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We’re battling a never-ending war with head lice!
Q: I have a 3-year-old who has been in daycare since she was 5 months old. We are now battling a never-ending war with head lice. Over-the-counter shampoos and cream rinses don't kill the lice—when I comb out her hair, the lice are still moving—but the doctor won't prescote the medical shampoo to help because it's too harsh.. Do you have any suggestions to help with this problem?
A: You’re not alone in struggling with head lice! Head lice strikes 10-12 million children in the U.S. each year. It can be difficult to get rid of head lice in families and child care programs because there are many steps to getting rid of them, and everyone—the child care centre and every family—needs to take all the steps at the same time. Here are the basic steps:
  • Check everyone’s head for lice and nits. If head lice has been going around the child care program, the children should be checked on a regular basis, such as every week, until you’re sure the lice are gone. After that, checks can be less frequent, such as every 2-3 months or after returning from each holiday.

  • Treat anyone with head lice with the special medicated shampoo. There are different brands of head lice treatment available without prescription with different active ingredients known as pyrethrins and permethrin. Doctors can also prescote another head lice treatment with lindane as the active ingredient. As you’ve observed, though, some head lice have developed resistance and are not killed by the anti-lice medications. If one brand has not worked well on your child’s head lice, try another brand with a different active ingredient. In addition, some doctors recommend keeping the medicated shampoo on for longer than stated in the instructions for the shampoo—be sure to ask your doctor’s advice about how long it’s safe to leave on the shampoo, since all of these medicated shampoos must be used with care.

  • After shampooing, go through the hair thoroughly to remove all the lice and nits. This nit-picking is crucial since none of the shampoos is 100% effective. Comb out what you can with a fine-tooth comb, but also go through your daughter’s hair by hand to pick out the remaining nits that the comb missed. Even though you think you’ve gotten out all the nits, it’s easy to miss some and you should keep going through your daughter’s hair every day for 1-2 weeks until you’re sure they’re all gone. Be sure to do this in good light because the nits can be difficult to spot. If your daughter has long hair, you might consider cutting it shorter to make it easier.

  • Launder all clothing, bed linens, towels, and stuffed animals that your daughter has used within the past few days to get rid of any lice that might be on them. Wash them in hot water and dry in a hot dryer. Non-washable items can be run through a hot dryer cycle, dry-cleaned, or sealed in a plastic bag for 10 days. Vacuum carpets, upholstered furniture, and car seats. Wash combs and brushes in the lice shampoo or soak in hot water for 10 minutes.

  • For more information, see my article on this site titled, “Surviving Head Lice” and visit the website for the National Pediculosis Association, www.headlice.org.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician