Don't Let the Hair Bugs Bite!

Good night, sleep tight, don’t let the hair bugs bite!

Confession: I’ve had lice.  It’s gross.  It’s itchy.  They’re really, really hard to get rid of.  But I can count it as a ‘good’ parenting experience in that I can fully empathize with my patients when they tell me they’ve tried everything.  I meant to post all about lice when school started.  However, time got away from me and since there are a lot of lice outbreaks going on right now, I though it was a good time as any to talk about it.

First off:  lice can go to any person—clean or dirty, small or tall, rich or not so rich.  We’ve all been there.  They don’t show any particular predilection, except for the fact that they can ONLY live on humans.  So besides doing all the hair cleaning, you also need to clean up your bedding, your stuffed animals, your jackets etc.

How can you tell if you or your child has lice?  The first place to look is at the layers of hair at the back of your head above your neck (also known as the occiput).  This is the most likely spot for them to hang out.  Check the hair shaft for small, white, shiny specks that you CANNOT flick off.  If you can flick it off, it is dandruff.  Or, in my house, sometimes it’s glitter.

Cleaning House

Rule of thumb: wash all sheets and bedding in hot water and place in medium/high dryer for at least 20 minutes.  Anything that can’t be washed or dried but still live on your kid’s beds or are snuggled often(i.e. Certain dolls and stuffed animals) can be tied up in a garbage bag for at least 2 weeks.  Some people say one month but my girls had a big outcry when we had a lice outbreak several years ago.  It’s a balance between really making sure that the nits have hatched and died with being reasonable.  As I said above, lice only live on humans and their egg hatching time can be up to nine days or so.  So if you’ve left the dolls for two weeks, you’re good.

Another rule: do not share hair brushes or hair ties or hats and scarves.  Currently there are many lice outbreaks happening at local schools.  To prevent unwanted stow-aways in your kids’ hair, tie up their hair if possible.  And tell your kids not to hug their friends, for now.  :D There are many lice-prevention hair sprays on the market—if they have tea tree oil, then they might work.  Live lice tend to be repelled by tea tree oil.  Others additions that may help include peppermint and rosemary, though tea tree oil seems to be the one backed up by current scientific data.

A hair louse. Gross, right? Photo from wikipedia.

Lice Removal:

As for getting rid of the lice?  You can use over-the-counter medicinal products like Nix or Rid but there is a high incidence of resistance.  These medicinal shampoos will only target the adult lice and not the nits/eggs.  
** Rid has Piperonyl Butoxide (4%), Pyrethrum Extract (Equivalent to 0.33% Pyrethrins)
** Nix has 1% Permethrin, Ultra Nix supposedly has a higher concentration but I can't verify it.
It’s the 1% Permethrin that we tend to prescribe because it has more ‘-cidal’ or killing effect rather than ‘-static’ or immobilizing effect.  If you have a highly resistant strain, your pediatrician may prescribe you Topical Ivermectin (0.5%).  I ended up using the Ivermectin (Sklice) for me and Little Lion when we got lice several years ago.  The over-the-counter Nix triggered my asthma and made my scalp itchy so I couldn’t tell if I had gotten rid of everything.  However the biggest help was actual combing through every night—see below.  FYI, Ivermectin is very expensive--we paid $120 for one tube as we have a high deductible.  And I used it for everyone in the house even though you're supposedly aren't supposed to share it.

Nit/Egg Removal:

You know that saying ‘nit-picking’?  It came about for a reason.  But in order for you NOT to have to pick out your child’s nits one by one, you need to buy a fine-toothed metal comb and comb through your child’s hair.  Adult lice will be crushed through the teeth and eggs will come out as well.  I usually tell people to use a disposable tupperware with some olive oil and use both that and conditioner to comb through the hair in sections.  

You can also hire a nit/lice remover!  Some specialty salons offer this service and some places will come to your house.  When Little Lion Bookworm had lice, she was in a private preschool that required these services before returning to school.  They’re not cheap.  But I understood why they were strict about it because when Mini Me was in kindergarten at the same school, there was a terrible lice outbreak that seemed never-ending.  Luckily, Mini Me didn’t get it but I inspected her every day and I washed her jackets or anything that went to preschool with her every day.  Plus I tied her hair up every single day.  

Au Natural

If you want to go the natural route, then you can just do comb-throughs (again, fine-toothed metal comb) with olive oil and conditioner.  However, if you or your child has thick and/or long hair, you may need to do this daily for two weeks.  Been there, done that.   You can also do the tried and true method of using mayonnaise (which my mom says they do in the Philippines along with picking out the nits).  It works to suffocate the lice, but you have to be willing to keep the mayo on overnight with a shower cap.  DO NOT USE THIS METHOD FOR YOUNG KIDS WITH A PLASTIC BAG or cap as there is risk of suffocation.  It’s happened, unfortunately.  

My lovely colleague, Dr. Laura P, also told me about the Cetaphil method from Seattle Children’s.  Basically, you work Cetaphil into dry hair and then comb through the extra cleanser.  Then you blow dry the hair—yes it will become crusty!  But it’s not as oily or smelly as mayonnaise and you don’t need to use a shower cap.  Leave the cetaphil on overnight and wash in the morning.  The cetaphil suffocates the lice just as good old mayo does.  See link for more info.

Blow drying in general helps as well as the eggs don’t like the temperature change.  Any little bit to get the lice killing from 95% to 100%.  Also, lice don’t like dirty hair.  The oilier the better because they can’t hold onto the hair shafts.  

Did you know that a single louse can lay up to ten eggs a day?  Yuck!  That’s why you need to get rid of the adult lice ASAP.  

Disclaimer: this is not medical advice.  There are likely other articles with more comprehensive advice.  I’m just telling you what has worked for me and my kids and my patients.  If you or your child have lice and it’s out of control, go see your pediatrician.  But please warn them before they examine you.  Because even we doctors scratch our heads after seeing kids with lice.