What Experts Say is the Best Lice Treatment
If your child comes home from school with an itchy scalp or you hear another student at school has lice, it’s easy to panic. Before you jump into treatments, the most important thing is to confirm whether you’re actually dealing with lice. Devon Balles, NP, UnityPoint Health, explains what to look for and how to treat lice effectively.
What Does Lice Look Like?
Lice are tiny, wingless insects that live by drinking small amounts of human blood from the scalp. Lice are very small and tricky to spot. They’re about the size of a sesame seed and usually a pale gray or white color. Lice live and lay eggs right on the scalp. Their oval-shaped, yellowish eggs are even smaller — usually less than a millimeter.
What are the First Signs of Lice?
Not all children show symptoms when they have lice, especially if it’s their first case. Sometimes, lice is present for up to six weeks before symptoms appear, so it’s important to consistently check your child’s scalp if you know they were exposed. If they do start to notice symptoms, they may appear as:
- Inability to sleep
- Scalp itching
- Sores or bleeding on the head from scratching
- Tickling sensation on the scalp
How to Check for Lice
“The first and most important thing is to stay calm if you hear a kid in your child’s classroom has lice,” Balles says.
“I always remind parents that lice don’t transmit disease, and this doesn't put your child at risk for any serious health problems.”
In a well-lit room, have your child sit down in front of you. Slowly move through each section of their hair. Lice can be anywhere on the scalp, but they tend to hide behind the ears and at the nape of the neck.
Sometimes, parents mistake dandruff for lice. The best way to tell the difference is that live lice crawl and move when you look closely, but dandruff does not.
How Do You Get Lice?
Finding lice in someone’s hair does not mean they have poor hygiene. Lice have no preference for dirty or clean hair — as long as they find a human scalp to live on, they’re satisfied.
Lice only spreads through direct, prolonged head-to-head contact where lice can crawl from one scalp to another. Because lice can’t jump or fly, it’s unlikely that you will catch lice through wearing another person’s hat or helmet or using their comb. Once lice leave or fall off the scalp, they lose their blood supply and die within 24 to 48 hours.
Can Black People Get Lice?
Lice affect all demographics of people and live and lay eggs on any human scalp. However, lice use their claws to cling to the hair shaft, so people with curly or coiled hair may be less susceptible to severe cases of head lice.
How to Clean Your House if Your Child has Lice
For peace of mind in your home, wash clothes, towels, linens and pillowcases with hot water and dry them on high heat. It’s not necessary to use harsh chemical sprays on these items.
For items you can’t wash, like stuffed animals, seal them in a plastic bag for two weeks.
Notably, pets and other animals can’t catch or spread head lice.
Lice Treatment
Shampoos and lotions containing permethrin or pyrethrin (for children ages two and older) are the only over-the-counter treatments for head lice approved by the CDC. Some medications kill lice and their eggs, but others aren’t as effective at removing the eggs, so carefully read the instructions and treat exactly as directed. If you try treatment with over-the-counter medications twice and still notice symptoms, your doctor can provide a prescription medication.
"We never recommend treating without first talking with your child's provider to make sure you’re appropriately treating lice, and not inappropriately treating dandruff, a rash or something else," Balles says.
After treating your child for lice, monitor all other household members for a few weeks. It’s also a good idea to inform your child’s school.
So, you can let out an exhale knowing there are science-based methods to evict lice from the scalp that don’t involve old wives tales.
“I can’t imagine a scenario where someone with lice would need to shave their head,” Balles says. “I feel like that was always told to us as kids, but we have other very effective treatments that don’t require a razor.”
Additionally, there’s no evidence that mayonnaise, chlorine, disinfectant spray or plastic bags are effective treatments for head lice.
When to See a Doctor for Lice
A head lice infestation alone isn’t a health hazard and won’t cause major medical problems. However, secondary bacterial infections from intense scalp scratching are possible, though rare. Contact your pediatrician if you notice any signs of infection:
- Excessive redness or inflammation on the scalp
- Pain beyond the itching sensation that worsens over time
- Pus, drainage or discharge coming from the scalp
Can you do a Telehealth Visit for Lice?
Yes, as long as the provider can clearly see the scalp, a virtual care visit is a great option for confirming a lice case and creating a treatment plan. Taking clear photos of your child’s scalp to send to your provider can be easier than trying to get them to sit still during a telehealth appointment.