What happens at a doctor’s appointment for head lice?

The first sign may be your child scratching their head. They say it itches a little, so you look closer. Is it head lice? While there are many ways people deal with head lice, sometimes a parent’s first thought is to call for a doctor’s appointment.

What happens at a doctor’s appointment for head lice? Today, I’ll go over all the typical things to expect when seeing a pediatrician (or other health care professional) for head lice. At the end, I’ll review some of the things they may want to discuss, including information from the 2022 American Academy of Pediatrics (AAP) clinical report for head lice. So, if you just want some general information about head lice without the appointment details, just scroll to the end. 

Scheduling an Appointment for Head Lice

To schedule an appointment for head lice, follow the usual regimen of scheduling an appointment with your child’s pediatrician. Usually, this means a phone call. And, considering many families want head lice taken care of as soon as possible, calling is a good way to get an earlier appointment. (For some offices, an appointment scheduled online or via a patient portal may take longer).

Some offices may have specific protocols for a child with suspected head lice, so be sure to explain the reason for the appointment if asked. 

Also, many pediatricians have different time slots for different types of appointments, so being upfront with your needs helps make sure you get an appropriate amount of time.

At the Appointment for Head Lice

Again, practices vary, but most pediatricians have patients with head lice follow the usual first steps of:

• check in at the front desk
• wait in the waiting room
• get vitals taken (like weight, heart rate, and temperature, for example)
• tell the person rooming the patient the reason for the visit
• wait in the exam room for the doctor

(This is pretty typical for the United States. It may be different in other countries).

What to Expect with the Doctor at an Appointment for Lice

After a patient is checked in, the doctor enters the room to begin their part of the appointment for lice. This can also vary a lot from one pediatrician to the next. However, if someone is concerned about head lice, it’s pretty likely is the physician will look at the child’s scalp. 

I’m using the terms pediatrician, doctor, and physician interchangeably. I also recognize that nurse practitioners, family practice physicians, and physician assistants may also treat kids with head lice.

Sometimes they may wear gloves. I liked to reassure families not to be offended by this. Physicians know that head lice is not dangerous. However, there may be other things on a scalp (like rashes ), so it’s better if they don’t touch with their uncovered fingers. So, if someone says their scalp is itchy, the doctor may choose to wear gloves.

The scalp exam for head lice

Lice are more likely to be on the hair shaft near the scalp, especially behind the ears or near the back of the neck. So, if someone isn’t sure where the lice are (or even if there are lice at all), the doctor may start their scalp exam there. If your child has their hair pulled back or in a pony tail, it may need to be undone for a complete exam. 

Questions a doctor may ask a patient when examining for head lice

As a pediatrician checks for head lice (or before they start looking) they may ask some questions like:

• How long has the child been itching?
• Is anything else bothering them?
• Has anyone around then had head lice?
• Were they sent home from school or daycare?
• Have you tried any treatments already? (If so, it’s helpful to know the details of the treatments like which ones used, and if they seemed to help)

What does a doctor look for when examining the scalp for lice?

When searching for head lice, a physician looks for two main things. First, they look for an actual live louse (lice is the plural). The louse has six legs and crawls quickly. A louse feeds on the human scalp, so they’re often found close to their meal source. In other words, they’re more likely to be close to the head instead of at the end of a pony tail.

And, they look for the lice eggs, often called nits. (Some people refer to nits when they’re talking about just the empty egg casings). Lice eggs are often sticky and can be stuck to the strands of hair. Many times families think their child has nits, when it’s just dandruff, dry skin, or flecks of hairspray. (This is a common misdiagnosis. The eggs don’t usually flake off easily). 

The physician may use a special magnifying glass or a special light, but this is not always necessary.

They are also looking at the skin and hair itself, to see if their are any signs of infection (different than a lice infestation).

After the doctor’s exam for head lice

Based on their exam, they can make a diagnosis. 

If the diagnosis is head lice, then they can come up with recommendations. These recommendations are based on their exam and the information provided about previous treatments, knowledge about what treatments work best in their community, and other factors.

