The Ultimate Goal: Your Child’s Health and Wellness

When parents discover their child has lice their typical reaction is dread. The dread comes from not really knowing what to do while feeling pressure to address the situation immediately.

It’s easy to understand why.

There is an overwhelming amount of information about lice on the web with all sides weighing in: the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), the National Pediculosis Association (NPA), the National Association of School Nurses, researchers, public health departments, school districts, universities, hospitals, allopathic health practitioners, holistic health practitioners, mommy blogs, mainstream news media, alternative news media, professional lice treatment services and pharmaceutical and chemical companies.

How do you decide the best course of action?

Some good questions to ask yourself are:

  • What is the primary motivation behind the solution being proposed?
  • Is the solution in the best interest of your child’s short and long-term health?

Safe Baby Healthy Child’s ultimate goal is to protect and enhance the health and wellness of children with the fundamental understanding that each child is unique and has their own sensitivities.

To this end, Safe Baby Healthy Child’s approach to lice places a child’s health first. The good news is that this approach is not only a safe and healthy solution, it is also economical and incredibly effective.

We’ll cover the following:

The Vast Array of Lice Treatments
The LiceMeister®: A Safe, Wise and Effective Approach to Caring for Children with Head Lice
What Do Lice Look Like and Where to Find Them
Not So Super: “Super” Lice Still Come Out With a Comb
By Definition, Head Lice Are a Communicable Disease
An Ounce of Early Detection is Worth a Pound of Cure
Does Your Child Have Head Lice?
How to Remove Nits and Lice
Reevaluating Well-Meaning Advice
The Truth About Getting Lice from Personal Belongings and the Environment
A Warning About Lice Sprays, Foggers And Fumigation

Q&A
I’m screening my child with a specialized lice comb. But I found some lice eggs! Am I doing something wrong?
Why won’t the lice go away?
I’ve read nits can be found in a child’s hair for months!
I’m concerned I won’t comb through my child’s hair properly and won’t get all the lice out. Is there someone I can hire to do this?
My local pharmacy has lots of inexpensive products that say they treat head lice.  Won’t one treatment with these save me a lot of time and eliminate the lice?
What about those products that are labeled pesticide-free, claim to be non-toxic, yet say they kill super lice?
Is getting a prescription product from a doctor safer and the most effective way to go?  (This answer includes an overview of prescription products, including if they kill eggs or not.)

This post is necessarily a long one but after reading it you will be prepared and free from doubt about the safe and effective way to care for a child with lice.

Smiling mom combing daughter's wet hair for SafBaby post on preventing and removing lice, super lice and nits

The Vast Array of Lice Treatments

“There’s a critical difference between treating lice and treating the child infested with lice.”

-Deborah Altschuler
President of the National Pediculosis Association

Many products have been created to kill lice, however safety and efficacy against lice and their eggs is another question.
Further details to follow in the article.

  1. Over-The-Counter (OTC) Pesticide-Based Products. Active Ingredient: Permethrin or pyrethrin, both are broad-spectrum pesticides. Inactive ingredients are usually chemicals (e.g. Nix® Lice Killing Crème Rinse or Rid® Lice Killing Shampoo).
  2. Over-The-Counter Chemical-Based Products. Active Ingredient: Dimethicone or some other form of silicone. Inactive ingredients vary (e.g. Nix® Ultra Super Lice Treatment, LiceMD® Pesticide-Free, Hedrin® 4% lotion).
  3. Over-The-Counter “Homeopathic” Products. Active Ingredient: Lists a homeopathic remedy. Inactive ingredients may be benzyl alcohol or other chemicals (e.g. LiceFreee!®).
  4. Topical Lotions & Shampoos Available by Prescription. Active Ingredients: May be a pesticide, chemical or soil bacterium. Inactive ingredients can be benzyl alcohol or other chemicals (e.g. Natroba™, ULESFIA®, Sklice®, Ovide®, Lindane Shampoo). (See FAQs for more information on these prescription products.)
  5. Nuvo Method (Cetaphil Cleanser). Contains synthetic ingredients such as cetyl alcohol, sodium lauryl sulfate, and several parabens.
  6. Enzyme-Based Products. Active Ingredient is an enzyme. Inactive ingredients may be natural and/or synthetic ingredients. (e.g. LiceBGone)
  7. Plant-Based Products. Contain natural and synthetic ingredients (e.g. LiceLogic®).
  8. Heated-Air Device. A heated air device that can be used on adults and children over the age of 4. (e.g. AirAllé®) Gels or rinses may be used after treatment with the heated-air device.
  9. Home Remedies. Mayonnaise, olive oil, tea tree oil or a mix of essential oils and other items found in a pantry.

Many people cringe at the thought of lice and will do whatever it takes to kill them. But as a parent, please remember that lice are on your child and the ingredients in a product could impact their health. As Deborah Altschuler, President of the National Pediculosis Association states, “there’s a critical difference between treating lice and treating the child infested with lice.”

Side Effects

Parents have reported adverse side effects ranging from rashes and hair loss to seizures, permanent neurological damage and even death. 

Less toxic products, even those that are marketed as non-toxic may meet the regulatory definition of “non-toxic” but can contain ingredients that have been associated with negative health impacts. Even essential oils must be used with awareness.

Instead of relying on a company’s claims, do your own research. Look up every ingredient in Environmental Working Group’s (EWG) Cosmetic Database Skin Deep®. Ideally, each ingredient should score a 1 or 2 (color-coded in green), which represents a “Low Hazard”. Seeing a product on the shelf or having it prescribed by a doctor does not mean it is safe for your child or that it lives up to your safety standards.

Parents who are concerned about side effects may opt for home remedies such as mayonnaise. However, if the hope is that these home remedies will kill lice, they may not work, leaving lice to proliferate.

