Treating head lice probably never seems easy.
Washing your child’s hair with a head lice shampoo, washing things that had contact with your child’s hair, removing nits, and retreating your child in a week can be a hassle.
As you can imagine, it can be incredibly more frustrating when you can’t seem to get rid of the lice or they keep coming back.
Treatments for Head Lice
Although you could just manually remove all of the live lice on your child’s head and new lice as they hatch, most people choose to treat their kids with an over-the-counter head lice shampoo, such as:
- Permethrin 1% lotion – Nix
- Pyrethrins – Rid
If your community has a lot of problems with resistance to Nix or Rid (they don’t work), your pediatrician might recommend that your first choice be a prescription head lice treatment instead, such as Ovide (malathion), Natroba (spinosad), Sklice (ivermectin), or Ulesfia (benzyl alcohol).
Never initiate treatment unless there is a clear diagnosis with living lice.
AAP Clinical Report on Head Lice
While all of the prescription head lice treatments work well, Sklice has the added benefit that it should only require one treatment, and like Natroba and Ulesfia, can be used on infants as young as six months old.
Ovide works well, but is flammable because of its high alcohol content, can only be used on kids who are at least two years old, and some lice are already resistant to it.
Unfortunately, these prescription head lice treatments are much more expensive than Nix or Rid, although coupons can help with some of that expense. Of course, even Nix or Rid can quickly get expensive if you have to keep buying them over and over and over again because they aren’t really working.
Buying all of the things that parents sometimes do to prevent head lice, most of it not proven to work, can get expensive too.
Treating Hard To Control Head Lice
What do you do if your kids still have lice after they have been treated?
Ask yourself these questions and discuss the answers with your pediatrician:
- Does your child really have lice?
- Do you really see live lice moving around in the hours or days after you treated your child with an OTC head lice shampoo?
- Do you just see dead or dying lice on your child’s head? Can you easily remove them?
- Do you just see old nits on your child’s head?
- Are you relying on natural or other home remedies to treat your child’s lice, such as essential oils, mayonnaise, or olive oil?
- Do you see live lice about a week after you had treated your kids with an OTC head lice shampoo? Did you remember to do a second treatment to kill hatching eggs?
- Are the live lice that you are seeing in the days after treatment very small and about the size of a pin head? These may be newly hatched lice. You can pick them off manually and know that any that remain will be killed when you do your second treatment. Ideally, any residue of the treatment left on your child’s head would have killed these newly hatched lice though.
- Do you see live lice several weeks to months after you had treated your kids with an OTC head lice shampoo?
- Are your kids continuing to share brushes or combs with other children?
- Did you closely follow the instructions on the medication’s label?
- Did you check other family members for head lice?
- Have other infested children that are around your kids been checked and treated?
- Are you at the point that you are considering shaving your child’s head?
While your kids may still have head lice after they have been properly treated with an OTC head lice shampoo, it is also possible that they don’t have an active head lice infestation anymore or that they simply got lice again. Getting reinfested is even more likely if you went weeks and weeks without seeing live lice and you don’t see many new nits yet. In that case, it is not that the OTC treatments are failing to work, it is that your kids keep getting new lice on their head.
Most importantly, remember that seeing live lice is the main sign to look for as to whether or not your kids need to be treated for an active head lice infestation. Simply having nits alone does not mean that your kids still have lice.
What To Know About Treating Hard To Control Head Lice
Treating your child’s head lice doesn’t have to be a nightmare, even when it seems like superlice are resistant to routine treatments.
For More Information On Treating Hard To Control Head Lice
- CDC – Head Lice
- FDA – Treating Head Lice
- AAD – Tips for Managing Head Lice
- Quick Guide to Removing Head Lice Safely
- Don’t Panic When Your Kid Gets Head Lice
- 5 Reasons Your Kids Keep Getting Head Lice
- CDC – Head Lice Life Cycle
- Head Lice
- Head Lice Information for Schools
- Head Lice: What Parents Need to Know
- Head Lice Treatment Myths & Realities
- SBM – Lice
- Lousology 101
- “No-Nit” Policies Discouraged in Schools
Last Updated on December 1, 2016 by Vincent Iannelli, MD