing and combing. Metal comb was the best.

We found that the 'natural' treatment we found was the very best for getting everything. The chemicals just slowed them down. We did the chemical treatment, combed for everything, got to where we were getting nothing else, then did the oil-based (olive oil and tea tree oil, essentially) approach, and EEWWWWW how much more crud and creepies came out that way. The oil approach was pretty close to the Cetaphil/white conditioner approach - maybe not quite as easy to see with the oil, but white tissue and oil worked.

Combing in direct sunlight was also really helpful - dimmer than that left opportunities for more nits to get through just because my eyes are not quite so sharp without the daylight boost.

We had a second mini-outbreak later (a week or so?) as some misses hatched and restarted the cycle, but we were on it faster, and the oil approach again worked fine. (In the US there are resistant lice, that don't respond much to the chemical approach. Toxic for nothing...)

Plus the oil made it easier to comb the hair with the metal comb. The same would be true for the white conditioner/cetaphil approach - much more comfortable all around. We did have to put towels on all the pillows to keep from greasing everything up, but that was a very small price to pay (and since I was washing EVERYTHING every day, bedding-wise, it all got washed promptly anyway).

Yeah, that was no fun.

But then, a friend of mine got a bed bug infestation at his apartment, and that's so very much worse... I'll take head lice any day over bed bugs.

[Chaya]

Sorry, no time today to read other comments, but my two cents is as follows- my daughter and I both have thick curly hair. When we've gotten it (twice each, if i recall correctly) i've dealt with it without any special shampoo. I comb the hair with a lice comb (a metal one), then slather with vaseline and put it up, and continue combing like a crazy person whenever possible for the next couple of days, and then every couple of days for the next week or so. But I do the vaseline till I haven't seen a louse or nit in a few days. It doesn't look awesome, but as long as it's in a bun it's not too too bad. And I wash all bed linen\clothes on hot, dry in dryer. That's our whole routine. And yes, lots of movies during the combing.

It could be we have just been lucky that we have gotten away that easy, but my thought has been that the main goal is to get the bugs AND eggs out, and the shampoos pretty much just kill the live bugs (I think?), which is only about 10% of the job. If you are going through close enough to get the nits, you are going to get the bugs too, even without shampoo. Yuck. Now I am itchy.

[Karie]

Gross, gross, gross!
And I'm from Florida, the land of creepy crawlies.

[Imanitsud]

We recently did a girl scout camping weekend, and drove home a girl who we discovered had lice right before the trip home. Our preventative efforts included washing everything immediately, storing pillows, sleeping bags, and stuffed animals in airtight trashbag for 15 days, and high-tailing it to Whole Foods for Giovanni "Triple Tree" shampoo (with witch hazel, tea tree, and eucalyptus oils, I think). A very similar shampoo is available at Trader Joes for cheaper. We never got it, even though the kids played very closely all weekend.

[the milliner]

Count me in for itching all over as I read the comments. Eek!

Well, at least I have a good excuse now for constantly wearing my hair in a bun!

[a lice treatment prevention?]

Wow, great article about "all things lice"...we had to deal w/ these little creepy crawlers in our family too, and wow, was it bad. We almost shaved our daugters hair off, but she begged us not to.

I also 100% agree that there are a lot of toxins and poisons in the shampoos out there, so you really need to be careful w/ that! I had no idea it caused cancer! UGH!

I'm starting to itch now, thanks! LOL.

Thanks again, and glad its over! That is FOR SURE...those things are horrible.

Scott

[CaliBoo]

Not sure how reliable this is (a blog post on a newspaper website quoting a health professional should never be construed as medical advice...) but interesting none the less:
http://blogs.orlandosentinel.com/news_education_edblog/2009/11/harvard-professor-thinks-parents-should-stop-freaking-out-about-lice.html

Although asking a parent to stop freaking out is a little like asking a fish not to swim...