Success Requires Removing the Eggs

It’s very important to realize that getting rid of lice does not end the infestation. To be successful, you must also get rid of the eggs (often referred to as nits). Eggs are harder to kill and thus, products are less effective at killing them than live lice. Because most OTC products leave the eggs unharmed, the eggs hatch new lice allowing the infestation to continue. Prescription products don’t necessarily kill eggs either. For those that do kill eggs, none can claim to be 100% ovicidal (kill all eggs).

Further, even if a product could kill all lice and their eggs, the dead lice and eggs would still need to be combed out.

There’s another way to eliminate head lice –
REMOVE lice and their eggs instead of trying to kill them.

Using a specialized lice comb removes lice AND eggs, dead AND alive. And unlike most lice treatment products, a specialized lice comb can be used every day, as many times as necessary, until lice and nits are gone.

Killing lice is not necessary. Simply removing live lice and their eggs can work just as well if not better and you determine your success by how thoroughly you comb your child’s hair.

Dr. Claire McCarthy, a pediatrician at Harvard-affiliated Boston Children’s Hospital agrees that combing works. She states, “It takes patience and perseverance, but not only does it get rid of both live lice and eggs, it’s completely nontoxic and without side effects. That can’t be said of any other treatment for head lice …”

The LiceMeister®: A Safe, Wise & Effective Approach to Caring for Children with Head Lice

“There’s no reason for parents to douse their children’s heads in chemicals.
Physically removing lice, while it seems daunting, is safest for your child’s head.”

– Urvashi Rangan, Ph.D.
Director of Consumer Safety and Sustainability for Consumer Reports

Most of us have read that: “Lice and nits are very hard to see, very hard to find, very hard to remove and, on top of it all, notoriously difficult to distinguish from hair debris.”

To be sure, trying to spot lice that are the size of sesame seeds while knowing they are running away from the exact place you are looking, is exasperating. But when you use a lice comb, the experience is entirely different – it’s faster and more accurate. This study quantifies the enormous difference:

Diagnosis of louse infestation using a louse comb is four times more efficient than direct visual examination and twice as fast. The direct visual examination technique underestimates active infestation and detects past, nonactive infestations. (Emphasis added.) (Mumucuoglu et al., 2001)

There are many lice combs on the market. Although they may look alike, they vary greatly in quality. Having a well-designed comb is critical to successfully removing lice.

Based on its many years of proven performance, outstanding functional design, exceptional quality and accolades from both parents and children, we recommend the LiceMeister®.

For over 35 years the National Pediculosis Association has taken a child-centered approach to addressing lice and, to that end, developed the LiceMeister® comb.

The LiceMeister® was specifically designed for screening as well as the removal of lice and eggs. Since 1998, the LiceMeister® has been cleared by the FDA as a 510(k) medical device (K981250).

Stand-Out Features of the LiceMeister®:

  • Long, tightly-spaced teeth effectively remove the tiniest lice and nits
  • Surgical-grade, stainless steel teeth never rust
  • Sealed handle prevents lice, nits and “gunk” from conditioners or other substances from getting stuck inside the handle
  • Works on all types of hair
  • No sharp edges to snag hair and cause a child discomfort
  • Made to last and reuse for years
Safe Baby Healthy Child Shop Licemeister lice comb and nit comb
PURCHASE THE LICEMEISTER

The comb can be sterilized by cleaning it with alcohol. It was also intentionally designed to withstand sterilization by boiling. (Other combs may disintegrate when boiled.) This feature aids school nurses, for example, who are screening multiple children. However, at home, among family, it is not necessary to boil. Simply wash the comb with soap and water and clean out the metal tines before moving on to the next person. A floss-type cleaning tool is included with the comb.

The LiceMeister® is available for $12 at the Safe Baby Healthy Child Shop.

Now that you know what comb to use, we’ll explain how to use it. But, first you need to know: What Do Lice Look Like?

What Do Lice Look Like and Where to Find Them

The head louse (commonly referred to in the plural form, lice, because they travel in groups) lives on the hair of a human head: the hair, eyebrows and eyelashes. (If you do find lice in the eyebrows or eyelashes, please see your physician.) The life cycle of the louse can be divided into three broad stages: the egg (nit), nymph and adult.

EGG (NIT)

Where: Attached to one side of a hair strand at an angle close to the scalp. They are typically found at the back of the neck and behind the ears but can appear in other areas around the hair and scalp.

You may come across information or studies stating that if nits are attached to hair strands further than ¼ inch from the scalp they are non-viable eggs or empty casings (already hatched). However, such advice may be based on studies conducted in cold climates.

Studies of lice in climates more commonly found in the U.S. (75F – 85F or warmer) found that lice can lay eggs several inches from the scalp. In fact: “If the temperature and humidity are suitable, female lice will lay their eggs anywhere in hair. This finding is particularly true in long-haired female children.”

Color: When an egg is first laid, it is yellowish-gray. As it develops, it turns tan or dark brown. Upon hatching, the empty shell is white.
Size & Shape: Oval-shaped and about the size of a knot in a strand of hair.
Characteristics: When female lice lay their eggs they attach them to the hair strand with a glue-like substance that encircles the hair shaft. Eggs are attached so strongly that they cannot be brushed, shaken or washed off.

