Treating Head Lice

I would appreciate detailed information on how to treat head lice. My child is in year-round school. Last year, we battled head lice all year long. Over her last break we were able to get it under control. She just started another session and already we’ve had an outbreak. It has become a serious subject of concern among the parents at my daughter’s school. What should we do? What are the latest recommendations? Is there anything that is not toxic that we can use?
Woodstock, New York

Dr. Greene’s Answer:

As I picked up the chart in my inbox, I glanced down to see what the nurse had written. “Lice.” Just looking at the word made my head itch.

Entering the exam room, I could tell that Mrs. X felt a bit uncomfortable.

“Hello, Mrs. X! How can I help you?”

“I can’t believe it!” she said. “There’s another outbreak of head lice at my kids’ school and this time, my kids have been sent home.”

Just listening to her made my head itch worse.

“Why can’t they do something about it? Now we’re stuck dealing with it, too! What can we do? I don’t want to deal with this ever again!” she cried.

Mrs. X’s feelings, and your feelings, are understandable and more common than you might expect. There are about 12 million cases of lice per year in the United States alone. Each year, many day-care centers, schools, neighborhoods, extended families, and small family units face this problem. You and Mrs. X are not alone.

Historically, the main method for getting rid of lice has been mechanical — physically removing the nits, or “nit-picking,” such as apes do for each other during their daily grooming routine. About 30 years ago, powerful pesticides were introduced as lice treatments. For a time these pesticides made treating lice much easier. Over the last several years, however, the lice have become increasingly resistant to these medicines. This resistance is growing. Now, once again, mechanical nit removal is the cornerstone of lice treatment, although the medicines can still be a real help.

The Great Lice Adventure

It is important for everyone potentially involved in an outbreak to be treated at the same time. If 99.99% of the lice are killed, but .01% are not, you already have the makings of another outbreak!

Here is a step-by-step guide for using common, over-the-counter medicines to kill the lice, followed by several great natural remedies:

  • Set a community-wide time to act — now!
  • Get all the kids excited about The Great Lice Adventure! Have teachers do projects on lice as insects. The more the kids know about what’s going on, the better. Use art, storytelling, science, even math. Start with one louse and calculate how many lice would be on an untreated head at the end of, say, a day, a week, a month …
  • Print detailed instructions on how to get rid of lice and distribute them to children, parents, teachers, and anyone else who works at the school.


Day One

Not all of the following steps are always necessary for an individual child. For stubborn cases, especially during school-wide outbreaks, following all of the steps can actually save a lot of hassle and repeated exposure to pesticides!

  • Carefully comb through the hair using a nit comb. I don’t recommend using the combs that come packaged with lice shampoos. Instead, use a new product, called the LiceMeister. Its metal teeth are very close together, catching lice well, but without catching or pulling on hair. Since most children will only sit still for a short time (and since most parents don’t want to spend longer than necessary combing through lousy hair), using this comb results in a more thorough delousing than when using the ordinary plastic nit combs.
  • Recent studies show that while white vinegar does loosen nits from the hair shaft.

Using stronger pesticides can set up a pattern of using more and more powerful pesticides as the lice develop ever-increasing resistance. This pattern has a definite negative long-term impact on the environment. It also exposes children to greater and greater levels of toxins.

Most alternative treatments are untested, but early reports are promising. One method with widespread stories of success is the Vaseline (or mayonnaise) treatment. Cover the infested head liberally in Vaseline. Place a shower cap over the entire head for the night (or an eight-hour period). Then shampoo the Vaseline out of the hair. This treatment is reported to “smother” the lice. The downside of this method is that the Vaseline does not shampoo out of the hair easily — in fact, it usually takes a week or so to get it all out. The upside is that it is not toxic, and from all reports, it seems to work. Washing the hair with dishwashing liquid, which has a degreasing agent in it, may help. I’ve smothered my own hair in mayonnaise (loved the smell), and it came out easily with dishwashing liquid.

To date, the jury is still out about whether or not these alternative treatments are effective. One research scientist has published several articles stating that Vaseline, mayonnaise, and other oil-based treatments cause the lice to go into a dormant state where they are inactive, but not dead. These dormant lice can later “revive” if they are not removed from the hair shaft. It’s important, when trying this method, to brush out any remaining lice to prevent reinfestation after the Vaseline (or mayo) is washed off.

