Head lice are a common problem with older children. Scratching the head is normally the first sign but eggs may be seen behind the ears and nape of the neck. The breastfeeding mother may need to apply preparations to her children and usually herself.  Head lice are spread by head-to-head contact common between all mums and children as well as siblings and friends, not forgetting grandparents. Headlice are not a sign of poor hygiene and in fact they prefer clean hair.

Medicated lotions should not be used unless live lice are detected after 17 days regular combing.

Prevention is best achieved by regular combing with a fine-toothed comb. For further information see https://www.nhs.uk/conditions/head-lice-and-nits/ and https://www.chc.org/for-parents-2/ for a video.

Head lice may be mechanically removed by meticulous combing of wet, well-conditioned hair with a fine-toothed detection comb. Combing needs to be undertaken for at least 30 minutes at four-day intervals for a minimum of two weeks. Conditioner facilitates combing particularly of long hair. If there are still live headlice then suitable chemical treatment should be used.

Treatments with lotions or liquids are preferable to shampoos which are diluted below an effective therapeutic concentration. Aqueous solutions are recommended for children with eczema or asthma. Rotation of treatments is no longer recommended. A mosaic approach is considered advisable however, whereby the child or adult is treated with a different chemical at each infestation or if a treatment fails.

Absorption of the products through the skin for sufficient quantities to pass into breastmilk is unlikely although the patient information leaflet in the box may suggest otherwise.  If a breastfeeding mother has to treat several children’s heads it may be sensible to use gloves to protect her hands and to ensure the room is well ventilated.

There are a variety of products available to treat head lice E.g., Vamousse™, Lyclear™, Full Marks™, Hedrin™

Treatments not recommended as evidence suggests that they are ineffective (https://www.nhs.uk/conditions/head-lice-and-nits/) :

• products containing permethrin
• head lice “repellents”
• electric combs for head lice
• tree and plant oil treatments, such as tea tree oil, eucalyptus oil and lavender oil herbal remedies