Up close of lice nit on hair strand for SafBaby post on preventing and removing lice, super lice and nits
J. Kalisch, UNL Department of Entomology
Hatched lice nit on hair strand for SafBaby post on preventing and removing lice, super lice and nits
J. Kalisch, UNL Department of Entomology

More facts about nits:

  • Eggs hatch into nymphs within 7-12 days, but on average, within 8 days. A study published in 2013 in the journal Medical and Veterinary Entomology did find that in 1.2% of the cases, eggs hatched as many as 13 days or more after the person was treated for lice.
  • Live head lice lay their eggs only in hair, not in carpet, around the house or on hair accessories.
  • Nits are said to be visually mistaken for dandruff and other hair debris such as DEC (desquamated epithelial cells) plugs. DEC plugs can develop after repeated treatments with pesticide or chemical lice products. Here’s how to tell the difference:

If it’s a nit, it will feel like a grain of sand stuck in the hair and will not come off easily. If, despite comb-throughs, the nit does not dislodge, take your fingernails and pull the nit all the way down and off the hair strand. If it is still stuck, you could cut off the single strand of hair with small safety scissors.

NYMPH (Sexually Immature Louse)

Where: Close to the scalp around the crown of the head, around the ears and near the neckline, but can appear in other areas around the hair and scalp.
Color: Clear when they first hatch and reddish brown after feeding.
Shape & Size: The size of a pinhead.
Characteristics: Nymphs start to lay eggs 9-12 days after they hatch.

ADULT HEAD LOUSE 

Where: Close to the scalp around the crown of the head, around the ears and near the neckline, but can appear in other areas around the hair and scalp.
Color: Tan, brown or grayish-white.
Shape & Size: Sesame seed-sized.
Characteristics: 6 legs that end with claws used to grab onto human hair. They move fast and away from light or disturbances such as a comb or brush.

Up-close of louse on hair strand and lice in hair for SafBaby post on preventing and removing lice, super lice and nits
Lice and nits attached to hair strand for SafBaby post on preventing and removing lice, super lice and nits

Other things to know about adult lice:

  • They only crawl. They don’t have wings to fly or hind legs to jump or hop.
  • They don’t burrow into furniture.
  • If they happen to crawl off a scalp and no longer have access to a scalp to feed, they usually live one day, but no more than two days depending on the humidity. (The less humidity the faster they die.) They can survive about 8 hours without feeding.
  • With a constant blood supply, lice live up to about 30 days.
  • They don’t live on pets because they require human blood.
  • The itching an infested person sometimes experiences is an allergic reaction to the louse saliva. Not everyone has this allergic reaction.
  • On average, a female louse lays 5 eggs a day but can lay up to 10 eggs per day.
  • Your child cannot get lice by swimming with someone who has lice; when submerged in water, lice grip the hair strand they are on and go into a state of suspended animation. They “wake up” later. Neither sea water nor chlorine kill head lice.

Not So Super: “Super” Lice Still Come Out With a Comb

Lice that have adapted to pesticide-based products are being publicized as “super” lice. A 2016 study in the Journal of Medical Entomology reported that 98.3% (with a standard deviation of ± 10%) of lice collected from 48 states are “super” lice. The authors of the study also noted that “OTC Nix formulation was essentially 100% [effective] from 1986 to 1998 … From 1998, the overall effectiveness of the Nix formulation steadily declined and was only ∼25% effective by 2009.” That was almost 10 years ago.

With this severe drop in effectiveness, companies have focused their attention on creating and promoting alternative lice products that require a doctor’s prescription. These prescription products are much more expensive than OTC options, not including paying for doctor visit(s), and like OTC products, can have serious side effects. (See FAQs.)

Despite the hype, the truth is, “super” lice aren’t that super. They have simply done what lice, and all creatures, are designed to do – adapt. They don’t even look any different. Most importantly, realize that “super” lice, just like regular lice, can be safely and effectively removed with the LiceMeister®.

Profile of little boy sitting having hair combed with a lice nit comb for SafBaby post on preventing and removing lice, super lice and nits

By Definition, Head Lice are a Communicable Disease

Pediculosis humanus capitis means infestation by the human head louse, a parasite. Head lice are a communicable disease specific to humans.

As defined by Merriam-Webster, a communicable disease is “an infectious disease transmissible (as from person to person) by direct contact with an affected individual or the individual’s discharges or by indirect means as by a vector [an organism, typically a biting insect or tick, that transmits a disease or parasite from one animal or plant to another].”

The Mayo Clinic explains, “Infectious diseases are disorders caused by organisms — such as bacteria, viruses, fungi or parasites. Many organisms live in and on our bodies. They’re normally harmless or even helpful, but under certain conditions, some organisms may cause disease.”

While many promise that head lice do not transmit disease, researchers have found otherwise. (See here for a summary of studies.)

An Ounce of Early Detection is Worth a Pound of Cure

“Lice isn’t something that happens and then goes away never to return. It’s like brushing teeth.
Your child brushes every day to avoid cavities. When they go to the dentist it’s great to hear that they are cavity-free,
but that doesn’t mean they get to stop brushing
. Screening for lice and nits is an ongoing measure.”

– Deborah Altschuler
President of the National Pediculosis Association

Lice are seldom given a thought outside the context of an outbreak. Parents receive notice that someone at their child’s camp or school has lice and suddenly they’re reminded that lice exist!

Getting head lice might be inevitable, but getting surprised by an infestation is entirely preventable. Add this simple practice to your child’s hygiene routine:

Use a specialized lice comb to screen for lice and nits
by combing through your child’s hair daily or at least twice a week.

In fact, parents report that performing this simple practice kept their child protected while classmates continued to battle lice.

The LiceMeister® works on dry, wet or conditioned hair. Some parents comb through their child’s hair before bedtime, others comb after bathing.  After washing the comb in soapy water and cleaning the tines, a parent can screen themselves.

That’s it! Ultimately, you’ll settle on the frequency of combing that gives you peace of mind. Remember that eggs hatch within 7-12 days after being laid and regular combing is what provides the greatest degree of success.

The most enticing lice treatment products promise “one and done”, meaning one treatment and lice and nits are gone. But the next time anyone in your family gets lice, you’ll end up buying the lice treatment product(s) all over again. It’s more like “one for now.”

