March 28th, 2011
08:41 AM ET

How should I treat my daughter's lice?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Mondays, it's pediatrician Dr. Jennifer Shu.

My 10-year-old daughter was just treated for lice for the third time this school year. What's the best way to get rid of them, and how can I make sure she doesn't get it again?

Asked by Carol of Dunwoody, Georgia

Thanks for your question. Head lice is very common in children, especially between 3 and 12 years of age. The insects can be found crawling around the hairline and lay their eggs on the hair shafts close to a person's scalp. Lice do not carry infectious diseases and are not a sign of a person's cleanliness, but they are a nuisance and can be difficult to treat.

Lice are transmitted from one person to another by direct contact (lice must crawl from one head to another; they do not jump or fly), and can spread during sleepovers or when working or playing closely together. The insects may also move from one person to another if objects such as hats or hairbrushes are shared.

The key to getting rid of lice is to remove all live lice and prevent eggs that are attached to the hair from hatching. There are many possible treatments, ranging from physically removing the bugs and their eggs from the hair to using medicated products to kill the lice and/or their eggs. If the eggs are not removed, they may hatch after a week or two, and the process to get rid of the live lice would then need to be repeated.

• Picking or combing. Both lice and eggs may be removed by painstakingly picking out or finely combing all parts of the hair. This process may need to be repeated for several days or even a few weeks to make sure everything has been removed.

• Home remedies. Many people have tried smothering lice by leaving household products such as mayonnaise, vinegar, or petroleum jelly on the hair overnight and then washing it out the next morning. Cetaphil cleanser has also been reported to treat lice. It should go without saying that one should not use potentially toxic products such as gasoline or kerosene - although they may kill the lice, they are also hazardous to children. Bottom line: If the home remedy is not harmful, it may be worth a try.

• Dry heat. A special machine called the LouseBuster delivers a controlled amount of heated air to dry hair with the goal of killing both lice and their eggs. It is designed for use by trained individuals in settings such as schools, camps, or clinics. Regular hair dryers can cause live lice to become airborne and spread to other people nearby and are therefore not recommended.

• Medicated treatments. Over-the-counter medicated lotions such as permethrin (Nix) and pyrethrin formulations (RID or Pronto) can be very effective in killing live lice. Prescription treatments such as benzyl alcohol (Ulesfia) and malathion (Ovide) may be successful even if the lice are resistant to the over-the-counter preparations. Ask your doctor which one is recommended in your community, and be sure to follow the product directions regarding how much to use, whether to apply to wet or dry hair, and how long to leave it on before washing. These products often need to be repeated within 7 to 10 days.

• Lice removal services. Some caregivers may choose to outsource the lice removal process to companies dedicated to getting rid of head lice. These companies may rely upon a combination of the above therapies.

• Treat the environment. It can be helpful to wash and dry clothing and bedding using hot water and high heat and to vacuum furniture, carpets, and car seats. Consider placing items that are difficult to wash (such as stuffed animals and pillows) in a plastic bag for two weeks to be sure that any remaining eggs will not hatch and survive.

• Avoid contact with lice. Even if you successfully remove all the lice and eggs from your daughter's hair, it's possible to be reinfested by someone else who has not been adequately treated. Teach children to be extra careful to avoid touching heads with one another. It's also a good idea to keep hats, jackets, combs, brushes, towels, and other personal items separated, although once a louse has been removed from its human host, it will die within a day or two unless it finds another warm scalp to live on.

• Extreme measures. While shaving a child's hair can definitely also remove lice and eggs, this drastic step is often not necessary.

Please be sure to contact your child's pediatrician if you have any other questions. Good luck!

soundoff (249 Responses)
  1. Melanie26

    I am a pedi nurse and in our clinic we use the Cetaphil treatment (OTC)or the Ulesfia(prescription). Both get great results especially need to do the nit picking and cleaning of the home goods. We have found the lice to be resisitant to OTC products like Nix or Rid.

    March 29, 2011 at 05:25 | Report abuse | Reply
    • Monica

      Yes we found that Nix, Rid and a store brand left some bugs literally still running in my 2 girl's heads! We finally called the pediatrician and were referred to a local lice removal company. We used the Lice Ladies of Atlanta and we finally got rid of it. I think these services are great and I am so happy my pile of laundry is finally done! It's such a nightmare we went through. I wish the schools did more to check all of the students hair properly! I know of 3 families that have been treating on their own for months and they keep spreading it!