Unfortunately, lice treatment or lice removal is not usually done during a typical doctor’s appointment. 

What may a doctor recommend for head lice?

First, it’s so important to remember that lice are not dangerous. They carry no harmful diseases and do not make people sick. This isn’t to minimize how very annoying lice are. It’s just to reassure that they won’t make a child ill. 

Head lice treatment depends on a few factors, including what someone has already tried. As mentioned earlier, some communities may also have lice that are resistant to some medications, so this influences recommendations too. And, certain medications are not recommended for infants.

Medication-free treatments for head lice

Note: This post contains affiliate links. As an Amazon Associate I may earn from qualifying purchases at no additional cost to you.

First, we must remember that once a lice is off someone’s head, it won’t just hop back on. They do not jump.

So, one possible treatment with no medications or chemicals is to remove each and every louse and each and every egg. Special combs are designed for just this (affiliate link). And, if the lice are combed out and thrown away (ideally in a sealed plastic bag, because they do crawl), and all the eggs are removed (and also thrown away because the eggs can still hatch), and the child is not in contact with live lice again? The head lice are gone. 

This is a labor-intense option though, isn’t it? And it’s challenging to get every egg. It is an option though.

Haircuts for head lice

Some people ask about haircuts for lice. The only adequate hair cut would be to shave the head. As I mentioned earlier, lice live on the hair close to the scalp, so even a short hair cut does not remove the risk of head lice. And, to be clear, the AAP does not recommend head shaving for the treatment of head lice.

Medication options for head lice in children (topical treatments)

The good news is many over-the-counter lice treatments are very useful and an excellent first step. Over-the-counter means no prescription is needed. Many physicians will still suggest starting with these treatments as they are often the best option for kids.

Most of these treatments involve putting the medication directly on the hair or scalp. Most of these medications kill live lice.

There are a few things to emphasize: It’s so important to follow the directions. If you’re going through the whole process of treating lice, it’s worth your time to follow the package directions as closely as possible. This may mean coating every strand of hair with the medication and leaving it on for the prescribed amount of time.

For some medications, like Nix, hair should not be shampooed for 24-48 hours after treatment. (It leaves a residue even after it is first rinsed out. This residue keeps working for any lice not killed at first). This is just one example of specific instructions that need to be followed for maximum effect. Some require a second treatment several days later. So, whatever treatment used, it’s important to read through all the directions first. 

A few common treatments for head lice in children

One common treatment is permethrin 1% (Nix is a brand name) which can be used for children and babies over age 2 months. (affiliate link)

Another medication is pyrethrin–piperonyl butoxide (RID is a brand name) and can be use for kids over age 24 months. (affiliate link)

One of these two treatments (Nix equivalent or RID equivalent) is often the first choice for a variety of reasons. 

If Nix or RID (or generic equivalents) are not options for your child:

If permethrin or pyrethrin–piperonyl butoxide medications aren’t available or if your child’s doctor needs to choose another, there are many other options. They include:

• Ivermectin lotion (brand name Sklice) for over age 6 months,
• malathion lotion for over age 6 years (though this is not a great choice for many families as I’ll discuss below in “What not to do”)
• Spinosad (brand name Natroba) for over age 6 months
• Abametapir (brand name Xeglyze) for over age 6 months has been FDA approved, but as of this writing, it doesn’t look like it’s available yet in United States pharmacies .

What about essential oils for lice?

According to the 2022 AAP recommendations, there’s not enough evidence to recommend using essential oils for head lice in children.

And, it’s worth remembering that essential oils aren’t regulated by the FDA so it’s heard to know exactly what formulation someone is using (so it’s also difficult to make a recommendation with such variability). Some individual pediatricians may discuss this further based on a family’s preferences. 

What about “occlusive” methods for head lice?

Some families would like to try other methods before using an insecticide like RID or Nix. Maye they haven’t had much luck with simply combing through the hair and picking nits and lice out.