With a specialized lice comb, you truly are “one and done.” Your one-time purchase provides the whole family with ongoing protection that can prevent head lice from becoming a full-on infestation.

Mom combing little girl's wet hair after bath for SafBaby post on preventing and removing lice, super lice and nits

Does Your Child Have Head Lice?

Itching is a classic sign of having lice, especially at the back of the neck or behind the ears. But did you know, you can have lice and not itch?

As mentioned earlier, a louse can cause itching, which is often an allergic reaction. But, some people are not allergic, others build up a tolerance and sometimes, if it’s a first-time infestation, itching shows up 4-6 weeks after becoming infested.

Here are other possible indications:

  • a feeling of something moving in your hair;
  • irritability from lack of sleep; lice are more active in the dark; or
  • redness, irritation and even scabs from scratching.

Official definitions vary on what is necessary to diagnose an active lice infestation:

The NPA notes: “An infestation can best be detected by combing but can also be discovered visually and/or by first seeing nits rather than by finding crawling lice.”

The AAP states: “Identification of eggs (nits), nymphs, or adult lice with the naked eye establishes the diagnosis.”

The CDC differs. They advise: “The diagnosis of head lice infestation is best made by finding a live nymph or adult louse on the scalp or hair of a person.” Thus, according to the CDC, finding only eggs means your child cannot be diagnosed with lice. It also means you should not use any of the pesticide or chemical lice products that the CDC advises for treating lice – because you haven’t found live lice to treat.

However, there’s only one way a viable lice egg could have ended up in the hair and this is via a live louse that laid it. And whether viable or not, no one wants lice eggs in their hair.

So, if all you can find are “just nits”, there’s no need to hesitate: you can perform a comb-out as described in the section below. Unlike pesticide and chemical products, a specialized lice comb does not have side effects and removal can only benefit your child, your family and others.

How to Remove Nits and Lice

“Lice are resistant to many of the products used against them, but there’s a better way to win this battle of bugs …
Try a simpler approach instead.
Our experts say that the best approach is also the easiest: using a wet comb.”

Consumer Reports

Close-up of short black hair with lice nits for SafBaby post on preventing and removing lice, super lice and nits

When you use a specialized lice comb like the LiceMeister, you don’t have to wonder … what do lice look like? You’ll know because the comb captures them and their nits so you can see them up close and be sure.

If you suspect that your child has lice, follow this step-by-step process to remove them:

Here’s What You’ll Need:

  • Comfortable chair for your child.
  • An activity to keep them engaged.
  • Regular comb or brush to detangle hair.
  • The LiceMeister®.
  • Hair clips or bands (if working with long hair).
  • Bowl of water.
  • Paper towels.
  • Conditioner, coconut oil or olive oil to detangle the hair and slow down live lice that run from light or disturbances such as a comb or brush. Australian lice expert Rick Speare noted that hair conditioner stuns lice for about 20 minutes. You can also use this 100% non-toxic product: Keys Mangrove Conditioner.

Optional Items:

  • Magnifying glass or a cell phone. A cell phone camera allows you to take pictures of suspected nits and lice and zoom in for confirmation.
  • Lint roller tape.
Close-up of louse and nit comb for SafBaby post on preventing and removing lice, super lice and nits
Close-up of nits and a louse on hair strands for SafBaby post on preventing and removing lice, super lice and nits

Ready to Start

  1. Sit your child in the chair.
  2. Ideally, work outside in the sunlight or indoors under a bright light.
  3. Detangle dry hair with a regular comb or brush.
  4. Condition the hair with one of the substances mentioned above, ensuring each strand is covered from root to end.
  5. Comb through with a regular comb again to ensure coverage and remove remaining tangles.
  6. If the child has long hair, part it down the middle. Tie one half in a ponytail to set aside while you work through the other half.
  7. Using the LiceMeister®, take a section of hair and run the comb through.
  8. After each pass, remove any nits, lice or debris by dipping the comb into the bowl of water or washing it under running water, then wiping it with the paper towel. You can also use lint roller tape to remove lice from the comb. When done, throw paper towels or roller tape into the wastebasket.
  9. Continue going through each section of hair on the entire head. Make additional passes until there is no debris.

When it’s time to shampoo your child’s hair, we suggest using one of these 100% non-toxic options: Keys MetaClean Shampoo & Soap, Keys KPRO Shampoo or Branch Basics (see User Guide Page 5).

Going through your child’s hair in a meticulous, organized way the first time will bring your child relief and you success in eliminating lice and nits. In this video, you’ll see how to do this.

Reevaluating Well-Meaning Advice

Pesticide and chemical-based products cannot be used every day to kill lice; safe-use instructions usually advise waiting 7-10 days to re-treat. Thus, it is the product that dictates how often you can try to remove the lice. And because parents can’t do anything during this in-between time, they enlist their children in the fight against lice by telling them to be vigilant:

Keep your head and hair away from other children!
Don’t give other children hugs!
Don’t lean in when you play together!

While this may seem like logical advice, how might a child perceive these directives?

They may worry about ostracizing a friend; they may feel guilty if they forget; they may be concerned about what other kids might say.

Asking this of your child has an effect you may not realize: it shifts the responsibility of controlling lice onto them. But managing head lice is the responsibility of parents, not children.

It’s not about if your child gets lice,
it’s about whether you have a tool that will successfully 
detect and remove them, as needed.

A specialized lice comb detects and removes lice as needed giving parents the ability to respond promptly, safely and effectively. This is one parent’s review on Amazon about the LiceMeister®

“Works flawless. 2 days in a row and no more critters. This comb worked for my daughter. I’m still checking it but no more nits or lice. I did it 6 times in 2 days. One before shower and one after. Total of 3 showers a day for 2 days. Now I do it once a day after school. So far no more signs of lice or nits.”

