What is the best way to tackle head lice?

‘You buy the shampoo, use it, comb for as long as you can endure the complaints, then think job done’

Removing head lice can be a difficult task which requires follow-up treatments. Photograph: iStock

Removing head lice can be a difficult task which requires follow-up treatments. Photograph: iStock


My heart used to sink when my school WhatsApp group buzzed with head lice warnings. It was annoying repeating the trauma of treatments and constantly forking out on shampoos. But that was before I got serious about wet combing.

According to the Irish Pharmacy Union (IPU) 10 per cent of children between the age of four and 16 will have head lice – hence the regular school emails. It’s difficult to get hard stats but research shows there is a higher incidence today with older kids getting them regularly. Ask any health professional and they will confirm this.

In my case I was at my wits’ end when an incident at the hairdresser last September forced me to examine my strategy after the manager (very nicely) asked us to leave when head lice were spotted in my daughter’s hair.

One week after I had treated the family following an infestation, so how could we have them again when the product I used promised one treatment was effective?

Follow up is key

When I got home and combed my daughter’s hair I discovered that what the hairdresser saw were some nits – the tiny eggs laid by lice which are difficult to remove. They are grey or caramel colour and white when empty. True diagnosis requires detecting live lice, so while technically my daughter did not have head lice it was very likely some of the nits remaining were viable and would soon hatch.

I realised my problem was complacency, and I suspect a lot of parents do the same. You buy the shampoo, use it, comb for as long as you can endure the complaints, then think job done and relax until the next panic.

The hairdresser saga highlighted to me how important follow-up combing was after any treatment to clear all the nits out and break the life cycle of the louse which usually hatches after seven-10 days. After doing some research, I decided to get serious and to treat wet combing like a weekly extracurricular activity we had to show up for. I planned to use it as my sole treatment the next time we got lice and see what happened.

An unexpected gain was guaranteed quality time with each child as they couldn’t run off to play Fortnite and had to sit and chat for up to 15 minutes, or if feeling uncommunicative could request songs on my phone. By some sort of a miracle it turned into a fun thing to do.

How did we fare? Over the six months carrying out weekly combing we got head lice once – a marked improvement. This was at Christmas when I missed three weeks of combing due to better options on a Sunday night. Two of my four children had a few live lice and the only treatment I used was wet combing with plenty of conditioner, repeating every four days for a fortnight and then going back to weekly combing. It worked and we have not had head lice since.

So what do the experts think? Is wet combing sufficient?

Bug busting possible by wet combing alone

Dr Mary Casey of the UCD school of nursing has carried out research on the effectiveness of wet combing and believes that used correctly this is a proven method to deal with head lice.

The 2008 study, carried out by the UCD school of nursing and the HSE, focused on natural remedies and found that by using wet combing alone 82 percent of parents did not experience a recurrence of head lice in the following year.

“Dedicated wet combing is time consuming for parents especially for children with long hair but in my opinion it is the safest option as you are not using any chemicals and it can have a better outcome than using lice shampoos,” she said.

She said that with family schedules so busy these days it was difficult to find time to comb.

“Both parents out working is probably adding to infestations. During the week there is homework and activities and at the weekend it’s not something parents want to do,” she said.

She added that the key to success with combing is education and co-ordinated efforts and recommends that schools organise a combing night a few times a year at high-risk times such as after any holidays which could tie in with no homework to make sure parents had sufficient time.

Screens and long hair increasing lice in teens?

When you think of head lice you think of small children consulting each other closely in playgrounds but research shows gathering around screens could be behind more infestations in teenagers.

A 2017 study in the United Kingdom involving 200 children found that 62 per cent who had a tablet or smartphone had picked up head lice in the past five years compared to 29 per cent without.

The study also highlighted how head lice was increasing with 45 per cent of participants having head lice at some point in the previous five years compared to the 8 per cent prevalence rates in the past.

Tess McPherson of Oxford University Hospitals NHS Foundation Trust was one of the researchers on this study and says there is a level of misinformation out there that older children are not affected by head lice.

“There is evidence that more older children get lice possibly due to factors such as celebrity long loose hair styles, events like festivals which mean sharing tents and children gathering around electronic devices. They may also be ashamed to admit to it,” she said.

Dr McPherson said it was possible to bug bust with combing alone but that you need to be committed to wet combing a couple times a week with conditioner until you get the all-clear and then comb weekly to prevent reinfestation.

Anne-Marie Tobin, dermatologist at Tallaght University Hospital, agrees with this.“There is a lot of resistance to some of the treatments available and also a lot of the shampoos contain alcohol so can be quite drying. My own opinion is that combing is the most effective way to treat and stay on top of head lice but that dedication is required for it to work effectively,” she said.

Lice now resistant to some products

According to Cork-based pharmacist Catriona O’Riordan there are currently some products containing pesticides on the shelves that she would no longer recommend as most head lice are now resistant to them.

This was highlighted in a 2016 US study which found that 98 per cent of head lice had developed resistance to most over-the-counter remedies.

Ms O’Riordan says nothing beats daily combing for prevention, and while it is possible to treat head lice just by combing with conditioner or coconut oil, she would still recommend that there is value in using one of the newer oil-based treatments which work by smothering the lice, though it is important to repeat the process a week later.

“Head lice are so difficult to spot and if using combing alone there is the risk some can go undetected,” she said.

“For successful combing set aside a dedicated time each week, use a head torch or even better pick a place with bright daylight and use a good fine comb – you can pick one up for a couple of euro in your chemist,” she advised.

Too busy to comb

Andrew Hennessy set up the Head Lice Experts five years ago and says the main cause of failure is not allocating enough time to combing out after treatment and a lack of awareness that no product will do the job 100 per cent for you.

“You must comb forensically and realise that success will not happen in one sitting as the life cycle of the louse makes this impossible. It is a very lengthy process, that must be repeated seven-10 days later.”

Mr Hennessy says once you are clear of head lice you need to do a weekly screen or forensic combing, which takes about 15 minutes. Then even if you do find live eggs or lice if you are repeating a week later you can keep on top of the life cycle of a louse as they lay their eggs on day seven.

If you have hair you can get lice if you are seven years old or 67, although they don’t like too much testosterone so post-puberty males are not as likely to get them. Mr Hennessy says he sees all ages in his clinic.

“Ninety per cent of children that come into the clinic have 50 crawling lice and 100 eggs. And a high proportion of the mums also have it and quite a few grandparents too,” says Mr Hennessy.

Head lice aren’t a major health danger but they are annoying and can be upsetting for everyone to deal with.

If your current approach is getting you down why not try a mental shift and embrace weekly combing as time together with your kids that you can enjoy.

It worked for our family – it requires patience and you need to really prioritise it, but it’s not toxic and best of all it’s free.

Head lice: did you know?

According to the IPU aromatherapy based products such as tea tree oil don’t kill head lice, but there is evidence of a reduction in louse ability to move and that these products may be useful in combination with frequent checking/combing and wearing the hair in a tight plait or bun.

You can treat head lice by wet combing using a fine-toothed comb but it takes dedication and you must spend at least 20 minutes combing every third or fourth day for two weeks. To prevent further infestation you need to comb once a week for about 15 minutes, wiping the comb with tissue each time you bring it through the hair from the root to the tip.

New products made from silicone suffocate lice so they can’t become resistant to it – as they can with insecticides. You need to carry out two treatments to kill the second batch of lice that hatch after a week.

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