Head Lice In Children: Causes, Treatment, Remedies And Prevention

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Head lice infestation may not be a severe problem, but it certainly is bothersome and contagious. These tiny parasites look like sesame seeds, stay on the scalp, feed on small amounts of blood, and live for about 28 days (1). During this period, their saliva irritates the scalp and causes itching that may lead to a skin infection.

Parents find head lice embarrassing and often think that they are a result of poor personal hygiene, but that is not the case. Head lice can affect anyone irrespective of their hair hygiene. Preventing their spread is the best way to avoid them.

In this post, we tell you about the causes of head lice in children, effective home remedies, and treatments that could provide relief to your child.

What Are The Causes Of Head Lice In Children?

In the US, around 6-12 million children between the ages of three and eleven get affected by lice infestation every year (2) (3). Some of the prominent reasons for head lice infestation are:

  1. Head contact: The most common cause of head lice is head-to-head contact with a person/child who is infested. This type of contact is common among children who go to playschool, daycare, and schools. The ease of spread through head contact is what makes head lice quite contagious.
  1. Sharing clothes and other belongings: Sharing personal belongings, such as clothes, caps/hats, sports uniforms, ribbons, combs, towels, etc., can cause the spread of hair lice or lice eggs.
  1. Sharing the same spaces: This is an unusual cause of lice spread, but sharing spaces like a bed or couch with an infected person can increase the probability of lice infestation.
  1. Boys are less affected than girls.

According to the CDC, pets, like dogs, cats, and other animals, do not have any role in the spread of lice. Head lice are not known to spread any diseases. 

What Are The Symptoms Of Head Lice?

The primary indicator is the continuous scratching of the scalp. It is something that a parent, caregiver, or teacher can quickly identify. Head lice infestation also irritates the back of the neck and the skin behind the ears.

Here are the various other symptoms of head lice infestation (2) (4).

  1. Ticklish feeling in the hair: An adult lice moving on the scalp will make your child feel ticklish. The child may also sense something crawling in the hair. This movement also triggers itching.
  1. Irritation and difficulty in sleeping: Lice are quite active in the dark. Therefore, the scalp might feel itchier at bedtime, and the child scratches it often.
  1. Sores leading to infection: Repeated scratching can rupture the sores caused by bites. The sores can get infected with bacteria present on the skin.
  1. Abrasions may be seen on the scalp, the neck, and behind the ears.
  1. The lymph nodes in the neck and behind the ears may enlarge. Most children may not show any symptoms beyond repeated scratching of the scalp. Check the scalp and hair of the child if head lice are suspected.

Most children may not show any symptoms beyond repeated scratching of the scalp. Check the scalp and hair of the child if head lice are suspected.  

How To Check For Head Lice In Children?

The most effective way to keep a check on head lice is to inspect the child’s head regularly. It will help you spot nits (lice eggs) and lice before they can substantially multiply.

You can follow these simple steps to check for head lice (3).

  1. Make your child sit in a comfortable chair or couch in a properly lit room.
  1. Take a fine-toothed comb and run it through the scalp while parting the hair in small sections.
  1. Wet combing appears to be more effective than dry combing
  1. Apply a lubricant to the hair such as a hair conditioner.
  1. Look carefully for lice, nits, and nymphs.
    • Eggs are attached to the hair within six millimeters or a quarter inch away from the scalp. Eggs over six millimeters away from the scalp are either dead or are empty eggshells.
    • Lice eggs or nits are oval-shaped and appear white or yellow. Eggs can be mistaken for dandruff or dust, but unlike these two, nits cannot be flaked out of the hair. Lice eggs are firmly attached to the hair shaft.
    • Nymph (young louse) and adult head louse are tan to grayish-white in color. A nymph looks similar to an adult head louse but with a smaller body.
    • Check for nymphs and adult lice in the comb bristles. The use of magnifying glass is recommended. Inspect parts of the scalp where the hair is dense, such as above the ears and near the neck.

If you suspect lice infestation, then prompt treatment is essential. Timely treatment can prevent the multiplication of lice on the scalp and problems such as constant itching and bite sores. 

Home Remedies For Head Lice In Children

Herbalists and natural remedy experts suggest using simple and effective home remedies or natural medicines for relief from lice. You can try these natural treatment options after consulting a doctor.