The Packard Children’s Health Services Pediatric Hotline at Stanford is hailing another popular treatment. It uses regular shampoo and three ingredients that can be found at most health-food stores:

Shampoo  3 tbsp olive oil. 1 tsp tea tree oil. 1 tsp rosemary or eucalyptus oil.

Add the oils to a small amount of shampoo and mix well. Work into hair and leave on for half an hour with a tight-fitting shower cap. This mixture has a strong smell. The fumes may burn the eyes, so don’t lean forward. Wash hair two or three times to get the oil out. Repeat the procedure if necessary.

I’m hearing positive reports about this nontoxic treatment, though to my knowledge, no medical studies have been conducted to establish the efficacy or possible side effects of this treatment.

Meanwhile, several other natural compounds are being studied as possible treatments for head lice. Recently, a group of scientists in Argentina published a study looking at treating head lice with the fruit of the “paraiso” tree (Melia azedarach L.). This is a tree that grows easily all over Argentina, also known as “chinaberry tree,” “Indian lilac,” or “white cedar.” They found that both the extract and the oil of this fruit were able to kill adult head lice and some of the nits (Carpinella et al. Journal of the American Academy of Dermatology, 56(2) 2007).

One of our readers suggested using a hot blow-dryer for 15 minutes, morning and evening, in conjunction with thorough nit combing. The heat helps to kill the nits and adult lice, but the combing is essential to the process. This type of treatment should not be combined with the over-the-counter chemical treatments such as Rid and Nix since those chemicals are deactivated by the heat of the blow-dryer.  . I’ve had great success combining the blow-dryer with an application of Cetaphil, though.

As a last resort for extra resistant lice, the Red Book 2000 mentions two prescription medications creams — Lindane and Malathion. To me these cures are worse than the disease — both for those being treated and for the environment. In fact, these creams are thought to be so dangerous in our water supply that the state of California banned the use of lindane to treat lice or scabies.

There are also several prescription oral medications currently being looked at as possible treatments. In the May 1999 issue of Infectious Diseases in Children, Septra (trimethoprim-sulfamethoxazole) is mentioned as a possible treatment for lice. The regimen is twice a day for three days with re-treatment after 7 days. There is some controversy as to whether or not it works. According to the article, it works by changing the bacteria in the gut of the louse, preventing the absorbance of vitamins. The lice then produce infertile eggs and die of malabsorption.

The Key to Success

Whatever treatment you choose, removing lice from the environment is critical to breaking the cycle.

Cleaning Method No. 1

  • After the head is treated, wear a tight-fitting shower cap or bathing cap to prevent re-infestation during the cleaning process.
  • Every surface in your home and car(s) that has touched a head, or has touched an object that has touched a head, must be deloused! All clothes need to be washed in hot water and dried in a hot drier. Even clean clothes that have been hanging in a closet might need to be washed — if a person with lice wears a sweater, then takes it off and puts it back in the closet, any piece of fabric that it touches could become a new home for lice!
  • Wash all bed clothing, including bedspreads, pillows, mattress covers — anything fabric. Dry-cleaning and ironing with a hot iron also kills lice and nits.
  • Clothing and bed coverings that cannot be safely washed in hot water can be double bagged in black plastic bags, sealed tightly, and put away for three days. At the end of that time, wash the clothing according to normal washing instructions.
  • Combs and brushes should be soaked in rubbing alcohol or Lysol for one hour, followed by washing in soapy water.
  • Thoroughly vacuum all carpets — even under the beds! Steam cleaning is even better. Using a high-powered vacuum (not a battery-operated hand-held version), thoroughly vacuum all upholstered furniture. Or better yet, have all upholstered furniture professionally cleaned.
  • Spray and powder forms of lice medicines can be used on carpets, floors, and upholstery. I personally prefer not to use these pesticides unless it is impossible to do a thorough cleaning. If you do need to use one of these products, be sure that your children are not present when you use it, and that you thoroughly air out the space before allowing your children to return.
  • Before you take that lovely shower cap off, be sure to take off all the clothes you’ve been wearing during this process. Put on freshly hot-water laundered clothes, and put your work clothes in the wash.
  • If you do not have access to a washer and dryer in your home, work in teams. Someone who has not been treated yet can put all the loads of laundry into the washers at a public laundry facility. Meanwhile, a second person can be treated, and then go to the laundry and take over. You want to avoid unlaundered clothes if you have been treated (unless you are wearing a shower or bathing cap), and you want to avoid handling clean clothes if you haven’t been treated.