      October 29, 2011 at 21:22 | Report abuse |
  2. Irene

    The only thing that ended up working for us was the robicomb. It had a battery in it and you would fine comb the hair every night for two weeks. It would shock and kill the lice as they hatched and after two weeks the life cycle was over.

    My daughter got lice as recently as 7th grade and her hair was waist-length. What a nightmare!

    March 29, 2011 at 06:56 | Report abuse | Reply
  3. National Pediculosis Association (NPA)

    Routine screening and early detection is the key! The CNN article failed to warn about the risks of pesticide treatments for lice especially for children with pre-exisitng health problems not to mention when one treatment is followed by another. FDA acknowledges that the products are not effective. This is why there are 2 applications recommended with each treatment. Chasing lice with chemicals is a losing proposition for everyone but the lice.

    And yes - nit picking can be challenging when infestations go unnoticed. 🙁 So be proactive rather than reactive and be safe! Check the children often (here's a video to show you how to do it: http://www.headlice.org/video/index.php ) and remove the lice and nits when there are few of them. BTW - No Nit Policies can be very different from one school to another. You can read NPA's fully referenced No Nit Policy here. It may surprise you! http://www.headlice.org/downloads/nonitpolicy.htm

    March 29, 2011 at 06:59 | Report abuse | Reply
  4. Richard Pollack

    Some claim that the FDA registered pesticides are neither safe nor effective. This is a gross generalization wedded to fear mongering. Whereas some products are less effective than others, there are products that can be used safely and effectively. When used according to label directions, the products should be expected to provide far more benefit than risk. The need to retreat is NOT a sign that the products are ineffective. Rather, it acknowledges that many products are not ovicidal (egg-killing). The second well-timed application is meant to target lice once they've hatched from their protective eggs. No-nit policies, no matter in what form they are presented, lack ANY scientific or medical basis. They've never been shown to be effective. They are unjustified and are counterproductive. Independent educational information that I formerly hosted at the Harvard School of Public Health is now freely available at https://identify.us.com/head-lice/index.html. I provide links to the latest reports by the American Academy of Pediatrics, the National Association of School Nurses, and the CDC. These are each worth reading.

    March 29, 2011 at 08:12 | Report abuse | Reply
    • Eric

      It is nice to have someone like yourself with actual experience and real facts commenting on this post.

      April 6, 2011 at 09:18 | Report abuse |
  5. Sneakipete

    My children and I inherited the annoying skin disorder called Psoriasis. As a result, we have to use a coal-tar shampoo such as Neutrogena T/Gel or Pentrax. The side benefit of these shampoos is that lice don't like this shampoo. It sounds extreme, as the shampoos definitely don't smell like perfume. But the odor goes away when the hair dries; but the coal tar prevents lice. My kids have never had head lice once, and they have been in enough environments where lice is a threat. I am convinved it is because of the coal tar shampoos. If your child has a problem with lice, pick up some Neutrogena T/Gel shampoo and see for yourself!

    March 29, 2011 at 08:58 | Report abuse | Reply
    • Noemi Ferres

      Wow!! That's another great tip to have, thnaks Sneakipete. I would try anything in order to get rid of lice on my head or my daughter's head. Of course I have had lice when young, but I really read this article to see if there was any new info on this subject. My daughter started day care and for some reason lice popped in to my head as a though to make sure she doesn't get any and how could I prevent it. So thanks for this tip because I can definitely use any new info.

      April 11, 2011 at 12:16 | Report abuse |
  6. MN Mom

    We battled lice for over 3 months in our home, the OTC meds and malathion are not effective in our area, the lice are very resistant. A combination of Cetaphil treatment (OTC) w/ heat and the Ulesfia(prescription) are the only things that worked, but it still took multiple treatments and time. We had to comb their hair with the nit combs every 2-3 days to remove any hatching eggs. Tedious, yes, but worth it.

    March 29, 2011 at 09:12 | Report abuse | Reply
  7. Christina

    The most effective method is to invest the time removing all the eggs. Your best tool is a bright camping style HEADLAMP to help you spot the eggs. Put in a movie, and go to work. Plan to pick through that hair at least 3 times the first day, it will take at least an hour each time. Your back will hurt, but it works. I have ended repeat infestations for friends this way. Picking every few days is just not going to get rid of them. I also dilute tea tree oil with water in a spray bottle. Spraying that around the lower parts of the hair sends the bugs running to the top, making them easier to find.

