Head Lice in Children: Treatment for the Whole Family

Head lice are treated by combing out live lice and eggs on a set schedule, or by using a lice lotion recommended by a doctor or pharmacist and repeating it after about a week, while checking everyone at home and treating only those who actually have live lice. Lice spread mainly by head to head contact, not because of dirty hair, so there is no reason for shame.

In India, head lice, or joon, are very common in school going children, especially girls with long hair and children in large or joint families who sleep close together. Many families try kerosene, strong oils or repeated home remedies for months. This guide explains what works, what is unsafe, and how to stop lice passing back and forth.

What are head lice?

Head lice are small, wingless insects about the size of a sesame seed that live on the scalp and feed on tiny amounts of blood. Their eggs, called nits, are glued firmly to the hair shaft close to the scalp.

DermNet explains their life cycle:

• Eggs hatch after about eight days
• The young louse becomes an adult about ten days after hatching
• An adult can live for about a month on the scalp
• Away from the scalp, lice usually die within one to two days because they cannot feed

This cycle is why one treatment is often not enough. Eggs that survive the first treatment hatch a few days later.

How do head lice spread?

The NHS and the American Academy of Dermatology both note that head lice spread mainly through head to head contact. DermNet adds that lice cannot jump or fly; they crawl from one hair to another. Sharing beds, clothing and hair brushes may also contribute.

DermNet notes that head lice are most common in children aged 4 to 14, more common in girls and in larger families, but they can affect anyone. The American Academy of Dermatology stresses that having head lice does not mean you are dirty.

What are the signs of head lice?

• Itching of the scalp, often behind the ears and at the back of the neck. HealthyChildren.org notes that itching may take four to six weeks to start after a first infestation.
• Nits, tiny white or yellow brown specks stuck firmly to hairs near the scalp. Unlike dandruff, they do not brush or blow away easily.
• Live lice moving on the scalp or hair.
• Scratch marks, sores or crusts, which can become infected.
• Disturbed sleep in severe cases, according to the American Academy of Dermatology.

The NHS says the only way to be sure is to find a live louse, using a fine toothed detection comb.

How do I check for head lice?

DermNet notes that finding lice is easier with wet combing than by looking alone.

1. Wash the hair and apply plenty of conditioner.
2. Use a wide toothed comb to remove tangles.
3. Switch to a fine toothed lice or detection comb.
4. Comb from the roots to the ends, section by section, wiping the comb on a white tissue after each stroke.
5. Look for lice on the comb and tissue.

The NHS notes this takes about 10 minutes for short hair and 20 to 30 minutes for long hair.

How are head lice treated?

There are two main approaches. Your doctor or pharmacist can help you choose.

Wet combing without chemicals. The NHS describes combing as above on days 1, 5, 9 and 13 to remove lice as they hatch, then checking again on day 17 to make sure none are left. It takes patience, but it is suitable for most people.

Lice lotions or sprays. Medicated lotions are available from pharmacies, and stronger options can be prescribed. DermNet notes that lotions tend to work better than shampoos and that two applications of a dimethicone based lotion seven to ten days apart, combined with combing out nits, is an effective approach. The American Academy of Dermatology advises following the directions carefully and repeating treatment after seven to nine days.

Important points:

• Resistance is common. DermNet notes that lice have become much more resistant to some older insecticides, so a product that worked years ago may not work now. If one treatment fails despite correct use, ask your doctor about alternatives rather than repeating it again and again.
• Babies, pregnant or breastfeeding women and people with scalp conditions should ask a doctor before using any lotion. HealthyChildren.org stresses talking to a doctor before starting any medicine, as products have specific age requirements.
• Safety first. Some lice treatments are flammable. The American Academy of Dermatology warns to keep certain lotions away from flames, stoves and heaters.

Should the whole family be treated?

Every member of the household should be checked, but only those with live lice should be treated. The American Academy of Dermatology notes that it is very common for close family and friends to get lice, and suggests checking everyone daily for 10 to 15 days. Treat everyone who has lice on the same day so lice do not pass back and forth.

This is different from scabies, where everyone in close contact is usually treated even without symptoms.

Do I need to clean the whole house?

Not intensively. Because lice die within a day or two away from the scalp, simple steps are enough. The American Academy of Dermatology suggests:

• Washing pillow covers, bedsheets, towels, caps and recently worn clothes in hot water and drying them on high heat or in strong sun
• Soaking combs, brushes and hair accessories in hot water
• Sealing items that cannot be washed, such as soft toys, in a plastic bag for about two weeks
• Vacuuming or sweeping floors, sofas and mattresses

There is no need for pesticide sprays in the house.

What should I not use for head lice?

• Kerosene or petrol. HealthyChildren.org warns never to use these. They can cause burns, poisoning and fire.
• Home remedies such as petroleum jelly, mayonnaise, olive oil and essential oils. HealthyChildren.org notes that no studies prove they work, and the NHS advises against plant oils such as tea tree or eucalyptus oil, head lice repellents and electric combs.
• Strong hair dyes or chemicals not meant for lice, which can irritate the scalp. If your child reacts to hair products, our guide to hair dye allergy explains the warning signs.
• Shaving the head, which is usually unnecessary and distressing for children.

Can my child go to school?

The NHS says there is no need to keep a child off school because of head lice, and the American Academy of Pediatrics believes children should not miss school because of lice. Start treatment promptly and let the class teacher know, so that other children can be checked. DermNet notes that school education programmes are among the most effective ways to reduce lice in a community.

How can lice be prevented?

• Encourage children not to share combs, brushes, caps, scarves and hair accessories
• Tie long hair up for school
• Check children’s hair with a detection comb once a week during outbreaks
• Treat promptly when lice are found

When to see a dermatologist

See a doctor or dermatologist if:

• Lice keep coming back despite correct treatment
• The scalp has sores, pus, crusts, swollen glands or fever, which may mean infection
• A baby, pregnant woman or person with a scalp condition needs treatment
• The scalp is scaly or has patches of hair loss, which may be a different condition such as dandruff or seborrhoeic dermatitis or a fungal infection
• Itching continues even though no live lice are found

Head lice are a nuisance, not a reflection of how you care for your child. If treatment is not working, Dr. Maria offers online consultations to help with a plan that suits your family.