1. Wet combing

This traditional method can be tried without any anti-lice products. Wet your child’s hair, spray it with any hair conditioner, and leave it for 10-15 minutes. Then, comb using a fine-tooth comb. Rinse the comb with water to check for the presence of lice.

This method is medicine-free and inexpensive. However, it needs time, effort, and patience. Your child has to sit for a long time with wet hair. Wet combing needs to be repeated on the 5th, 9th, and 13th day from the first day. The child may attain relief in 17 days (5).

2. Suffocating the lice

Apply oil, such as olive oil or almond oil, to your child’s head, and leave it for a few minutes. Then using a nit comb, comb your child’s hair in sections. After each swipe through the hair, wash the comb under warm running water.

After combing the hair, wash your child’s head with shampoo. Follow this procedure every day for a week, and nit comb your child’s head daily to ensure that no live lice or nits are left. Some people prefer to apply oil on the comb instead of scalp. You may try both ways to see what works for your child.  

3. Essential oils

Some people use essential oils, although there is no scientific evidence to prove that they work against lice. You should also check for allergies through a patch test. Some of the oils that you could try are tea tree, lavender, eucalyptus, and peppermint. To prepare a mixture:

  • Put the mixture in a spray bottle and drench your child’s hair with it. Leave the mixture on the hair for 12 hours.
  • Comb your child’s hair with a nit comb and wash it with a mild shampoo. 

4. Vinegar

Vinegar is an aqueous solution of acetic acid that you can use to remove lice. Alternatively, you can use organic apple cider vinegar, as well. Apply vinegar to your child’s scalp and leave it for 15 minutes. Wash hair with a mild shampoo and do wet-combing. Some parents oil their child’s hair after washing and then comb it with a nit-comb. 

5. Salt and vinegar

Salt and vinegar solution is an old practice to remove lice. Mix equal parts of salt and warm vinegar, transfer the mixture into a spray bottle, and spray it on your child’s head. Drench the head with the liquid, cover the scalp with a shower cap and leave it for a couple of hours. Rinse hair with a mild shampoo and nit comb to remove the lice. Repeat once every three days. 

6. Garlic

The use of garlic is another old practice. To use this home remedy, you need to:

  • Add ten garlic cloves to lime juice and grind them into a paste.
  • Apply this mixture on your child’s scalp and cover it with a shower cap for 20-30 minutes.
  • Rinse with warm water and comb the hair using a nit comb to remove any live/dead lice and nits.

7. Onion juice

Onion juice is believed to be an effective remedy for lice. To use it:

  • Take a medium-sized onion and grate it to make juice.
  • Apply this juice on your child’s scalp with a cotton ball. Leave the juice for three to four hours.
  • Wash with a mild shampoo and nit comb the hair while the hair is still wet. Repeat this every alternate day for the best results.

8. Anise oil

The use of anise oil in children has shown effective results against lice infestation, with no severe side effects. Anise oil, when applied on hair, can suffocate the lice by blocking the air channels of the insect, leading to anoxia and death (6). Some natural remedy experts suggest covering the hair with anise oil and leaving it for at least eight hours, and then, using a nit comb to remove lice/nit. Rinse the hair with a mild shampoo; repeat the process three to four times a week.  

9. Neem oil

Neem is a natural insect repellent. Several neem-based shampoo and lotions have shown effectiveness against lice (7). However, before using herbal oils for children, consult a herbalist or a doctor. 

10. Hairdryers

Blowing hot air from a hairdryer has helped some individuals get relief from lice. However, the effectiveness and safety of this method are not completely known. If you are blowing your child’s hair with a hairdryer, do it outside the house to prevent lice from falling on surfaces from where they can re-infest the child or someone else.  

11. Baking soda

Baking soda is commonly used to remove head lice. To use baking soda:

  • Mix a part of baking soda with three parts of the hair conditioner.
  • Apply this mixture on your child’s hair and comb the hair in sections using a nit comb.
  • Use a soft tissue to wipe off the comb and remove the nits, nymphs, and adult lice.
  • Rinse the hair with anti-lice shampoo.
  • Repeat the process three to four times a week to see results.

Most home remedies have minimal scientific evidence but are propagated through anecdotal evidence. These home remedies may or may not work for your child. You may try multiple remedies but only after confirming their safety. 