    March 29, 2011 at 12:31 | Report abuse | Reply
  8. Nit Picky

    Nit Picky Professional Preventative Tips

    •No Sharing Personal Items

    (Brushes, Hats and Pillows)

    •Avoid head to head contact.

    (Even a hug can spread head lice)

    •Keep hair up in a ponytail or braid.

    •Use a lice preventative product.

    Order Product Here: http://www.nit-picky.com/apps/webstore/

    •Screen your child for lice or nits.

    (Look on the hair, at the nape of the neck, behind the ears, the crown and the hairline at the front of the face.)

    •Use a lice comb regularly.

    (Regular combing with a lice comb can provide early detection and prevent infestations. If lice or nits (eggs) are found early enough, you may be able to stop the infestation from spreading to other family members.)


    March 29, 2011 at 13:57 | Report abuse | Reply
  9. MMS

    Monteith Mineralized Solutions (MMS) provides a new product which is organic, safe and effective for treating head lice. It is a clear liquid (so it won't stain) and the active ingredient is cedar oil. This cedar oil extract blocks the respiratory system of the lice so they suffocate but it also organic so it won't irritate your skin and hair like other chemical products you buy in the drugstore. In fact, it can be quite a nice conditioner. You can apply it easily yourself and it will keep for several years in your medicine cabinet so you can have some on-hand for next time and nip the problem in the bud!

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    March 29, 2011 at 14:56 | Report abuse | Reply
  10. Pamela

    Parents please stay away from Lindane, a prescription "treatment" for head lice and scabies. The FDA blackboxed it in 2003 to be used with extreme caution on ANYONE under 110 pounds. In the FDA's own wording they have said that lindane has been known to cause seizures and death even when used as directed. Lindane is a second line treatment and is not to be used more than once. Using multiple treatments of any headlice product can be toxic.

    I know has my own son has life long neurological problems from lindane including numerous seizure activity.

    It has been known for many years that lice have become resistant to many of the products both prescribed and over the counter. The safest way to treat children is by using a good lice comb. The reason they are reinfested is because some schools are allowing children with lice and nits to stay in school without notifying parents of other children in the classroom.

    Like the NPA suggested be proactive, check your children regularly and if you see any lice start using the comb.

    March 30, 2011 at 00:35 | Report abuse | Reply
  11. DD

    I have battled lice since she was 3. Once my ex husband and a friend of his treated her head to much and burned and blisterd her head. I talked to her MD and she told me to get Flea, Tick, and lice shampoo for cats. Cause unlike the OTC treatments u can repeat with the shampoo everyday and it kills the lice on contact. I do her hair once a week now and check her hair everyday. Even though it is a cemical it is not enough to be a danger to the child. But it does work.

    March 30, 2011 at 08:10 | Report abuse | Reply
    • Pamela

      It's time to find a new pediatrician for your daughter ! NO doctor should recommend a flea treatment for a child. Flea treatments have caused seizures in cats and dogs along with lethargy.
      There is NO reason for you to be treating your daughter every week with any treatment other than checking her head for lice and if you find any then use a good lice comb. It's a one time purchase and then you will know you are doing what is best for her, not putting toxic pesticides/chemicals on your child.

      Childrens heads are very porous so whatever is put on their heads is absorbed thus going into the bloodstream and affecting vital organs such as the brain.

      I am worried about your daughter, please contact your local heath department, and telll them the situation. I cringe hearing that her head was burned and blistered. She really needs a total workup with a good pediatrician who will order bloodwork etc to find if there is any damage from the toxic treatments used.

      Go to headlice.org to get info on treating head lice.

      And I hope that Dr. Shu follows up on your post.

      March 30, 2011 at 09:36 | Report abuse |
    • Richard Pollack

      Human beings are physiologically different from dogs and cats. Products that are reasonable to use on one kind of animal may be far too risky on another. Considering the products available for human use, there is no justification to apply a veterinary formulation to treat a head louse infestation on a person. I, too, would suggest you find another pediatrician.

      March 30, 2011 at 10:27 | Report abuse |
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    Carol if you contact me i will take care of it for free no strings attached and teach you personally how to take care of the situation you are in.