Cleaning Method No. 2 — The Real Alternative

  • This great suggestion came from my friend Dr. Donnica, formerly of NBC’s Later Today show. Instead of cleaning every inch of the house, just lock your house up tight and go on vacation. Get rid of the lice on your heads, and then get out of town. I like this idea. Lice die after 55 hours without a human host. If you can afford to be gone for at least three days, you will return to a lice-free environment.


Returning to School

  • After everyone in the community has completed Day One treatment, it is safe to return to school. Every child, teacher, and staff member should be inspected for lice prior to re-entry. This will make coming back to school the first day after the big cleanup a real zoo. Consider making it into a party! Have a few parents meet early and inspect each other’s heads. Then they can break up into stations in the school parking lot, playground, or some other convenient location that everyone must pass before going into any of the buildings. As each person is inspected, give him or her a sticker — “The Great Lice Adventure!”
  • If a child does not pass, have a plan. Parents cannot be allowed to just drop off their kids on that day. If the child doesn’t pass, the parent must have a provision for alternative child-care (this will be a real incentive to comply with the plan). In addition, have prepared instructions to give to any parents who may need to do all that work over again.


Days Two Through 13

  • Shampoo daily and follow with careful nit-combing. I like using tea tree oil shampoo for this purpose (this is not full-strength tea tree oil, but the shampoo that contains tea tree oil.) Found in health-food stores, this shampoo is reported to prevent re-infestation with lice, but studies have not been done to determine its efficacy.


Day 14

  • Repeat your original treatment choice in order to catch any lice that might have hatched since the first application. Do one last, thorough nit-combing.


Beyond Day 14

  • Continue scalp inspections until the lice have left the community — at least for the time being.


Going back to school to face another year of lice must be very discouraging. Remember that you are part of a community. Blaming others doesn’t help anything; it is important for everyone to work together. By staying positive, the whole process can actually help bring a school together! I know my own children have fond memories of The Great Lice Adventure — now that it’s over!

June 22, 2011

Dr. Alan Greene

As a father of four himself, Dr. Greene has devoted himself to freely giving real answers to parents' real questions -- from questions about those all too common childhood conditions to those that address the most recent and rare pediatric illnesses. His answers combine cutting edge science, practical wisdom, warm empathy, and a deep respect for parents, children, and the environment. He is also an electrifying public speaker, and has personally touched many during his talks in North America, Europe, Asia, and the Middle East.

Dr. Greene is a graduate of Princeton University and the University of California at San Francisco. Upon completion of his pediatric residency program at Children's Hospital Medical Center of Northern California he served as Chief Resident. He entered primary care pediatrics in January 1993.

Dr. Greene is the Past President of The Organic Center and on the Board of Directors of Healthy Child Healthy World. He is a founding partner of the Collaborative on Health and the Environment. He also consults for the Environmental Working Group.

In 1995, he launched, cited by the AMA as “the pioneer physician Web site” on the Internet. His award-winning site has received over 80 million Unique Users from parents, concerned family members, students, and healthcare professionals. In addition to being the founder of, he is the Medical Director for HealthTap.

In 2010 Dr. Greene founded the WhiteOut Movement to change how babies in the United States are fed. In 2012 he founded TICC TOCC - Transitioning Immediate Cord Clamping To Optimal Cord Clamping. He is also the founder of KidGlyphs, a free iPhone app that provides a tool for young children to express themselves beyond their verbal skills while teaching them important language skills.

Dr. Greene is the Founding President of the Society for Participatory Medicine and has served as both President and Board Chair of Hi-Ethics (Health Internet Ethics. He is on the Board of Directors for Healthy Child Healthy World, The Lunchbox Project, and The Society for Participatory Medicine. He has also served as an advisor to URAC for both their inaugural and their updated health web site accreditation program. He is a founding member of the e-Patient Scholars Working Group, and a founding board member of the Center for Information Therapy.

Dr. Greene is a regular columnist for Parenting Magazine. He is also the Pediatric Expert for The People’s Pharmacy (as heard on NPR) and Healing Quest (seen on PBS stations). He was the original Pediatric Expert for both Yahoo! and iVillage.

