At age 3, my daughter, Molly, had long, thick hair with soft, loose curls. I absolutely loved it -- until lice struck when my son, Frankie, was only 3 weeks old. What's worse than a colicky newborn and a newly potty-trained preschooler? Try that plus a lice infestation lasting three months (yes, I said months). Before the diagnosis, I worried about how I'd keep the house clean, take care of a newborn, and still have quality time with Molly. I never suspected that QT would be spent wrestling a nit comb through her hair while she screamed and the baby cried.
Lice are tiny insects that attach to human hair and feed on the host's blood, usually causing intense itching. Since they move fast and avoid light, the tip-off to their presence is often their eggs -- called nits -- which are small gray or light-brown specks that seem glued to the hair shaft.
Back when we were kids, getting rid of the pests was a simple if unpleasant process: Your mom would douse your hair in Kwell, a chemical lice-killing shampoo, and then make you sit still while she combed out the nits.
It's more complicated today. Lindane, the active ingredient in Kwell, was found to cause seizures and even death in rare cases, prompting the FDA to issue a public-health advisory against products containing lindane in 2003. While it's still on the market, the American Academy of Pediatrics (AAP) doesn't recommend it. Moreover, lice have developed resistance to lindane and other chemical treatments.
Thankfully, head lice don't transmit disease and they may be less common than we think. Although there are an estimated 6 to 12 million reported cases of head lice annually, Richard J. Pollack, Ph.D., an entomologist at the Harvard School of Public Health, says that dandruff, dirt, and tiny clumps of scalp cells called DEC plugs are all often mistaken for nits.
But if head lice strike your household, take comfort in knowing there are now a host (sorry!) of treatment options. So many, in fact, that you'll need this handy guide to figure out which is best for your family.
Are you most comfortable with a removal method that's been around a while? Choose one of these.
Louse- and nit-combing This is the oldest approach. If you use it with another treatment, follow package directions for that product. If it's your sole method, slow down lice before you comb by moistening hair with any thick white conditioner (which makes it easier to get the comb through), or a dimethicone-based product such as LiceMD PesticideFree, or a mix of conditioner and baking soda (for extra grip). This way you can remove live lice and nits. For two weeks, comb the entire head every day or so, targeting a small section at a time and starting as close to the scalp as possible. Most experts recommend using a metal nit comb (found at drugstores) and wiping off the nits and lice frequently. The process can take more than an hour and works only if you get every louse and viable egg. (Put on a movie for your kid!)
Over-the-counter chemical treatments These include the brands Nix (for kids 2 months and up) and Rid (2 years and up). They get their power from the chrysanthemum flower, either through its extracts (pyrethrin) or a synthetic version (permethrin). Treatments that have these ingredients are the only OTC products that are FDA-approved to treat head lice. They come in a rinse or a shampoo you leave on the hair for ten minutes, but they can't completely kill the eggs, so you'll need to nit-comb and re-treat nine days later to kill any newly hatched lice. These products have been used for years, but lice are becoming increasingly resistant to them. However, the AAP still recommends this type of treatment as the first line of defense. "It has the longest safety track record, it's available without a prescription at a fair price, and it will work in the majority of cases if used correctly," says Barbara Frankowski, M.D., professor of pediatrics at The University of Vermont College of Medicine and coauthor of the AAP's most recent report on head lice.
Malathion This lotion (brand name: Ovide, for ages 6 and up) is an insecticide commonly used to fight agricultural pests. It's about 90 percent effective, but is also flammable and needs to be left on a child's head for eight to 12 hours. It's supposed to kill lice and eggs in one treatment, though you can re-treat in seven to nine days if needed. It's available only by prescription and is the only Rx treatment that comes in generic form (which costs less).