When your child heads off to school or camp, braid or fasten their hair up if its long and explain how lice usually get transmitted. You can ask them to be cautious but without the pressure that it’s all riding on them. If they happen to get lice, they know you can take care of it – lice come out with a comb.

young girl sitting having hair braided for SafBaby post on getting rid of and preventing lice, super lice and nits

The Truth About Getting Lice from Personal Belongings and the Environment

The mention of lice make parents feel like they have to exhaustively clean their house: washing everything, putting stuffed animals in plastic bags, even buying household lice sprays or foggers. But when you understand the biology of lice, you’ll see why it is unlikely to get lice from inanimate objects such as hair accessories, combs, brushes, hats, clothing, bedding, stuffed animals, carpet or furniture.

  • Lice need to stay warm and close to their food source. They will die in 1, maximum 2, days if they don’t feed off a scalp. In fact, after a few hours in an air-conditioned room, they become severely dehydrated.
  • They are designed to grab onto and live on human hair strands, not, for example, fabric fibers. They have a hard time on surfaces other than human hair.
  • They crawl – they don’t have hind legs to jump or wings to fly into other environments.

A 2010 report published in The Open Dermatology Journal, entitled “Indirect Transmission of Head Lice via Inanimate Objects” reviewed various studies that found this mode of transmission was rare. The following summaries are taken from this report.

Floors

The floors of 118 school classrooms in Australia were vacuumed and the debris was inspected for evidence of lice, lice parts and lice eggs. Although 14,033 lice were collected off the heads of those children that were infested with lice, no lice, parts or eggs were found: (21% of children attending those 118 school classrooms were infested with lice; 91.5% of the classrooms had at least one student with an active lice infestation with an average of 130 lice per infested classroom; and a 4 year-old female had 1,623 lice.)

Bedding

48 pillow cases used overnight by 48 participants that had a total of 1,845 lice in their hair were inspected. Researchers found one live nymph on two pillow cases and a dehydrated nymph on a third pillow case. The 2010 review of this study concluded: “the occurrence of overnight live lice transference to pillow cases was 4.2% and proportionately, 0.1% of the head lice population actively transferred onto a fomite [an object or material that is likely to carry infection such as clothes, utensils, and furniture] … Pillow cases do pose a slight risk for transmission or reinfestation but that risk is low enough to be considered unimportant compared to other modes of transmission.”

Combs & Brushes

Three studies concluded that there was no association between having lice and sharing combs/brushes. In the one study that did find an association, no lice were found on the brushes of 10 children with an active lice infestation. The authors of the 2010 report concluded: “The body of evidence thus suggests that this mode of transmission is possible, but most likely of little consequence compared to other modes.”

Hats

In one Australian study, researchers captured 5500 head lice from the heads of students in four Australian schools. They then looked for lice in the hats they wore. No head lice were found in the 1000 hats they examined.

In another Australian study at a different school, they inspected 1000 hats and found just one louse on the hat of a child who had been treated for lice an hour prior. The assumption was that this louse was trying to escape to survive the treatment.

At Home Work Smart, Not Hard

The take-away message is: Lice live on human hair, not in the environment.

Spend your energy on what will lead to success – combing through your child’s hair regularly with a specialized lice comb. Many parents find that cleaning their home gives them peace of mind. If this is the case, below are some suggestions for targeted cleaning.

  • Pillow Cases and Bed Linens: Wash in hot water or put in a dryer on the hottest cycle for 30 minutes.
  • Floors, Rugs, Furniture and Car Seats: Vacuum the floors of the rooms where the person with lice spends a lot of time, i.e. their bedroom. Use the attachments on the floor models for smaller items such as furniture and car seats. If you are using a handheld vacuum, make sure the suction is strong.
  • Combs, Brushes, Hair Accessories: Place in hot, but not boiling, soapy solution for 10 minutes.
  • Stuffed Animals: It can be disturbing to a child to have their favorite stuffed animal taken away or see it being put into a plastic bag. They may already feel anxious and may want to turn to their stuffed animal for comfort. Keep things in perspective – you are a parent caring for your child, not an exterminator. Here are some options:

Place stuffed animals in a dryer on high heat for 30 minutes. If they will be damaged from being put in the dryer, use an attachment from a floor model vacuum or a handheld with very strong suction to vacuum the entire surface of the stuffed animal. If such actions would distress your child, do this when they are not present. Lice don’t survive more than 1-2 days without a food source.

Little girl in pigtails lying on sofa cuddling teddy bear for SafBaby post on getting rid of and preventing super lice and nits stuffed animals

A Warning About Lice Sprays, Foggers and Fumigation

DO NOT USE THE FOLLOWING TO CONTROL HEAD LICE:

  • sprays for bedding that target lice or bed bugs or other insects;
  • household sprays that target lice or insects in general;
  • indoor foggers or bombs that target lice or insects in general; or
  • professional fumigators to spray for lice.

Sometimes lice treatment products come packaged with lice sprays giving the impression that they should be used together. They should not.

We could not find any study on how the combination of these two products affects a child’s health. Several organizations, including the CDC, agree and warn against taking such high-risk measures given that these products can be very toxic if inhaled or absorbed through the skin. In fact, we could not find a single organization that promoted their use for lice. It seems only the manufacturers of these products endorse their use.

Remember that lice have adapted to the insecticides in these sprays as well, i.e. the sprays won’t work.

Q & A

I’m screening my child with a specialized lice comb. But I found some lice eggs! Am I doing something wrong?

This is success! Not only did you find the eggs, the comb removed them. This is the purpose of screening – to let you know what is going on with the added benefit of removing what you find.

Refer to the section “How to Remove Nits and Lice” and increase screening to daily or twice daily until you no longer find any lice or nits.

