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My advice for head lice: comb them out.

Posted by Dr. Claire McCarthy  November 15, 2013 08:20 AM

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head lice combing.jpgI've been seeing and hearing a bunch about head lice recently. I'm not sure why; maybe it's because school is back in full swing and the weather has grown cool enough that more kids are wearing and possibly sharing hats.

Whatever the reason, there have been a bunch of itchy kids and freaking-out parents. My advice to them? Buy a good comb, and get ready for some quality time together.

It's totally understandable to want a quick fix when it comes to the creepy crawlies. My entire family got infested about a decade ago, and I still itch when I think about it. But when it comes to head lice, quick fixes are hard to come by. These are hardy buggers. 

I think it's fine to use the over-the-counter creme rinses, which are generally permethrin or pyrethrin. They can help, and they may even get rid of a mild infestation. I always recommend giving them a try. But I would caution against stronger treatments such as lindane or malathion; they have real possible side effects. And when something as side-effect-free as combing can do the trick, I can't see why anyone would risk using pesticides on a child's head.

Another positive for combing is that it gets rid of nits, the eggs laid by lice. Even though most nits that are an inch or more out from the scalp are empty and/or dead (which, along with the fact that lice don't jump or fly, is why No-Nit policies don't make sense), school nurses, other parents and friends can get alarmed when they see them. Combing them out saves you all that headache.

Here's what you need to know to make combing work for you:
  • Buy the right comb. You need one with long metal tines that are very close together. The LiceMeister is a good example, but there are various ones out there that will do the trick. Do not rely on the one that comes with the lice treatments.
  • Set time aside for combing every day. Whether it's quick or long depends on how much hair your child has. At the beginning, when there's more to get out, it will take longer; after a few days, it should go faster.
  • Have good lighting, and a cup of water (or sink) nearby for cleaning the comb after each swipe.
  • The hair needs to be tangle-free or the comb will get stuck. You can put conditioner on and do it in the tub, or use detangling spray.
  • Separate the hair into sections, and comb from the scalp out. The nape of the neck and behind the ears are where lice are most likely to hang out.
  • Use distractions, like a video, while you comb. Or make up stories together. 
  • Keep combing every day until you've gone 8-10 days without finding anything--that's how long it takes for an egg to hatch. 
It's a good idea to comb everyone in the house, to be on the safe side. And speaking of the house...lice don't live very long off of people (and don't fly), but there are a few things you should do:
  • Make sure everyone has their own brush and comb. No sharing allowed.
  • Wash all hats and clothing in the hottest water possible, and forbid any sharing until the infestation is over.
  • Wash bedding regularly in the hottest water possible. If things can't be washed, put them in the drier on the hottest setting possible (this is a good way to deal with stuffed animals).
  • Vacuum furniture regularly. Don't buy the anti-lice furniture sprays--they can be toxic, and vacuuming works just fine.
If things aren't getting better, talk to your doctor for advice. But most of the time, with patience and perseverance, you can get rid of head lice--without any chemicals. And while most of us would rather have a different sort of quality time with our children than combing out lice, any excuse to spend extra time together is, in my opinion, not a bad thing.

Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post. 

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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