There’s another option, referred to as “occlusive” methods. With these treatments, the idea is to basically suffocate the lice by coating them. People have tried mayonnaise, petroleum jelly, Cetaphil, melted butter, and dimethicone lotion.

Despite the logic in these being effective, there is not high quality research. 

There is one study regarding dimethicone lotion, so this could be an option, especially for an infant too young to use other treatments. 

Cetaphil for head lice

And, using an occlusive treatment regimen with the Cetaphil cleanser (affiliate link) can work for some kids too. When I’ve discussed this method with families, some are eager to try an option with fewer risks and side effects than other treatments. Other families comment on how labor-intensive it is. (It involves coating the hair with Cetaphil, drying it completely with a hair dryer, then leaving the Cetaphil on over night. Full directions are here.

What not to do when dealing with head lice

Depending on the appointment, a physician may need to emphasize a few things that are not recommended for kids with lice. 

1. Malathion has some high risks: Do not smoke or use a hair dryer around someone treated with malathion.

One treatment approved for kids over age 6 years old is called malathion. However, it is a highly flammable liquid. So, if someone uses this, it is crucial that no one smokes around them, especially while the hair is still wet with this product. They should also not use a hair dryer or curling iron (or flat iron) while being treated. 

2. Lindane 1% is not approved for children.

Lindane is toxic to children’s brains and nervous system. It is not safe for children or other vulnerable people.

3. Do not retreat for head lice only because of itching.

There is no need to retreat for scalp itching only (if no lice are seen). After using most topical treatments, it’s common to have some scalp and skin irritation. So, if someone is itchy after using the treatment, it does not necessarily mean they still have lice and need another treatment right away. It may just be the skin recovering. 

4. Kerosene is not an option for treating lice.

Kerosene should not be used under any circumstances to treat head lice. 

5. Animal medications should not be used on children.

Sometimes ingredients on human lice treatments look very similar to ingredients on products made for pets or other animals. They are not interchangeable. Even if it’s a cream or a shampoo, it can still be absorbed into a child’s skin. Animal medications often have additional ingredients that are not meant for kids. If this is something you’ve wondered about, I suggest talking in more detail with your child’s pediatrician. They can help find a much safer solution. 

6. Do not skip wearing a helmet with high risk activities due to a risk of lice.

Certain activities always require a helmet. If a child or teen is going to play tackle football or ride a bicycle (for examples), helmets and head protection are still important. This is true even if there is a risk of lice. This is another point the AAP emphasized in their 2022 clinical report on head lice.

(It’s also worth mentioning that lice are more likely to spread when one child’s head touches another child’s head, like when they’re hugging, than when they share helmets). My next post will go over in much more detail about preventing spread and limiting risks at home and school. Stay tuned!

Recommendations regarding school and head lice

This is key. The AAP states that head lice should not keep a child out of school. Risk of spread in school is generally low. Obviously, some measures can be taken and a child’s parent notified. Different schools can have policies that best work for their students.

 Again, head lice are annoying (!) but not dangerous. Most pediatricians will still recommend treatment, but mostly due to the distraction than anything else. (It’s hard for a child to focus if they have an itchy scalp or if they’re worried about classmates noticing). So, of course treatment is still a good idea. Ideally, a child can be treated the same day that they’re diagnosed so that they can go back to school the next day.

Summary: A doctor’s appointment for head lice includes a few questions, a physical exam, and recommendations based on the individual situation.

A doctor’s appointment for head lice will probably feel similar to other appointments for a specific concern, like a runny nose or pain with urination. There’s a few focused questions, a focused exam (looking at the scalp in this head lice example), and suggestions for the next step. If head lice is diagnosed, there are several effective treatment options. Your child’s pediatrician can also provide additional recommendations for your child’s safety and overall well-being.

Maya Mahmood, D.O., F.A.A.P. is a board-certified pediatrician and mom. She is passionate about parents having evidence-based information to help their families be healthier.

Disclaimer:

This is for information only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. See the full disclaimer here.