What is the recommended treatment for pediculosis (lice infestation) in children?

Treatment of Pediculosis (Lice Infestation) in Children

The first-line treatment for head lice in children is permethrin 1% cream rinse applied to affected areas and washed off after 10 minutes. 1

First-Line Treatment Options

• Permethrin 1% cream rinse:

  • Apply to dry hair and scalp
  • Leave on for 10 minutes
  • Rinse thoroughly with warm water
  • Re-treat in 7-10 days to kill newly hatched lice 1

• Pyrethrins with piperonyl butoxide:

  • Apply to dry hair
  • Leave on for 10 minutes
  • Wash off thoroughly
  • Re-treat in 7-10 days if live lice are still seen 2, 1

Alternative Treatment Options (for resistant cases)

1. Malathion 0.5% lotion (for children ≥24 months):

   • Apply to dry hair
   • Leave on for 8-12 hours
   • Wash off thoroughly
   • CAUTION: Highly flammable (78% isopropyl alcohol) 2, 1
   • Do not use hair dryers, curling irons, or flat irons while hair is wet
   • Keep away from flames and heat sources

2. Benzyl alcohol 5% (for children ≥6 months):

   • Not ovicidal
   • Apply for 10 minutes
   • Repeat in 7 days 2

3. Spinosad topical suspension (for children ≥6 months):

   • Apply to dry scalp and hair
   • Leave on for 10 minutes
   • Rinse thoroughly with warm water
   • Re-treat if live lice are seen 7 days after first treatment 3

4. Ivermectin (for children weighing >15 kg):

   • Oral: 250μg/kg repeated in 2 weeks
   • Limited ovicidal activity 2, 1

Management of Infested Items

• Machine wash clothing, bedding, and towels in hot water and dry on high heat cycle for at least 20 minutes 1
• Items that cannot be washed should be removed from body contact for at least 72 hours 2, 1
• Soak combs and brushes in hot water (>130°F) for 5-10 minutes

Important Considerations

• School attendance: Children can return to school immediately after receiving proper treatment; "no-nit" policies should be abandoned 1

• Treatment failure causes:

  • Improper application technique
  • Insufficient contact time
  • Failure to do second treatment
  • Resistance to pediculicide
  • Reinfestation

• Special populations:

  • Children <2 years: Avoid lindane
  • Children <24 months: Avoid malathion 2, 1
  • Children <6 months: Avoid spinosad 3
  • Pregnant/breastfeeding women: Use permethrin or pyrethrins with piperonyl butoxide 2, 1

Follow-Up

• Evaluate after 1 week if symptoms persist 2, 1
• Re-treatment may be necessary if live lice are found
• If initial treatment fails despite correct application, switch to an alternative regimen 2, 1

Relief of Symptoms

• Topical corticosteroids or oral antihistamines may provide relief for itching or mild burning of the scalp 1

Prevention of Reinfestation

• Educate children to avoid head-to-head contact
• Discourage sharing of personal items (combs, brushes, hats)
• Regular examination using a louse comb
• Check child's head before and after sleepovers 1

Manual removal of nits after treatment is not necessary to prevent spread, but can be helpful for aesthetic reasons and to distinguish from previously treated infestations 1.