Don’t fear the super lice!
Every year, an estimated 6 million to 12 million U.S. children ages 3 to 11 contract head lice, according to the Centers for Disease Control and Prevention. Preschoolers and elementary students are more vulnerable, primarily because lice are transmitted head to head.
Kids touch heads at camps, sleepovers, on sports teams, and just roughhousing. Anecdotally, outbreaks occur most frequently in the warm months.
By offering this guide to you now, though, I hope to have you well prepared if you notice your daughter scratching her head fiercely, or get a note sent home from preschool that says another child has contracted head lice.
It Can Happen to Anyone
First off, a head lice infestation is not a sign of a dirty home, poor hygiene or bad parenting. Though a child’s infestation is quite inconvenient, it’s not a tragedy. You and your family can successfully cope with head lice and live to laugh about it. Using the method I recommend will take some time, but it does not require you to shave your child’s head.
Don’t do what I did, years ago, when I encountered lice on one of my offspring: run out and buy a slew of lice-killing and lice-preventing shampoos and sprays. These products are frequently ineffective, toxic, or both. Pediculus humanus capitis—human head lice—can be defeated with old-fashioned nit picking, using a special metal comb, and combing is not harmful to humans at all.
It’s also remarkably effective, unlike many over-the-counter shampoos containing active ingredients such as pyrethrin or permethrin. Such shampoos’ lice-killing capacity has waned over the years. In fact, lice resistance to pediculicides—caused by misuse and overuse—has led to the term “super lice.”
What’s more, many shampoos do not kill nits (the lice eggs), so you have to shampoo the child repeatedly, seven to 10 days between applications, to destroy the hatched lice. (Several preparations are flammable, so they’re not to be used with blow dryers or near cigarettes. The synthetic silicone oils called dimethicones are not pesticides; they’re used in some newer anti-lice systems, but they are among these flammable substances.)
The good news is that head lice are rather delicate. Lice at all phases of their life cycle are specifically adapted to feed, grow and reproduce on the human scalp. They need the heat, humidity and availability of human blood (gross, I know) in order to thrive.
Off the scalp, even a full-grown adult louse will weaken and die in a little over a day. And the claws of the head louse—perfect for crawling on human hair or the scalp—don’t work to get around on household objects or fabrics. Once a louse falls off a head, it’s nearly impossible for it to find its way back. The nits, too, require the moisture of the scalp in order to develop and hatch. If you pick them off, they dry up.
For the same reason, in my opinion (and that of the researchers whose studies I reviewed) you don’t need to go through all the bother of vacuuming furniture, isolating stuffed animals, or doing many loads of laundry. If you want to be extra cautious, wash the pillow cases of the person with the infestation. Use hot water and a hot dryer. Or just set the pillowcases aside for a day or two.
Your Weapon: a Comb
So how do you know your kid has lice? I’d recommend you get a metal lice comb first. It’s the best tool for combing out lice and nits, and ensuring that what you’re seeing isn’t skin flakes or just dirt. (Most drugstores have several types available for sale. Only buy the kind with metal teeth.) Lice most prefer the areas at the nape of the neck and behind the ears. A bad infestation will be obvious; the child’s head will be teaming with moving critters, some as large as a sesame seed. A newer infestation might be subtler. Wet the child’s hair and comb through it to determine if there are any lice moving around.
Nits are especially hard to see. They are attached to the hair, near the scalp, and are hard and teardrop shaped. Each one is white or yellow and less than a millimeter long—barely larger than the hair itself. They are usually close to the scalp. Unlike dandruff, they won’t come off a strand of hair easily.
A louse’s life cycle takes about two weeks to complete. The nit hatches in six to nine days. In seven days, the hatched nymphs reach adulthood and are able to lay more eggs and infect other people whose hair they contact. Each adult female can lay up to eight nits a day, according to the CDC. So within a week of contracting lice, a child could be harboring 56 nits or more, from the egg laying of a single female. Sadly, there’s never just one louse. And the numbers increase exponentially, until an entire uncivil civilization is spreading across your kid’s scalp.
But you can fight those invaders and reclaim your child’s head. Above all, remain calm. (This is my standard advice for all crises, big and small.) Your lice enemies are numerous, stealthy and relentless. You need to keep a cool head and be methodical in your approach.
You are going to have to buy some products, set up a work space, encourage your child to sit still for at least an hour and probably longer (depending on how many lice he’s got), and go through your kid’s hair with a literal fine-toothed comb. Indeed, you can do all of this without a comb; I’ve read of people nit picking with their fingernails alone.
For my suggested setup, you need: an ordinary wide-toothed plastic comb; a metal lice comb, preferably with grooved teeth; a hair conditioner or mild cleanser like Cetaphil or the generic version; a source of water, such as a sink or basin; and plenty of tissues or paper towels.
Wash your child’s hair with an ordinary shampoo and rinse. It’s easier to comb through wet hair. Entice your itchy kid to sit on a stool or the lid of the toilet by offering her a tablet filled with entertaining videos and perhaps give her a lollipop or some chewing gum. This is no time to withhold treats of any kind; your job is to make the experience as bearable as possible. It’s going to take a while.
Talk to her in a soothing voice. Work through each section of hair methodically, applying the conditioner or cleanser, and combing through first with the wide-toothed comb, to prevent tangles, then from the scalp to the ends with the lice comb. Wipe the comb off on tissues or paper towels. Or rinse it in a basin, and put the bugs down the sink. You may have to comb each hair multiple times to remove nits, which are glued to each strand of hair.
Long hair obviously involves more time and effort. Let your spouse take a turn at the combing through, or at least have him or her provide moral support, cheerleading and care for any other children (who, one hopes, haven’t also been infested).
Keep on Combing
On Day 1 you will take care of the bulk of the infestation. Continue to comb through all of the child’s hair daily to remove any remaining lice or nits. Each succeeding day, you should encounter fewer lice or nits. Do this every day for 10 to 14 days, and you should eventually remove all the potentially egg-laying lice, from nymphs to adults. Each day you’ll see fewer and fewer live lice, until they’re all gone.
Then you just have to keep checking and combing to ensure that you catch newly hatched lice from eggs you didn’t remove—before they reach adulthood and lay more eggs. After two weeks, or three to be certain, you will have broken the cycle. (After the first infestation in our family, I started checking every week. We already had the comb!)
Above all, use this as an opportunity to be kind and compassionate toward your child. She is itchy and uncomfortable. She has to sit still for you to get through all the hair. You may accidentally tug and hurt her. So speak nicely, and try to enjoy jokes together or talk about the videos she’s watching. Together you can get through this trial. And at the end of it, you’ll have the lice comb and be able to squelch any future infestations before they get out of control.
Centers for Disease Control and Prevention: https://www.cdc.gov/parasites/lice/head/epi.html
U.S. National Library of Medicine, National Institutes of Health, published in Deutsches Arzteblatt Internatinal (in English): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5165061/
“Head Lice Guide, Frequently Asked Questions,” Cornell Cooperative Extension, New York State Integrated Pest Management Program (available as a PDF by searching “head lice” at https://ecommons.cornell.edu)