Lice is a very common childhood nuisance. If your child has been diagnosed with head lice don’t despair–take a deep breath, clear your calendar for the day, and read on:

Treatment of head lice is a two-pronged approach, you need to treat the live lice, and remove the eggs, or nits, that cling to the hair shaft. Unfortunately there is significant resistance to over-the-counter lice treatments in our area, thus we recommend a secondary form of treatment as well if this is your second bout, or you want to be ultra-cautious.

The CDC has an excellent review of the topic found here:

The AAP also has a great review found here

  1. Examine the whole family carefully for lice and nits. Even just one nit indicates infestation.
  2. Shampoo all those affected (or just do the whole family) with RID or NIX- pesticides available over-the-counter and effective only for live lice. Alternatively you can try LiceFreee!, a sodium chloride treatment that does not contain pesticides and will also only kill live lice. RID and NIX are still usually the first-line lice treatment. However; lice have been growing resistant to pyrethroids, likely due to a particular genetic mutation. This mutation appears to be virtually universal in the U.S., which would suggest that the first-line treatment is mostly useless.  See below for second line treatments. After treatment, rinse with a dilute white vinegar solution, this will help loosen the protein that holds the nits in place on the hair shaft.
  3. Comb out any nits you may see. Invest in a fine, metal nit comb. This work is tedious, but a thorough removal of nits will ensure no recurrence.
  4. If you prefer to avoid any chemical treatments, you can very carefully comb thru wet hair and remove all live lice and nits without shampooing.
  5. Soak combs and brushes in hot water (at least 130°F) for 5–10 minutes.
  6. Change pillowcases and sheets before treatment and one day following.
  7. Any items that have come in contact with your child’s head in the last 2 days should be washed on a hot cycle and dried on high heat OR dry cleaned OR put away in a bag for two weeks (i.e. stuffed animals.) Lice cannot live off of a live host for more than 24 hours, and nits need to be on a hair shaft at approximately body temperature to stay alive- you are much more likely to get lice from an infested head than from an inanimate object or bedding.
  8. Use a vacuum and lint roller on couches, chairs, car seats that came in contact with your child’s head in the last 2 days.
  9. Check your child’s hair daily for one week, then every other day for another week. Retreat if you continue to find live lice, or if at one week if you continue to find new nits. We recommend considering a second line prescription treatment such as SKLICE (Ivermectin) or ULEFSIA (benzoyl alcohol lotion). Both of these medications are now available over the counter.
  10. Children may return to school once they have been treated and are free of live lice (NO NEED TO MISS SCHOOL JUST FOR NITS). Remaining nits should be removed as seen, but many represent dead eggs that were missed at the first comb-thru and do not pose a risk to other children. If you find live lice after treatment, you will need to retreat prior to sending your child back to class.