Lice Management: A Guide for Families
Lice: just the word can make your head itch. But while lice infestations are unpleasant and inconvenient, they’re also very manageable with the right information, support, and tools. As a Family Nurse Practitioner (FNP), I’ve guided many families through this process, and I want to share the most current, practical advice to help you handle lice confidently and compassionately.
What Are Lice?
Lice are tiny, wingless insects that live on the human scalp and feed on blood. The most common type affecting families is the head louse (Pediculus humanus capitis). Lice are not dangerous and do not spread disease, but they can cause itching, discomfort, and stress.
Fast Facts:
Lice spread through head-to-head contact (not poor hygiene).
They do not jump or fly.
Nits (lice eggs) are often mistaken for dandruff but are firmly attached to hair shafts.
Although not as common, head lice may spread by:
Wearing clothing, such as hats, scarves, coats, sports uniforms, or hair ribbons worn by an infested person
Using infested combs, brushes, or towels
Lying on a bed, couch, pillow, carpet, or stuffed animal that has recently been in contact with an infested person
Who Gets Lice?
Anyone can get lice — regardless of age, background, or hygiene. Lice are most common in children ages 3–11, especially those in school or daycare settings where close contact is frequent.
How to Check for Lice
Early detection is key. Look for:
Live lice: tiny, moving insects about the size of a sesame seed.
Nits: oval-shaped, white or yellow eggs glued near the scalp (especially behind the ears and neck).
Itching: especially at the back of the head and ears.
Red bite marks or sores from scratching.
Tip: Use a fine-tooth lice comb and good lighting to check thoroughly.
Lice Treatment Options
There are several effective approaches, both over-the-counter and prescription.
1. Over-the-Counter (OTC) Treatments
Permethrin (Nix): safe for children 2 months and older.
Pyrethrin-based products (Rid): derived from chrysanthemum flowers.
Follow instructions exactly. Repeat in 7–10 days to kill newly hatched lice.
2. Prescription Treatments
Malathion (Ovide): for children 6 and older; flammable and must be used with care.
Spinosad (Natroba): kills both lice and nits, often no combing required.
Ivermectin (Sklice): single-dose, often effective without nit removal.
3. Manual Removal
Use a metal lice comb daily on wet hair.
Section hair and comb carefully from scalp to ends.
May take 7–10 days to fully clear an infestation.
4. Natural Remedies?
Tea tree oil, mayonnaise, or essential oils lack strong scientific backing and may irritate skin. Always consult your healthcare provider before using alternative treatments.
Cleaning Your Home (Without Overdoing It)
Lice don’t live long off the scalp, so focus on personal items:
Wash bedding, hats, and brushes in hot water (130°F) and dry on high heat.
Seal non-washable items in plastic bags for 48 hours.
Vacuum sofas, carpets, and car seats — no need to spray chemicals.
Preventing Future Infestations
Teach kids not to share hats, hairbrushes, or headphones.
Keep long hair tied back at school or daycare.
Regular head checks during outbreak seasons.
Talking to Kids and Schools
It’s easy for children to feel embarrassed or ashamed. Reassure them that lice are common and treatable. Inform your child’s school, daycare, or caregivers discreetly — not to shame, but to prevent further spread.
Resources for Families
Here are trusted sources for more guidance:
Centers for Disease Control and Prevention (CDC)
American Academy of Pediatrics (AAP)
National Association of School Nurses
When to Call Your Healthcare Provider
See a provider if:
OTC treatments don’t work.
Your child is under 2 months old.
There are signs of infection (e.g., pus, fever, swollen lymph nodes).
As an FNP, I’m here to support families through issues like these — no judgment, just care. Lice can be a hassle, but with the right tools and calm approach, your family will get through it just fine.