K I D S Ñ S o lut i o n s
14 days after being treated with dimethicone. The only hitch: It’s not as readily available as a lice treatment in the United States as it is abroad. But there are some products sold in the U.S. that contain dimethicone, such as Nix Ultra, which may make the treatment more effective.
The Rx Route There are also a handful of prescription options that are more powerful than OTC treatments (and which, happily, lice are less likely to be resistant to). One is benzyl alcohol lotion, which kills lice over two treatments but does not kill nits, and is approved for use on children 6 months and older. Another is the lotion sold under the brand name Sklice, whose active ingredient is ivermectin. (If the name of this drug sounds familiar, it’s because you’ve likely heard about people attempting to treat COVID-19 with it—unsuccessfully, and at great risk to their health, since they’re using a version of the drug meant for horses.) This treatment does not kill nits either. But another option, malathion lotion, kills both live lice and some nits, and can be used on kids age 6 and up. Finally, spinosad (brand name Natroba) is a topical medication that is effective at killing both lice and nits, requires no combing, and is typically effective after one treatment. Perhaps you’re wondering: If they work so well, why not just start with a prescription? Some doctors do recommend this, but many others insist that making prescription options the norm will only increase lice’s resistance to these chemicals. Another major downside to prescription treatments is that these powerful topical pesticides can be even more irritating to the skin than OTC options, and even more potentially dangerous if they get into the eyes or are ingested. (If your child is prone to dry skin or eczema, mention this to your pediatrician so they can take this into account when prescribing.) In fact, it’s worth noting that the American Academy of Pediatrics advises washing all chemical treatments, both prescription and OTC, out of the hair only over the sink, not in the shower, to prevent the
The Biggest Lice Treatment Mistake Parents who are worried about lice may see what they assume are nits and treat their kids unnecessarily. “I often see parents who think they’ve found lice but haven’t,” says Bernard Cohen, M.D., of the Johns Hopkins University School of Medicine. What else might it be? Dandruff, dried hair products, scaly skin, and more are often confused with nits. In order to truly diagnose a case of lice, you must spot a live and crawling louse. If after a thorough check you don’t see anything moving, your child might just have an itchy scalp from cold weather, or their hair gel is flaking. Congrats!
lotions from coming into contact with other parts of the body. So when should you pull the trigger on a prescription? Head to the pediatrician only after nothing else has worked. “If you’ve used an OTC treatment but your child still has active lice after five to seven days, don’t wait to do the second treatment,” Dr. Bode says. “Just go see your child’s physician for a prescription.” In this situation, it’s very likely that the bugs aren’t all from just-hatched eggs but are instead survivors of the first treatment. “It’s also smart to see the doctor if you did the recommended two treatments, then within a month the lice are back,” Dr. Bode adds.
Nonchemical Solutions For many parents, dousing a child’s head with an insecticide is simply a nonstarter. That’s a reasonable position to take, Dr. Bode says. “I think it’s always important to have some concerns anytime you’re giving your child medication or a topical treatment.” However, not all “natural” treatments are superior. For instance, excessive or inappropriate application of essential oils (tea tree and other oils are often falsely billed as treatments) can poison children, even through the skin. Other popular alternative treatments aren’t as potentially dangerous but do tend to lack clear data indicating that they work. Many methods involve the application of food-grade oils, hair conditioner, or lotions to the head. “These are thought to smother lice on the scalp,” Dr. Pollack says. “But none of them have been sufficiently tested for use against lice, and none are labeled for this purpose.” That said, there was one small study that reported a 96 percent cure rate when Cetaphil face cleanser was applied to hair, combed out, dried with a blow-dryer, left overnight, and shampooed in the morning. (This was repeated once a week for three weeks.) However, “this wasn’t a randomized controlled trial, which is the gold standard of studies,” Dr. Cohen says. “There’s really no definitive data to support that this is effective.” What we do have, though, are anecdotal reports from parents who say it works. “While there’s no proof that covering