Treatment For Head Lice In Children

In some cases, severe lice infestation might lead to problems such as iron-deficiency anemia (8). Allergic reactions to lice bites and feces may also happen.

1. Anti-lice hair products without prescription

Several anti-lice hair products, such as medicated shampoos, creams, and lotions, are available without a medical prescription (9). These can be used for children to remove head lice.

  • These products contain active ingredients, like permethrin, malathion, or pyrethrin. These compounds are insecticides and can be present in different concentrations. If you are not sure about the product to choose, then consult your doctor or pharmacist.
  • Since these products are chemical-based, they may irritate your child’s scalp and aggravate itching. Their smell can also bother the child. In either case, be cautious and discuss the product’s use with a doctor.
  • You may need re treatment with non-prescription anti-lice products. It means that you will have to treat your child again about a week after the first lice treatment (first application) to kill any lice hatched from remaining eggs.
  • Sometimes, the lice may become resistant to the topical use of a specific insecticide. In such cases, the child may require a combination of insecticides or an insecticide at a higher concentration. Prescription oral treatment might be needed in severe lice infestation or when lice display resistance against most topical insecticides.

Always check for the safety of the products for your child’s age. Consult a doctor in cases where you are not sure about re treatment, the lice are resistant, or the product seems to cause skin irritation.  

2. Anti-lice treatment with prescription

These head lice medicines are approved by the FDA and are available as prescription medications for head lice treatment 

  • Benzyl alcohol: When used as directed, a 5% benzyl alcohol lotion is considered an effective treatment to remove head lice. The compound does not eliminate lice eggs. Thus, a second treatment is needed seven days after the first treatment to kill any newly hatched lice.
  • Ivermectin lotion: Topical 0.5% ivermectin lotion is effective in most cases without the need for nit combing. Re treatment might be required if directed by the doctor. 
  • Malathion lotion: Malathion lotion in 0.5% concentration is safe and effective when used as directed. It kills lice as well as the eggs. Retreatment is usually needed if live lice are present seven to nine days after treatment. Malathion can irritate the skin, and the compound is flammable. Thus, the lotion should be applied to wet hair. Do not use a hairdryer on your child’s hair after the application of malathion. The child should also stay away from other heat sources. 
  • Spinosad: The topical use of spinosad in 0.9% concentration is considered useful in killing live lice as well as unhatched eggs. The product usually requires no nit combing and no re treatment. The doctor may consider re treatment only in cases where live lice are visible seven days after the first treatment.

The child’s doctor may consider lindane shampoo as the second line of treatment. The use of any prescription and the non-prescription product should be done only under medical guidance.  

Refractory Infestations

The most common causes of treatment failure are:

  • Failure to adhere to therapy
  • Continued contact with infested individuals
  • Resistance to topical therapy

Prevention Of Head Lice In Children

There is no particular method to prevent lice. These precautions can reduce the possibility of the spread to some extent (10).

  1. Instruct children to avoid sitting too close with other children to avoid head-to-head contact.
  1. Tell them not to share their personal items, such as combs, caps, hair ribbons, and other pieces of clothing with others.
  1. If a family member or sibling of the child is infested with lice, then keep their personal items separately.
  1. Wash things, such as hats, bed sheets, pillow covers, brushes, or combs, that have been in close contact with someone who has lice. Machine wash using hot water (130°F/54°C) laundry for at least five minutes.
  1. Use a high heat drying cycle to dry the washed clothes, if your washing machine has the heat drying feature.
  1. Seal and keep all the un washable stuff like stuffed toys in a plastic bag and store them away for at least two to three weeks. This will cause any lice or nits on the items to perish.
  1. Vacuum cleaning floors and furniture where lice may have fallen is advisable.
  1. Soak items like combs, brushes, hair ties or rubber bands, and headbands in hot water.
  1. Head lice are contagious, so check and treat all the members at home to help prevent re infestation.

In general, it is believed that children who have head lice should not go to school to prevent the spread. In fact, some schools have “no-nit” policies. However, prominent organizations, including the American Academy of Pediatrics (AAP), discourage such policies and advocate that no child should be excluded due to head lice (1).

You can try various natural remedies and over-the-counter medications for lice. However, if they do not seem to be effective,  then consult a doctor. Prompt and regular care can help alleviate or eradicate the infestation.

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