Best Ways to Fight Lice

You've discovered the little bugs in your child's hair. Now what?

Your kid with head lice joins the 6 million to 12 million children in the U.S. that the Centers for Disease Control and Prevention (CDC) estimates are infested each year. We consulted experts for the best way to get rid of these common and pesky parasites.


Over-the-Counter and Rx Treatments

There are many over-the-counter products available to treat head lice -- some of them a little zany, such as the electrified comb that "zaps" bugs. "But the most effective strategy is to treat and then brush with a nit comb daily until there is no longer evidence of nits," says Paradi Mirmirani, M.D., a board-certified dermatologist with the American Academy of American Dermatology (AAD). Don't worry about contracting lice by simply treating your child. "Lice don't jump," says Dr. Mirmirani. "You can't get lice from looking at or touching your child's hair." (See the "Prevention" section for all the ways lice can spread.)

The most common OTC treatments are shampoos containing bug killers such as pyrethrin (in the product RID) or permethrin (in the product Nix). If these over-the-counter treatments don't work, your doctor may prescribe prescription-strength solutions, listed by the AAD:

- Malathion lotion is a hair-and-scalp medicine for children 6 and older that paralyzes and kills lice and nits. It's very potent and can irritate skin.- Lindane shampoo is FDA-approved to treat head lice. It can be toxic when misused.- Benzyl alcohol lotion treats head lice in children 6 months and older, but it doesn?t kill eggs, so repeat treatment is important. Irritated skin is a common side effect.

Careful Use

The AAD suggests guidelines for using all of these over-the-counter products on your child:

Use only one product. Using a combination of two products to treat head lice can be dangerous, unless your dermatologist or doctor says otherwise.

Follow the directions. Lice shampoo usually requires lathering and leaving the product in for a few minutes. Use only recommended amounts.

Use the provided lice comb. The densely packed teeth snag stray bugs.

Examine the hair 8 to 12 hours after treatment. If the lice are as active as they were before the treatment, call your doctor or dermatologist. Your child may need a different product.

Follow up the next day. If the medicine seems to be working the next day, wait two days to wash hair so that the product will continue to work.

Continue combing out. Use the lice comb for two to three weeks to ensure that all lice and nits are removed.

Repeat treatment as recommended. Most products recommend another treatment in seven to nine days, which should get rid of any lice that may have hatched since the first treatment. Use as directed, and repeat all the steps of the first treatment.

An Alternate Method

Sally Kelly, R.N., is a school nurse who makes lice-removal house calls in the Chatham, New Jersey, area. When she treats a child for head lice, she avoids the pesticide shampoos. "The only way to completely get rid of head lice and nits is to physically remove them," says Kelly. "Pesticides are generally 92 to 94 percent effective, so you'll need to use a nit comb anyway. Why apply pesticides when you'll need to do all the same steps as the natural method anyway?"

Here's a quick rundown of her routine:

1. Initial comb-through. Kelly begins with a very thorough combing, using the LiceMeister comb; its teeth are 1 to 2 inches long and very close together, which helps snag nits and lice (it's available online). If your child has thin hair, first dip the comb in conditioner. Any cheap, thick kind will do, says Kelly; white conditioner works best because you can see the bugs against it more easily. Then dip it in a dish of baking soda, which adds abrasion. For coarse hair, dip the comb only in conditioner. Work through very small sections of hair at a 45-degree angle -- up, down, back, forth -- while also making sure to run the comb along the scalp.

2. Second comb-through. Now wet your child's hair. Apply conditioner directly to the hair and wrap it in a towel to remove the bulk of the water, leaving the conditioner in. Comb the hair again with the nit comb, this time working through slightly larger, inch-thick sections. Lice are sensitive to light, and they're fast. They'll scurry the minute you expose them, so work quickly while still making sure to cover every area. When you're finished, boil the comb for a few minutes or disinfect it with a 20-minute dip in ammonia (or you could run it in the top rack of the dishwasher). Repeat this step every day for five days. Change your child's pillowcase and bath towel on each of these days.

3. Delousing. On the first day, wash your child's bedding. Also dry pillows, stuffed animals, and the comforter on high for 20 to 30 minutes. Wash all brushes on the top rack of the dishwasher, or soak them in ammonia for 20 minutes, or boil them for a few minutes. Roll a sticky lint brush over the top half of the bedding each day for five days. Vacuum rugs or furniture your child has lounged on in the past 48 hours -- the maximum length of time a louse can live off of the human head.

4. Follow-up. This final comb-through is very important to make sure all traces of nits and lice are gone. Two weeks from your initial combing, do it one more time.

Know how to properly check and treat your child for head lice. Video courtesy of Le Bonheur Children's Hospital.

What Doesn't Work

You've probably heard many wives' tales about how to get rid of head lice. Crisco, butter, tea tree oil, rosemary -- none of them are as effective as combing out rigorously and regularly with a nit comb. "I treat the people who've used those, and they have head lice," says Kelly.

Some parents buzz their child's head, but because nits are so close to the scalp, it's very difficult to shave close enough to actually remove them. "You'd have to shave the head bald, if you're using that method," says Kelly.


The AAD suggests teaching your child to avoid sharing items that touch the head, such as:

- Brushes- Combs- Hair accessories- Hats- Helmets- Scarves- Towels- Ear buds

When a child in the house has head lice, the rest of you should avoid the couches, chairs, pillows, rugs, and beds of the infested kid until you've done the vacuuming and other cleanup. It's also good to teach your child to avoid head-to-head contact, which can happen when kids stand close together to pore over a video-game screen or tablet.

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