[Alison S]

We have had quite a few bouts of lice - maybe 7 times? (my girls are now 15 and 11, so we have been at it a while rather than infested every 5 minutes!) I have never used chemicals or done all the bagging and freezing stuff. I just use lots of white conditioner and comb for ages and ages every second or third day until I get two or three clear combings in a row. You do need to be careful with the combing and get right down to the scalp all over the head, which can be tedious with long-haired girls. You do need to check all family members. I have always got rid of the problem completely within 10 days at most, and been down to just the odd straggler after the first 2 treatments. You do need good eyesight, a good comb and lots of patience for this method, but as others have said, really it's no big deal. Personally I wouldn't use the chemicals - not effective enough to be worth the risk - and don't see the point in all the freaking out with toys etc when the problem IME goes away without all that. The problem is rife in the UK - my daughters' school always has someone with it - it's just a matter of keeping it at bay.

[Lucy]

We've been battling this with out three year old since Easter! EASTER! Problem is that even if you do all the right things, there will be some littlie at creche who's parents don't catch them all. I've stopped even being grossed out by them. No, that's not true. I hate those little f**kers.

[Q]

Late in the game here, but thought I'd toss out another tool for the arsenal - it's a magnifying glass with a small UV light (supposed to make the hard to see nits glow). http://www.licelight.com/Default.aspx

From what I've read, I think that's the way we'd go. With a good comb, a big bottle of Pantene w/ baking soda (I believe I read that tip from the NYC nit-picker referenced above), and a large roll of white paper towels. In the meantime, it's just a lot of prayers that it's a hassle we never have to deal with!

[lice ridden]

We have lice!!!!!!!!!!! My family of five girls and two boys are struggling with this! I found a recipe of ajax dish detergent, salt, tea tree oil and vinegar. I have no idea how much of which to use so I guess but what ever combo is needed, its for sure killing them. However, we also have folks in our family with dandruff and that shampoo called Denerex exta strength also works (just pricey). Killing the lice does not seem to be a big problem. Its those bleepity-bleep eggs! Or nits! Whatever! Its been a nightmare of cleaning and combing and shampooing...I absolutely HATE this! As mom of the house, I found out I had them first when I kept itching. It was noticed over night so I thought it was a shampoo issue. But nope! So I checked all 7 kids and hubby and only two kids (at the time) had it. Now? A third kid is inflicted. I honestly am about done with this and everyone's going to get their heads shaved!

[Healthy Home Remedy]

Head lice are tiny (pin-head sized) grey-brown, wingless insects that live by sucking blood from the scalp; surething they are really itchy that they are needed to be treated as early as the early sign appears

[Karen]

Shaving the head does tend to be quite a drastic move, but boy does it get tempting I know. They are disgusting looking too...i saw some crazy photos on http://www.picturesofheadlice.net and EWWW...i learned a lot about them, more than I wanted. Gross...shaving may be a good idea after all.

Karen

[Top 10 Cigars]

I hate when you read about something and are suddenly convinced you have the issue... and my daughter is probably infected too. Ha.. maybe not, but it really stinks to think about it!
-Sylvia

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[url=http://sportsillustrated.cnn.com/]sportsillustrated.cnn.com[/url]

[Tea Tree Oil]

Embaressing to say, but I got lice from my 9 year old last year, and about 6 drops of tea tree oil in a small tube of baby shampoo cleared me right up! Amazing stuff and thanks for the informative post, great job :)

[Ron Hartwell]

With head lice building resistance to most of the pesticides used to treat them in the past, essential oils have been looked at with some optomism, as a treatment with potential.
I have hear good things about Licender products and tea tree oil is an old time natural remedy so I found your regemin to be very thouough, seems like you have had some experience.
There are a plethera of natural home remedies that work with various degrees of success, but one thing they all have in common is that there is no one shot 10-15 min solution. It is a long drawn out treatment. There are some new over the counter remedies that do promise easier and faster solutions if used according the instructions. Some of these even make the lice and nits glow so there will be less chance to that some nits will be missed. Of course there is one fast 100% effective solution- the GI hair cut.

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