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For parents or other primary caregivers, there are few calls home from school that can make you cringe like a nurse telling you your child has lice. Although head lice are incredibly common in childhood—and not a reflection or result of poor hygiene— it doesn’t mean they’re easy to deal with.
Lice spreads quickly from person to person and can be difficult to eliminate. Although the lice themselves are not dangerous and don’t spread disease, their bites are irritating and can make a child’s scalp itchy, with the resulting scratching leading to potential infection.
If you’re dealing with a lice outbreak in your home, read on for the top treatments for children with lice, according to pediatricians on the Forbes Health Advisory Board.
What Are Lice?
Lice are small, pale gray bugs about the size of a sesame seed (2 to 3 millimeters long), according to the American Academy of Pediatrics (AAP). Head lice feed on blood from the scalp, making your child’s head a vulnerable spot.
Head lice can live for about 28 days, according to the AAP, and develop in three phases. Once the egg or nit develops into an adult (called a louse), it’s able to lay about 10 eggs a day—allowing it to quickly multiply. While they cannot hop or fly, they can be spread via head-to-head contact, and there’s a small chance they can spread by sharing products like combs and hats.
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Symptoms of Lice
Your child itching and scratching at their scalp is the most common sign of possible lice, particularly behind the ears or the back of the neck. If you’re unsure if lice are present, ask your child’s pediatrician or even the school nurse for help.
Since lice can be present four to six weeks before itching occurs, it might be beneficial to regularly check your child’s head for lice.
Head lice might be small, but they’re still visible if you go hunting for them. When checking your little one’s head for lice, look for the nits, which are lice eggs. They are tiny and yellow, tan or brown in color before they hatch, and will likely be near the scalp, possibly resembling dandruff (although they aren’t easily removed by brushing).
Seeing nits is more likely than seeing live lice on the scalp and hair, unless the case is more progressed and your child has many lice.
How Can I Check My Child for Head Lice?
If you suspect your child might have lice or nits, check their scalp, behind their ears and the nape of their neck, according to Nemours Children’s Health. Tools you may want to use include:
- Bright light or magnifying glass: This can help you locate the lice, as they move quickly and can be hard to find.
- Conditioner: Add a generous amount of conditioner to wet hair before you start combing through and searching for the critters.
- A fine tooth comb: Use a fine-tooth comb to section off wet hair when searching for lice, and inspect the comb as you brush through. Wipe the comb off on a paper towel, which may help you see the lice.
Best Lice Treatments for Kids
It can be unsettling to find out your child has lice, but fortunately, there are plenty of treatment options, both prescription and non-prescription, to tackle the pesky bugs and banish them from your life and home. Below, pediatricians from the Forbes Health Advisory Board share their advice on the best active ingredients and products to get rid of lice—and tips to make those treatments as effective as possible. Note: Read product instructions carefully before application.
Permethrin (Nix)
Permethrin is an insecticide, derived from synthetic chemicals that “act like natural extracts from the chrysanthemum flower,” according to the National Pesticide Information Center (NPIC). Permethrin affects the nervous system of insects, and is a common ingredient in products like bug protectant spray for clothing and gear. Permethrin lotion 1% is approved by the U.S. Food and Drug Administration (FDA) for treating head lice in children 2 months and older.
Permethrin is the active ingredient in Nix, a non-prescription product recommended by Ruth Kanthula, M.D., a board-certified pediatric infectious diseases specialist for MedStar Health—practicing at MedStar Georgetown University Hospital—and Forbes Health Advisory Board member. The product, “kills live lice and young lice, hatching from eggs,” explains Dr. Kanthula. It leaves residue on the hair “so the product can continue to kill the lice that will hatch from the eggs (nits) remaining on the hair after the first application.”
Products containing permethrin are also recommended by Robert Dracker, M.D., founder and director of Summerwood Pediatrics and Infusacare Medical Services and a Forbes Health Advisory Board member, though he does note that products with permethrin as an active ingredient usually need to be repeated.
