Lice on a child: what should be done and what treatments are available? - briefly
Inspect the child's scalp, comb out nits with a fine-tooth comb, and treat the infestation with an FDA‑approved pediculicide such as permethrin or a prescription option like malathion, then wash bedding, clothing, and personal items in hot water to prevent re‑infestation.
Lice on a child: what should be done and what treatments are available? - in detail
Head lice infestations in children require prompt identification, thorough removal, and environmental decontamination. Early detection relies on visual inspection of the scalp and hair, focusing on the nape, behind the ears, and near the crown. Live insects, nymphs, or viable eggs (nits) attached firmly to hair shafts indicate an active problem.
Immediate actions
- Separate the affected child from classmates for a minimum of 24 hours to limit spread.
- Wash all bedding, clothing, and personal items in hot water (≥ 130 °F/54 °C) and tumble‑dry on high heat for at least 20 minutes.
- Seal non‑washable items (e.g., stuffed toys) in sealed plastic bags for two weeks, a period that exceeds the lice life cycle.
- Vacuum carpets, upholstered furniture, and car seats to remove stray nits and insects.
Pharmacologic treatments
- Permethrin 1 % lotion – applied to dry hair, left for 10 minutes, then rinsed; a second application 7–10 days later eliminates newly hatched lice.
- Pyrethrin‑based shampoos – combined with piperonyl‑butoxide to enhance efficacy; repeat treatment after 7 days.
- Spinosad 0.9 % suspension – a single application sufficient for most cases; no repeat needed.
- Malathion 0.5 % lotion – reserved for resistant infestations; requires a 12‑hour exposure before washing.
- Ivermectin 0.5 % lotion – prescription‑only, applied for 10 minutes; effective against resistant strains.
Non‑chemical options
- Manual removal – fine‑toothed lice combs used on wet, conditioned hair; repeat every 2–3 days for two weeks.
- Dimethicone‑based products – silicone oils that suffocate lice; minimal risk of resistance.
- Essential‑oil preparations – tea tree, lavender, or neem oil may have modest activity but lack robust clinical validation; should be used adjunctively, not as sole therapy.
Post‑treatment verification
- Re‑inspect hair 7 days after the initial application; any remaining live lice require retreatment.
- Continue weekly combing for an additional two weeks to capture late hatching nymphs.
- Notify schools, daycare centers, or other caregivers to initiate parallel checks and treatment if necessary.
Prevention strategies
- Discourage head‑to‑head contact during play.
- Avoid sharing combs, hats, hair accessories, or pillows.
- Maintain regular hair‑care routines that include periodic comb checks, especially in communal settings.
Adhering to this systematic approach—prompt isolation, evidence‑based treatment, thorough cleaning, and vigilant follow‑up—effectively eliminates head lice and reduces the likelihood of recurrence.