What to Do If Your Child Has Lice

Getting rid of lice can be difficult. Treatment requires two steps. The first step is to kill all of the live lice. This can be achieved either by smothering the scalp with petroleum jelly (Vaseline), mayonnaise, or oil to suffocate the lice or by washing with a medicated shampoo. If you choose to use a suffocant, leave it on the scalp overnight. A shower cap will keep the pillow clean and makes the process a little more manageable. Even the shampoo should be left on for 1 to 8 hours, rather than the 10 minutes rec­ommended in the directions, for best results.

Given the life cycle of a louse, it is clear that a single attempt to kill all of the live lice does not get rid of the infestation. Hundreds of unhatched eggs can survive the initial treatment. So a treat­ment designed to kill live lice must be repeated a week later to address the previously unhatched eggs. In addition, topical treat­ments are rarely left on long enough to kill all of the existing lice. The survivors can become resistant to the treatment, eventually creating a bigger problem.

The second step in lice treatment is physical removal. This is done using a fine-tooth comb. By combing through each hair, the nits can be plucked off the hair shafts and the eggs weeded out of the scalp. Some lice will remain affixed to the shafts, but the comb can damage the insects’ legs, thus reducing their ability to hold on to the hair.

Each and every nit and egg needs to be removed to prevent reinfestation. That means that each hair must be combed through. Just a few shafts retaining nits or unhatched eggs will result in a new round of infestation. The removal process can be very time-consuming in children with thick or coarse hair. There are products available to help loosen eggs and nits that adhere to the shafts. There is also the option of simply cutting off the hair.

When does my doctor need to be involved?

Call your doctor if your child has recurrent visible lice or inces­sant itching despite attempts to treat the condition with combing and over-the-counter topical therapies.

If your child has scratched his scalp so much that the area is red, swollen, crusty, or tender, you should show your doctor.

What tests need to be done, and what do the results mean?

The presence of lice is a clinical diagnosis: when someone sees the lice or nits, the diagnosis is made. No tests need to be done.

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