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    March 30, 2011 at 15:19 | Report abuse | Reply
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  14. lisa

    An all natural eradication of nits and lice. Lisa Cooperman has hands of gold- with her combing technique and non- pesticide remedy. Service to NY, NJ, CT- http://www.licemedic.com 347-551-6684

    October 2, 2011 at 12:09 | Report abuse | Reply
  15. Sara

    Most parents don't realize that OTC lice products/shampoos can harm their child, and nowadays, many strains of lice have become immune to them anyways!

    Pesticide based lice shampoos are full of chemicals that are known or suspected to cause cancer, negatively affect the nervous system, or have other harmful effects.  The scalp is one of the most absorbent parts of the body – especially in children, and products that are applied to the scalp get picked up directly by the bloodstream, without being filtered in any way.  That means that these harmful chemicals are being put directly into your child’s system.

    The safest, most effective way of eliminating lice in your child's hair is manual lice removal.
    To find out more, check out our site:

    Natural Choice Lice Removal
    Los Angeles, CA
    Ventura County, CA

    February 4, 2012 at 20:30 | Report abuse | Reply
  16. Noah Lucas

    I Am a girl, and we girls worry about our hair a lot. I have really curly hair, and its frizzy so I had been using new anti frizz products. When my head started to itch, my mom told me it was because my scalp was sensitive to the products. So I stopped using it, and the itching continued. So I did some research and I figured out I had lice. I fortunately I got rid of them quickly. Then I started working with low income families kids (I am 14) and I got them again almost a year later. : ( This time was war. They had become resistant to the lice shampoos, I used them anyhow, and a few other things. First, I brushed my hair with the Robi Comb ($24 walgreens) to get rid of nits and a few lice. It kills lice by electrocution. Day 2: I went back to walgreens to buy; a spray bottle ($.99) tea tree oil ($8) and natural rosemary & other natural ingredients tea ($4) and walgreens brand shampoo and conditioner ($8 for both) and got to work. First I made tea using all of the teabags, and two cups of water, so it was very strong. Then i mixed in a little bit of tea tree oil and filled the bottle. Next I mixed in equal amounts of tea tree oil to the conditioner and shampoo. Here is the order in which I did next: 1.Brushed hair with robi comb. 2. sectioned off hair 3. sprayed each sections roots with the tea spray 4. shampooed and conditioned with the tea tree oil. and i got rid of the lice! tip: when your shampooing your hair start at your hair line all the way around your hair and go in wards towards your crown.

    February 19, 2012 at 16:56 | Report abuse | Reply
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  27. garzapi

    The use of highly toxic poisons totally misses the mark in how to deal with lice and it can cause serious damage to the health of some children. Although many medical websites recommend the use of poison, it is NOT sound medical advice. Also, it is neither scientific nor is it effective.

    So called “shampoos” and treatments contain permethrin, malathion and Lindane. Why not just go to your local garden shop, purchase a pesticide and put it on your kid’s head? At one time some of these chemicals were banned because they were hurting children and now they are back. Why? is there a chemical lobby controlling the flow of information on this issue. And where are our physicians? It's a complete shame doctors condone these products and that so many Americans continue to buy poisons to put on their children’s heads.

    Lice and their eggs can be easily removed using hair conditioner and a good comb. This method has been highly effective for my family (plus all the usual protocol for surrounding spaces such as bed, couch, car seats, hats, etc.). There is no need for anything more. In fact, I have observed that families who rely solely on finding the most potent poison, end up being the least effective in eliminating lice. This site gives good advice. http://licecombing.com/how-to-lice-comb/. Also, the combs sold in stores are worthless. there are better ones available online.

    March 19, 2013 at 03:27 | Report abuse | Reply
  28. Smscott

    Actuallly... Ive done the research and flea and tick shampoo contains the EXACT same chemicals as RID and in slightly lower concentrations. So Please explain to me exactly how thats "not safe" to put on a child but RID is? my only thing is you might have to use more since the chemical concentrations are a bit lower.

    April 3, 2013 at 11:50 | Report abuse | Reply
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    June 21, 2013 at 23:05 | Report abuse | Reply
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    December 2, 2013 at 07:04 | Report abuse | Reply
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    November 26, 2016 at 00:23 | Report abuse | Reply
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