Dr. Greene is the author of Feeding Baby Green (Wiley, 2009), Raising Baby Green (Wiley, 2007), From First Kicks to First Steps (McGraw-Hill, 2004), The Parent's Complete Guide to Ear Infections (People's Medical Society, 1997), and a co-author of The A.D.A.M. Illustrated Family Health Guide (A.D.A.M., Inc., 2004). He is the medical expert for three additional books, The Parent's Soup A-to-Z Guide to Your New Baby, (Contemporary Books, 1998) The Parent's Soup A-to-Z Guide to Your Toddler, (Contemporary Books, 1999), and The Mother of All Baby Books, (Hungry Minds, Inc., 2002).

Dr. Greene is a frequent keynote speaker at important events such as Health 2.0 2011 held in San Diego, CA, IFOAM 2008 (International Federation of Organic Agriculture Movements), held in Modena Italy, the first European Internet health conference, held in Maastricht, the first International eHealth Association Conference, held in Jeddah, and the largest e-Healthcare World Conference, held in Las Vegas, and the first Green Power Baby Shower, held in Hollywood. Dr. Greene also appears frequently on TV, radio, websites, and in newspapers and magazines around the world, including such venues as the TODAY Show, Good Morning America, Fox and Friends, The Dr. Oz Show, CNN, ABC, CBS, and NBC network news, NPR, The New York Times, The Wall Street Journal, USA Today, Time Magazine, Parade, Parenting, Child, Baby Talk, Working Mother, Better Home's & Gardens, and the Reader's Digest.

Dr. Greene loves to think about challenging ideas, he enjoys being where nothing manmade can be seen, and he wears green socks.

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  1. Johann

    A lice party? I don’t think so. There is nothing fun about getting rid of lice. Coco oil, star anise oil, are good but those pesky little eggs shells are impossible to get out. Those combs that they give are a joke, for a $30 bottle of shampoo. They break apart easily. The schools won’t have anything to do with a lice infested kid, making the kids levels of stress much higher than it should be. Wash their hair do all laundry throw all pillows out and vacuum daily all beds couches and carpets. And use Bleach, lots of it. And that’s all a hefty price to pay for a nuisance, which a lot of people can’t afford. And then they charge at some places $250 for 2 hours of removal. Even more money spent. Lice is annoying and concerning because of children. Adults can deal with their stuff just fine, but kids are a different story, and that causes adults stress levels to become higher. I’d say after you get rid of them, RELAX for a few days. And keep all people away from you. How can people recommend things without any proof that they work completely. Humor aside, nobody wants to deal with this, but since some do, just get to the point fully.

  2. Jeff Evans

    It’s crazy to think that even with 99.99% of the lice killed, .01% can still cause another outbreak. I remember when I was in elementary school a kid gave a lot of our class members lice and I ended up being one. I got it treated quickly, but I remember having to stay out of school for a couple weeks. Fun times! Thanks for the good read!

  3. Danni Black

    I am so glad that I came across this article. There was a breakout of lice at my daughter’s school a few days ago and I have been really worried that she is going to get it too. I’ll have to keep this information in mind if she shows any signs of it. Thank you for sharing!

  4. Kate Hansen

    My daughter has head lice and I have no idea how to get rid of them. I didn’t know that if you didn’t kill all the lice and leave .01% of them, you could have another outbreak. I definitely need to find a way to kill them all so she doesn’t have to stay home from school more.

  5. Patricia Anderson

    Thank you for posting this. My daughter came home form school with head lice and I was overwhelmed. Thank you giving step by step processes to help resolve this problem. Thank you!

  6. McCall Hazelton

    Lice can be scary, and in the long run kind of difficult to treat. I wonder how many people end up getting lice annually, and if we can figure out some sort of treatment that would permanently get rid of them. You for sure need to go see a doctor if you think you have lice, there might be some home remedies, but they are nothing compared to professional help.

  7. SJ

    We’ve used a product that’s essentially a salt water spray with licorice scent– and it totally works. In fact, I looked it up and salt water is very effective at dessicating nits and lice. Worth it to just make your own and give it a try! Follow up by letting it dry completely, then shampoo, condition, nit comb. And keep fingers crossed!

  8. Aliza

    Hi, very nice and informative post. now these days very common problem with every children and mother are worry about your children for this problem. this post very helpful, specially for mothers. thanks for sharing with us.

    Holistic | Head Lice Treatment


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