Why won’t the lice go away?

Long-term infestations and re-infestations most likely stem from not removing every louse and nit from the head the first time around. Combing daily or twice a day until you are sure there are absolutely no more nits or lice is essential and will work! After that, it is prudent to comb as a screening and early detection measure at least twice a week.

I’ve read nits can be found in a child’s hair for months!

The term ‘nits’ can refer to a viable egg or the empty shell casing that is left after the louse hatches. Viable eggs will hatch an average of 7-12 days after being laid; empty casings can stay in the hair for months unless they are combed out. Thorough, regular comb-throughs with a specialized lice comb like the LiceMeister® will simultaneously detect and remove nits without possible side effects.

I’m concerned I won’t comb through my child’s hair properly and won’t get all the lice out. Is there someone I can hire to do this?

Combing your child’s hair to remove lice and eggs does not require specialized experience. Any parent can do it and do it right the first time. Having the right comb is half the battle. The other part is being systematic and going over the same section of hair several times to ensure all lice and eggs are removed.

If you are still concerned, there are professional lice removal services such as salons and mobile services.

Lice removal services can be franchises, family-owned businesses or individual consultants. Each offers a different approach ranging from manual nitpicking to some kind of lice treatment product to working with a type of blow dryer, sometimes called a heated-air machine. Note that heated-air treatments will still require combing to pull the dead eggs and lice out of the hair.

A Wall Street Journal reporter decided to document her experience of lice removal services after she and her two daughters caught lice. For her 2014 article, Elizabeth Garone, her daughters and husband (who went in for a preventative treatment) tested three salons and one home option: NitPixies, the Hair Angels, LoveBugs and AirAllé heat treatment. She describes her experiences below:

NitPixies:  “Like: The salon had toys, a TV and activities for waiting clients, as well as industrial-size washers and dryers for customers to wash bed linens. Dislike: There were no distractions offered to my daughter during her treatment. The owner later said children usually are asked if they would like to watch a video.”

Hair Angels:  “Like: The friendly technician quickly put my daughter at ease. Dislike: I didn’t know about the $25 travel fee to our home before the appointment.”

LoveBugs: “Like: Salon had a good selection of kids’ movies and a discreet location. Dislike: We spent two hours at the busy salon, most of it waiting for the sole technician working at the time to be free.”

AirAllé: “Like: The treatment didn’t involve lots of different products being applied to the hair. Dislike: I was dealing with the effects of the treatment days after.”

“The hose attachment is placed for 30 seconds on different spots and my technician said to let her know if it was too hot. It felt manageable at the time. By the end, though, I wished I had spoken up: The high heat of the AirAllé machine made my scalp feel inflamed and days later, it was painful to the touch. An application of dimethicone (silicone oil), which is supposed to suffocate any remaining nits and lice, followed and felt cool on my scalp. The dimethicone, though, was difficult to get out of my hair.”

Pricing for a professional lice service typically varies with length of hair and the degree of infestation, but you can expect services to start at about $100.00.

Many companies use and sell their own private label products along with their services. But some will use chemical or pesticide-based OTC products on your child. Before anyone puts a product on your child’s hair or scalp, make sure you know what is in it. Many services claim that their products are natural, non-toxic, organic or eco-friendly, but upon asking for the ingredients, you may find the product does not live up to the claims.

Always ask for the entire ingredient list (inactive ingredients can be just as problematic) and look each one up on EWG’s Cosmetic Database Skin Deep®. Ideally, each ingredient should score a 1 or at most a 2 (color-coded in green), which represents a “Low Hazard”. If the product contains essential oils, make sure to perform a patch test on your child before proceeding. (These sites offer expert advice on essential oil safety: The Herbal Academy and Tisserand Institute.)

If you do hire a service, our recommendation is to choose one that uses a specialized lice comb and a truly non-toxic substance as listed above in “How to Remove Nits and Lice”. Consider bringing the LiceMeister® and asking them to use it. It may be more effective and hygienic (given the sealed handle) than the comb they are using.

Ask the service to teach you what to do so that you don’t have to keep relying on them, as more than one comb-out may be needed.

My local pharmacy has lots of inexpensive products that say they treat head lice.  Won’t one treatment with these save me a lot of time and eliminate the lice?

These are referred to as OTC products and many come with health warnings and usage limitations to avoid possible side effects. Many rely on a broad-spectrum pesticide (meaning, “kills many varieties of organisms”) as their active ingredient. The active ingredient is either pyrethrin (an extract from the chrysanthemum flower that is neurotoxic to lice) or the synthetic version of pyrethrin, permethrin. In addition to these toxic active ingredients, the products contain “inactive” ingredients that are not always listed on the box label but may also be toxic. Pregnant and nursing mothers are advised to avoid these products whether for their own treatment or when handling them while treating their children or others.

The enthusiastic claims on these products’ boxes – “Kills Lice and Removes Eggs” – can easily lead a parent to think one treatment will “Kill All Lice and Kill All Eggs.” But the reality is: the product likely won’t kill 100% of live lice; it wasn’t designed to kill ANY eggs; removal of eggs requires a comb; and you often must treat a second time – which still does not kill or remove the eggs. And it’s the FDA that doesn’t require manufacturers to notify consumers that the product may not work at all – because lice have become resistant.

The Reality of Failed Treatments

After realizing that a product has failed and their child still has lice, a parent may feel as though they have no choice but to re-treat with a presumably stronger product. While a parent may have considered exposure to the chemicals in a single lice treatment an acceptable risk to take, now they face subjecting their child to multiple exposures to pesticides and chemicals – all in a short period of time. This could have life-long implications: children are developing and are impacted much more than adults by harmful ingredients.

Taking a chance on these lice treatment products exacts another cost: the time and energy spent on ineffective treatments displaces the time and energy that could have been spent removing lice with a comb – an approach that allows you to determine your success.

