Wellness Matters

Super Lice? Maybe Not: 5 Things You Should Know About Lice

April 05, 2016


It’s the call from the school nurse every parent dreads: Your child has head lice.

After you stop shuddering and scratching your own head, calm down. Fixing the problem may be unpleasant and inconvenient, but it can be done. Though in truth, it could be harder than it used to be.
  1. Before rushing to the drug store, make sure it’s actually lice. If the white speck you’re seeing is stuck to the hair, it’s probably a nit. If it comes off easily, chances are it’s just dandruff.
  2. Once you confirm your child has head lice, check other household members to see if they have any adult lice or nits. Every infestation must be treated.
  3. Whatever treatment you choose, read and follow the directions carefully. You will need to keep the medication on the hair and scalp long enough to work, but don’t go overboard. Leaving it on too long or applying more than the recommended amount can be toxic.
  4. You don’t need to clean your entire house or spend money having your carpets and drapes cleaned. Any lice that may have been on surfaces would only survive a day or two without human contact.
  5. You should wash any pillowcases, combs and brushes that family members who have lice may have used.

Some areas of the country have reported lice infestations that are resistant to traditional over-the-counter treatments – a strain referred to as super lice. So how do you know what you’re dealing with if these unwelcome bugs show up?




You shouldn’t assume it’s super lice if the first attempt to get rid of the problem fails. It could mean your child has a new infestation, or the medication wasn’t used correctly. I still recommend inexpensive, over-the-counter treatments – those with the active ingredient Permethrin – as the first line of defense.

If you are certain you used the medicine by the directions, including leaving it on long enough and you don’t think she or he could possibly have been back in contact with another child with head lice, it could be resistant lice. In any case, there are plenty of prescription medications available. It’s like an antibiotic for your child’s ear infection. If the first one doesn’t work, we’ll try something else. Don’t reuse a treatment unless instructed to do so by your doctor. But, regardless if they are truly resistant lice or not, there are options to help.

Many parents choose to treat a lice infestation naturally, without chemicals. One option is to smother the lice with a thick coat of mayonnaise or olive oil. As with over-the-counter medications, this method won’t remove the nits, though it likely kills most of them. These treatments can work, but every case is different. If you want to avoid chemicals, many of these alternative non-chemical treatments are worth trying and certainly safe.
Lice infestations are most common in preschool and elementary school children. In almost all cases, the lice spread through direct head-to-head contact. We still recommend kids not share things like hats and combs, but the risk of getting lice this way is less than most people realize. Head lice may be a fact of life, but they don’t pose a serious health risk. They’re not known to spread disease or cause infection. And having lice does not mean your child or your house is not clean.

People immediately assume they’ve done something wrong, but lice are a common problem whenever you have kids playing together. The best advice is not to panic. And don't repeat treatments that didn’t work unless instructed to do so by your doctor. If you have questions, you should contact your pediatrician.

About the Author



Ronald J. Pudlo, MD is Cone Health chief of pediatrics and a pediatrician at Greensboro Pediatricians.

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