Kids have been back in school for a while now, which means, of course, lots of shared germs. And (unfortunately)...critters, too! Yes, head lice is a common thing for many school-aged kids. If your little darling comes down with a case—what do you do?

First, know that head lice is not a health hazard, and not a sign of poor hygiene. Also, don’t despair. It’s common, and there are safe, effective options for treatment. But, I’m not going to lie: treating head lice can be a time-consuming venture, and a bit of a pain in the ass, to be honest. Still, it’s a reality of life, so roll up your sleeves and get treating, mama. Here’s what you need to know.

How do you treat head lice?

There are three insecticides approved in Canada for head lice treatment:

  • Permethrin (brand names Nix and Kwellada-P)
  • Pyrethrin (brand name: R+C)
  • Lindane (brand names Hexit and PMS-Lindane)

All of these are available without a prescription.

The first two (permethrin and pyrethrin) have been studied extensively, and are safe when used on humans. However, lindane can be toxic, so it should not be used on infants and kids under the age of 2. Personally, I don’t use it on anyone.

You should follow package directions carefully, but the general idea is to treat once, and then repeat in 7-10 days. That’s because there’s a life cycle for head lice, and the first treatment won’t get all the critters that are in the dormant stage. But the second one will get them.  

Are there other treatment options?

Many people wonder about alternative treatments to the insecticide options. Now, if you’ve read any of my stuff in the past, you’ll know that even though there’s an “M.D.” after my name, I’m not at all opposed to natural or alternative treatments. But here’s my caveat: those remedies have got to be effective. And safe. I need evidence to buy into something, not just a bunch of hype. I’m picky that way.

So I looked into all the commonly-cited natural treatments for head lice to see if there are any viable alternatives to the insecticides listed above. Here’s what I found. Most of the alternative treatments are considered “suffocants,” which means that although they don’t directly kill the lice, they may suffocate or create an otherwise inhabitable environment for head lice. Some of the commonly used home remedies that fall under this category are:

  • Olive Oil
  • Mayonnaise
  • Petroleum Jelly (Vaseline)

Other natural treatments fall under the category of essential oils, most specifically tea tree oil.

So, the question is: do any of these home remedies actually work? Well, sadly, I found that precious little research has been done. One small study in Australia did find that suffocants, and an essential oil mixture including tea tree oil, were effective against head lice. But a single study is not a lot to go on. Much more research needs to be done.  In the meantime, there are plenty of people who have reported, in an informal way, that these treatments worked for them. And, because I would consider all these treatments to be safe, there’s no reason not to give them a go (apart from lost time and effort if they don’t work).

If you’re going try one of these options, check this site for advice on how to use the them.

Nit removal

This is important adjunct treatment, whether you go for an insecticide or an alternative. Nits are the eggs of head lice and they firmly cement their nasty little selves to the hair shaft. They don’t fall off with treatment, natural or otherwise, so you have to get in there with a comb and physically remove them. You can use your fingernails, or a louse removal comb that you get at the drug store (metal ones are probably more effective than the plastic). Here’s how you do it: sit your little one down in front of a good movie on TV, get yourself comfortable, channel your inner mama gorilla, and start removing those nits by slowly and systematically combing through your child’s entire head. Repeat frequently over the next two weeks.

What about housecleaning?

Well, head lice only live away from the human head for about 3 days—not a terribly long time—so you don’t need to go nuts. (You may know I’m not a fan of extra housework). But you should wash stuff that’s come in contact with your kid’s head, like hats, pillowcases, and towels, in hot water and then dry in hot water for at least 15 minutes. Or, alternatively, store the items in an airtight plastic bag for two weeks.

And school attendance?

This is another contentious issue. Should kids with head lice be excluded from school? The unanimous answer from all the official bodies (Canadian Pediatric Society, et al): No!

That’s right: kids with head lice should be treated, but they can, and should, attend school or child care as usual.

Here’s why:

  • Head lice is common in kids.
  • Head lice don’t spread disease, and they aren’t a health hazard.
  • Kids can have symptom-free head lice for several weeks.
  • It’s easy to misdiagnose a case of head lice.

“No-nit” policies that exist in some schools are misguided, and could result in perfectly healthy kids missing several weeks of school, which would be quite wrong.

One last note, on the prevention side: make sure you teach your kids to avoid sharing combs, brushes, hats, or hair accessories.

And there you go. Everything you wanted to know (but didn’t really want to think about). Got that creepy crawly feeling yet?