What about those products that are labeled pesticide-free, claim to be non-toxic, yet say they kill super lice?

Previously mentioned pesticide-based products use a neurological mechanism of action to kill lice. (e.g., permethrin paralyzes lice.) On the other hand, products labeled pesticide-free use ingredients to disrupt the physical integrity of the louse.

The ingredients used to accomplish this are siloxanes: dimethicone (also spelled dimeticone) and usually cyclomethicones (i.e., cyclomethicone D3, cyclomethicone D4. cyclomethicone D5).

Lice treatment products containing siloxanes and carrier ingredients can have possible side effects such as: breathing difficulties, rash, swelling, flaking of the scalp, itching, irritation around the eyes, and hair loss. Others have reported these products leave the hair extremely greasy and are hard to wash out. And, there are important use limitations to be aware of, such as to avoid inhaling the spray or keeping hair away from sources of ignition.

Siloxanes are one of the “The Dirty Dozen Ingredients” according to The David Suzuki Foundation. The longer-term effects identified below are quite different than the side effects on package inserts.

“… the European Union classifies D4 as a endocrine disruptor, based on evidence that it interferes with human hormone function, and a possible reproductive toxicant that may impair human fertility. In laboratory experiments, exposure to high doses of D5 has been shown to cause uterine tumours and harm to the reproductive and immune systems. D5 can also influence neurotransmitters in the nervous system. … Cyclomethicone is a mixture of D4, D5 and D6 siloxanes. … Polydimethylsiloxane (PDMS) silicone polymers are produced from D4 and contain residual amounts of D4 and D5. Dimethicone is a common PDMS ingredient in cosmetics.”

These physical-action products are not 100% ovicidal. Additional treatments may be needed to kill any newly hatched lice.

Again, a specialized lice comb will still be necessary to remove the dead lice and eggs from the hair.

Is getting a prescription product from a doctor safer and the most effective way to go?

In the U.S., many doctors will not issue a prescription for a lice treatment product until you show that two treatments with a permethrin or pyrethrin-based OTC lice treatment product failed.

However, it is so well-established that lice have become resistant to these OTC products that, recently, some doctors are advocating parents be given prescription products without having to try these OTC products first. They state that prescription products are very safe, effective and lice have not grown resistant to them. (Except a 2010 report in Pediatrics noted, “resistance to lindane, pyrethrins, permethrin, and the UK formulation of malathion has been reported.” Lindane and malathion are available by prescription.)

These are some prescription products. The information, except where hyperlinked to another source, comes from the manufacturer’s prescribing information which can be found by clicking on the name of the product.

Note: No study cited in the prescribing information of any of these products was 100% successful at all the intervals tested. And no studies were included that tested efficacy on lice eggs.

  • ULESFIA® Topical lotion. Active Ingredient: Benzyl alcohol 5% lotion. Cost: $354.17
    • Eggs: Does not get rid of lice eggs. Benzyl alcohol has no ovicidal activity.
    • Effectiveness: Two clinical studies were conducted. Treatment with Ulesfia was applied two times separated by one week. Fourteen days after the last treatment, between 75-76.2% of 127 subjects were free of live lice.
    • Some study subjects experienced: pruritus (severe itching of the skin), erythema (abnormal redness of the skin), pyoderma (skin infection with formation of pus), eye irritation, application site dryness, application site excoriation (scraping of the skin), paraesthesia (tingling, pricking, chilling, burning, or numb sensation on the skin), application site dermatitis (red inflammation), thermal burn, dandruff, rash, and skin exfoliation.
    • Pregnant or plan to become pregnant: It is not known if ULESFIA® Lotion can harm your unborn baby.
    • Nursing or plan to nurse: It is not known if ULESFIA® Lotion passes into your breast milk or if it can harm your baby. You should choose to breastfeed or use ULESFIA® Lotion, but not both.
    • Other: Long-term studies in animals to evaluate carcinogenic potential of ULESFIA® Lotion have not been conducted.
  • Ovide® Topical lotion. Active Ingredient: Malathion, a neurotoxic pesticide. Cost: $276.44
    • Note: The safety and effectiveness of Ovide® Lotion in children less than 6 years of age has not been established via well-controlled trials.
    • Eggs: Partially effective against eggs.
    • Warnings: Chemical burns including second-degree burns and stinging sensations may occur with the use of Ovide® Lotion. Ovide® Lotion is flammable. Keep away from heat sources and flames.
    • Effectiveness: Two clinical studies were conducted. After one treatment on 129 subjects, 100% were free of live lice immediately after shampooing, 94.5% were free of live lice 24 hours later, and 90% were free of live lice 7 days later. No study on the efficacy of Ovide® on eggs was mentioned.
    • Adverse reactions: Malathion has been shown to be irritating to the skin and scalp. Other adverse reactions reported are chemical burns including second-degree burns. Accidental contact with the eyes can result in mild conjunctivitis. It is not known if Ovide® Lotion has the potential to cause contact allergic sensitization.
    • Pregnant or plan to become pregnant: Because animal reproduction studies are not always predictive of human responses, this drug should be used (or handled) during pregnancy only if clearly needed.
    • Nursing or plan to nurse: Percutaneous absorption from the Ovide® (malathion) Lotion, 0.5% formulation has not been studied, and it is not known whether malathion is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Ovide® Lotion is administered to (or handled by) a nursing mother.
    • Other: Carcinogenesis, mutagenesis and impairment of fertility have not been studied with Ovide® Lotion (0.5% pharmaceutical grade malathion).
  • Sklice® Topical lotion. Active Ingredient: Ivermectin, derived from a soil bacterium. Cost: $367.00
    • Note: For single use only; do not re-treat. Per the CDC, should not be used on children weighing less than 15kg (~33 lbs)
    • Eggs: Per the CDC, Sklice® is not ovicidal, but appears to prevent nymphs (newly hatched lice) from surviving.
    • Effectiveness: Two clinical studies were conducted. Fourteen days following one single treatment between 70-76.1% of 141 subjects were free of live lice. No study on the efficacy of Ovide® on eggs was mentioned.
    • Some study subjects experienced: conjunctivitis (pink eye), ocular hyperemia (excess of blood in the vessels in the eye), eye irritation, dandruff, dry skin, and skin burning sensation.
    • Pregnant or plan to become pregnant: It is not known if SKLICE Lotion can harm your unborn baby. The CDC states it should not be used by pregnant women.
    • Nursing or plan to nurse: Ivermectin has been found in breast milk when taken by mouth and may pass into breast milk after using SKLICE Lotion.
    • Other: Long-term studies in animals have not been performed to evaluate the carcinogenic potential of SKLICE Lotion or ivermectin.
  • Natroba™ Topical Suspension. Active Ingredient: Spinosad, derived from a soil bacterium. Cost: $283.38
    • Note: Contains 10% benzyl alcohol.
    • Eggs: The CDC states it kills lice as well as unhatched eggs, but the prescribing information does not confirm this.
    • Effectiveness: Two clinical studies were conducted. Fourteen days following the last treatment, between 84.6-86.7% of 174 primary subjects were free of live lice. No study on the efficacy of Natroba® on eggs was mentioned.
    • Some study subjects experienced: application site erythema, ocular erythema, application site irritation, application site dryness, application site exfoliation, alopecia (hair loss), and dry skin.
    • Pregnant or plan to become pregnant: It is not known if Natroba Topical Suspension can harm your unborn baby.
    • Nursing: NATROBA Topical Suspension contains benzyl alcohol, which may be systemically absorbed through the skin, and the amount of benzyl alcohol excreted in human milk with use of NATROBA Topical Suspension is unknown. Caution should be exercised when NATROBA Topical Suspension is administered to a lactating woman. A lactating woman may choose to pump and discard breast milk for 8 hours (5 half-lives of benzyl alcohol) after use to avoid infant ingestion of benzyl alcohol.
  • Lindane Topical Lotion. Active Ingredient: Lindane, a neurotoxic pesticide. Discontinued in 2016.
  • Lindane Shampoo. Active Ingredient: Lindane, a neurotoxic pesticide. Cost: $101.43
    • Note: NOT to be used by those who weigh less than 110 lbs.

