Back to School: What to Do About Lice

Roni Shye
Roni Shye, PharmD BCGP BCACP, is a licensed pharmacist in the states of Florida, Ohio, and Pennsylvania.
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If you have little ones heading back to school in the next few weeks, you may already be prepared for the colds, flu, and other bugs that get passed around each fall. You may not be as ready for actual bugs though—and it’s important to know what to do if your child comes home with head lice.

Know that if the unthinkable happens, treating head lice can be as easy as going to the store and picking up an over-the-counter treatment. However, in some cases, you may need to see your pediatrician for a prescription medication. Here’s what you need to be prepared.

How can my child get head lice?

The most common way to get head lice is by head-to head contact with a person who already has lice. This can mean sharing hair brushes, combs, hats, scarves, or protective headgear like helmets.

How can I keep my child from getting lice?

You can help prevent your child from getting head lice by encouraging them to hang their coats, hats, and scarves on a separate hook from others. They also shouldn’t share personal items like brushes and combs, hats, scarves, or helmets.

What type of treatments are available without a prescription?

The two most common medications for head lice are Nix and Rid. Both are available alone or as a treatment kit that comes with shampoo, comb, and spray for your home.

Is there an advantage to using either Nix or Rid?

Yes. There are multiple advantages to using Nix over Rid.

First, Nix has a much more relaxed age restriction. Nix can be used in children older than two months. Compare that to Rid, which can’t be used until your child is two years or older.

Second, Nix kills lice and eggs in a single application, while Rid requires a second dose in 7 to 10 days.

Finally, Nix also prevents re-infestation by continuing to kill lice—including baby lice as they hatch—and protect against re-infestation for up to 14 days after you apply it, even if you shampoo as usual.

How do I know when my child needs to see a doctor for head lice?

If you think your child may have head lice it can be a good idea to go to the doctor to confirm before bothering with over-the-counter treatment. Your doctor can inspect your child’s head and hair to confirm and give an accurate diagnosis of a head lice infestation.

If you’ve tried Nix or Rid and the lice aren’t gone, you’ll also need to go to your doctor. They may be able to recommend a prescription treatment that will be more effective.

Why would I visit the doctor for a prescription instead of using Nix or Rid?

First, you may have heard of a new type of treatment-resistant lice some are calling “super lice.” These lice are resistant to over-the-counter treatments like Nix and Rid. Never fear though—they still respond to prescription medications.

You could also find some savings at the pharmacy. Prescription treatments include Sklice (ivermectin), Ovide (malathion), Ulesfia (benzyl alcohol), Natroba (spinosad), and lindane. All but Sklice and Ulesfia have generic options available, and if you have insurance, your co-pay could be less than you would pay for Nix or Rid at the store.


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