Pediatric Associates of Richmond

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Lice Treatment Instructions

For a pdf version of these instructions you may click here

  1. Shampoo your child’s head with an over-the-counter lice shampoo, such as RID or Nix. Before shampooing, have your child wear an old tshirt, and drape the shoulders with a beach towel.  Do not use conditioners before applying the lice shampoo.  Thoroughly massage the shampoo into the scalp, being sure to pay attention to the back of the neck and the area behind the ears. If your child has very long hair, a second bottle may be needed to coat the entire head.  Keep the medicine out of your child’s eyes.  Allow the medicine to sit on the scalp as directed on the bottle and then rinse with water. You do not need to use regular shampoo or conditioner after the lice treatment. In fact, it is best to not shampoo again for 2 days, in order to give the medicine time to work. The medicine will kill the live lice bugs, generally within 12 hours.
  2. Comb your child’s hair.  This is the MOST important step! Make your child and yourself comfortable.  Put on a favorite movie, CD or audiobook.  Have a ready supply of clips available for pinning back sections of the hair. Find a bright light source to make it easy to see the nits.  Have a trash can and some rubbing alcohol and paper towels nearby.  Comb your child’s wet hair with a standard comb to remove knots and tangles.  Using a bit of olive oil to coat the hair shaft may make this task easier for both you and your child.  Pin up all but a very small section of hair.  You will work in small sections, which is where the clips come in handy! Using a lice comb, (either provided in the kit with the lice medicated shampoo or sold in pharmacies) comb a tiny section of hair, going through it strand by strand.  If you spot a nit, pull it firmly with your fingernail.  Some people think that pulling out the entire shaft of hair is easier, especially if your child has very long hair. Use whichever method seems most effective but most comfortable for your child.  Discard any nits in the trash can.  Nits may be pulled off in the teeth of the lice comb.  Rinse your comb in some rubbing alcohol, dry it with the paper towel, and begin again.  Once you are sure a section of hair is free of nits, pin it up and continue the process with another section of hair, until you have combed the entire scalp.  Rinse the comb after each pass through the hair.  Inspect your child’s eyebrows and eyelashes for nits, too.  Most importantly, keep your child and yourself comfortable and at ease during this process.  This is a time consuming process!  Take breaks briefly, use the time to talk with your child, tell stories, have a snack, etc.
  3. Once you have treated the child that you know to be infested, then examine all remaining family members for nits or lice.  If you see any nits or live bugs, follow the tips for shampooing and combing as above.  Don’t forget to have someone comb through your hair, as well!
  4. Regarding cleaning: First and foremost,please remember head lice do not survive if they cannot feed.  They will die if not living on a human head for 48 hours.  You don’t need to spend a lot of time or energy cleaning your home!  It is a good idea to machine wash and dry all clothing, bed linens and towels that your child wore during the 2 days before treatment using hot water and high drying heat.  In the winter, remember hats and coats, as well.  All brushes and hair accessories should be washed (brushes can be soaked in the lice shampoo or put into the dishwasher).  Any items that are not washable may be dry cleaned or stored in an airtight bag for 2 weeks.  Vacuum the floor and the furniture.  However, remember that the chances of alive bug falling from a head onto the floor or furniture and crawling to a new head are very small.  Nits will not hatch if away from a human scalp for one week.  It is not necessary to scrub or vacuum every surface in your home!  Focus only on those areas that have been in contact with the head of the infested person 24 to 48 hours prior to treatment.  Please do not use fumigant sprays, they are not effective and can be toxic.  Put your time and energy into combing, not cleaning!
  5. Continue to comb the infested child’s hair every 2-3 days for the next 10 days, using the method described above. On the 9th day after the initial shampoo, it is recommended that you shampoo with the lice shampoo again.  If you continue to see live bugs 2 days after shampooing, please call our office for recommendations.  A prescription may be called to your pharmacy to help.  It is important that you remember to continue to comb, to remove any residual nits, as well as remember to retreat with the lice shampoo.  The most common reason for ‘reinfestation’ or recurrence is that not all the nits were removed with the initial treatment.
  6. Your child may return to school once you have completed the initial shampoo treatment and nolonger see live bugs.  Your child DOES NOT have to be free of nits to return to school.  Some school nurses favor a ‘no nit’ policy, but the American Academy of Pediatrics does not endorse this practice.
  7. Now that your family is free of lice, remind yourself and your child of some important ways to prevent lice in the future. Do not share brushes, hats, hair accessories or pillows with others.  Encourage your child to put his or her coat inside the backpack at school rather than hang it on a hook with his classmates.  Tuck hats inside the sleeves of coats or in the pocket.  Consider having your child to wear long hair back in a braid or ponytail while at school.  Take a fewminutes once a week to visually inspect your child’s hair and scalp for the signs and symptoms of lice.