The American Academy of Pediatrics no longer recommends this as a pediculocide.

    • Precautions: Do not use Lindane Shampoo more than 1 time to treat an attack of lice. Do not use Lindane Shampoo to treat a second attack that comes soon after the first episode. No one knows a safe time to reuse Lindane Shampoo. Do not keep Lindane Shampoo on your hair for more than 4 minutes. If you are putting Lindane Shampoo on another person, wear special gloves made of nitrile, latex with neoprene, or sheer vinyl. Do not use natural latex gloves because more Lindane can go through that kind of glove.
    • Side effects: The most common side effects of Lindane Shampoo are: itching skin, burning skin, dry skin, a skin rash. Lindane Shampoo goes through your skin and can affect your brain and nerves. Lindane Shampoo may cause serious side effects such as seizures (convulsions, fits) or death. Lindane Shampoo can also make you feel sleepy, dizzy, or can cause body shaking that you cannot control. These are not all of the possible side effects of Lindane Shampoo.

Lindane is so toxic that 69 countries and California have banned its use. The EPA has canceled it. However, it is still available for use as a lice treatment by prescription in the United States (except California). The FDA requires it come with a “black box“ warning in the labeling to prescribers. This type of warning is “designed to call attention to serious or life-threatening risks.”

No matter what approach you take for managing head lice, do your homework and be informed.

Please visit this page for stories of parents whose children had severe adverse reactions to lice treatment products. Some had deadly outcomes as described in an investigative report from the Center for Public Integrity about a two-and-a-half-year-old girl whose parents trustingly applied a lice shampoo:

“The little girl’s condition deteriorated quickly. She labored to breathe. Her eyes rolled back in her head, and her skin peeled off in clumps, according to a lawsuit filed by the family.”

Despite endorsement by the medical establishment, product recommendations by a pharmacist or doctor, and packaging that promises to kill lice, you will have to deal with the effects that any product has on your child. Every child is unique with their own particular sensitivities.

In stark contrast, in the time it takes to go to the doctor and back, you could have removed the lice and nits with the LiceMeister® for $12 without any concern about worrisome side effects, warnings or precautions.

Kids playing tug of war for SafBaby post on how to get rid of lice, super lice and nits

A Truly Complete Solution

You can now see that when you take a child-centered approach to dealing with lice, a safer, wiser and more effective course of action becomes apparent.

Using a specialized lice comb:

  • Is child-friendly and user-friendly.
  • Gives you the chance to be proactive: screening every day by combing your child’s hair allows for early detection. When you catch lice early, there will be less to remove.
  • Is a complete solution: it removes lice and eggs, both dead and alive.
  • Puts you in control at home: a comb can be used continually until lice are gone. Chemical-based products can only be “safely” used once a week or even less often, allowing lice to proliferate between treatments.
  • Has NO side effects: avoids the possibility of eye and skin irritation, hair loss, seizures and death.
  • Is economical: your one-time purchase provides the whole family with ongoing protection for years and years.

Most importantly, you’ve placed the health and wellness of your child first – the greatest gift a parent can give a child.

1 The NPA is a non-profit volunteer organization, including scientific advisors, dedicated since 1983 to protecting children and their environment from the misuse and abuse of prescription and over-the-counter pesticide treatments for lice and scabies.

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