How should lice and nits be treated in a child? - briefly
Apply an FDA‑approved pediculicide (such as 1 % permethrin lotion) to the child’s hair, follow the label‑specified contact time, rinse, and repeat the application after 7–10 days. Then comb out all viable nits with a fine‑tooth nit comb and launder clothing, bedding, and personal items in hot water to prevent reinfestation.
How should lice and nits be treated in a child? - in detail
Effective management of head‑lice infestation in a pediatric patient requires a systematic approach: confirmation, pharmacologic eradication, mechanical removal of eggs, environmental decontamination, and follow‑up assessment.
First, verify the presence of live insects or viable eggs. Live lice appear as six‑mm, grayish‑brown insects moving quickly on the scalp; nits are oval, firmly attached to hair shafts within ¼‑inch of the scalp. Use a fine‑toothed comb on damp hair to improve visibility.
Second, apply an approved topical pediculicide. Options include 1 % permethrin lotion, 0.5 % malathion cream, or 0.05 % ivermectin lotion. Follow manufacturer instructions regarding application time, amount, and repeat dosing—typically a second treatment 7–10 days after the first to eliminate newly hatched lice. Prescription options (e.g., benzyl alcohol 5 % lotion, spinosad 0.9 % suspension) are appropriate when resistance to over‑the‑counter agents is suspected.
Third, remove eggs mechanically. After chemical treatment, comb the hair with a fine, metal lice comb at 5‑minute intervals for three consecutive days. Divide hair into sections, pull each section taut, and run the comb from scalp to tip, wiping the comb after each pass. This process eliminates residual nits and reduces reinfestation risk.
Fourth, decontaminate personal items and the environment. Wash clothing, bedding, and towels used within the previous 48 hours in hot water (≥ 60 °C) and tumble‑dry on high heat. Items that cannot be laundered should be sealed in a plastic bag for two weeks. Vacuum carpets, upholstered furniture, and car seats; discard vacuum bags promptly. No fumigation or insecticide sprays are required for the home environment.
Fifth, monitor for treatment failure. Re‑examine the child 1–2 weeks after the final application. Persistent live lice indicate possible resistance, incorrect application, or reinfestation; consider switching to an alternative pediculicide or adding oral ivermectin under medical supervision.
Finally, educate caregivers on prevention: discourage head‑to‑head contact, avoid sharing hats, hair accessories, and combs, and perform routine scalp inspections in schools or daycare settings. Consistent application of these steps yields a high success rate in eliminating infestation and preventing recurrence.