Dr. Kanthula agrees, advising a second treatment be administered nine to 10 days after the first treatment.
Pyrethrin (Rid)
Another non-prescription product recommended by Dr. Kanthula is Rid. This product is formulated with pyrethrin, which is similar to permethrin, but instead of being synthetic, is naturally derived from the chrysanthemum flower. Rid kills living lice and is “safe and effective when used as directed,” according to Dr. Kanthula. She says there’s no residual lice-killing activity after the product is rinsed off, so it also requires a second treatment.
Since pyrethrin is a naturally occurring extract from the chrysanthemum flower, it should be avoided by people who are allergic to chrysanthemums and ragweed, and is only approved for those ages 2 years and older.
Malathion (Ovide)
Malathion (the generic name for brand-name, prescription head lice treatment lotion Ovide) kills live lice and some lice eggs. Dr. Dracker says this medication is “very effective” but cautions to keep it away from mucous membranes—like the mouth and eyes—during application, a warning echoed by the Centers for Disease Control and Prevention (CDC). The CDC also notes that malathion is flammable and to keep the medication and wet hair away from heat sources such as hair dryers, electric curlers, cigarettes or open flames.
Malathion should only be used in children over the age of 2, according to the CDC. Dr. Dracker adds that you can re-apply this treatment if live lice are still noticeable one week later.
LiceMD Pesticide Free Lice and Eggs Removal Kit
For parents who would prefer not to use pyrethroid-based containing agents to kill lice, Dr. Kanthula recommends LiceMD. “This product contains dimethicone; a silicone-based polymer that lubricates the hair to help with removal of nits and lice,” she explains. The product is non-toxic and odorless, with Dr. Kanthula noting that you may only need one application for it to be effective.
Ivermectin Lotion (Sklice)
Sklice is recommended by Dr. Dracker. The American Academy of Family Physicians (AAFP) recommends the product for people over 6 months old, and notes that its active ingredient, ivermectin, does not have the neurotoxicity concerns or flammability concerns of other active ingredients.
The AAFP calls the non-prescription medication safe, effective and easy to administer, as it only requires a single application and rinse cycle with no nit combing. However, it comes at a higher cost than other non-prescription treatments with a single tube costing as much as $300.
Spinosad
Spinosad is approved for use in eliminating lice for children older than four years and can be used to treat both lice and scabies. It is another topical medication that mitigates the risk for neurotoxic side effects and is generally well tolerated.
Spinosad is a liquid medication applied to the scalp, hair and skin. After spinosad is applied, it should be left to sit for 10 minutes before being washed completely out of hair. A second treatment is recommended if live lice are present a week after the initial treatment cycle. For children with long or thick hair, the entire bottle may be needed to coat the scalp and hair. Dr. Dracker notes that spinosad is effective but usually needs to be repeated.
When to See a Doctor
You should always consult with your child’s doctor if you think they have lice and follow their instructions for treatment.
“In addition to lice treatment products, manual removal of lice is encouraged using a nit removal comb, as no product is 100% effective at killing lice,” advises Dr. Kanthula. “Parents should consult with their pediatrician before selecting over-the-counter therapy and should contact their pediatrician if treatment is not successful.”
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Meet Our Panel Of Experts
Ruth Kanthula, M.D., M.P.H.
Pediatrics / Pediatric Infectious Diseases
Robert Dracker, M.D.
Pediatrics
Frequently Asked Questions (FAQs)
What do lice look like?
Lice eggs—or nits—look like small yellow or brown dots and are often located near the scalp. After hatching, the remaining egg may look white or clear. Nits are commonly mistaken for dandruff. Adult lice are about the size of a sesame seed and are gray or tan in color.
How do you get lice?
Because lice cannot jump or fly, the most common way that they spread is through direct head-to-head contact.
How common are lice?
Lice are most common in children who are in preschool or elementary school. However, anyone who comes into direct head-to-head contact with an infested person can get head lice.
