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The information provided is taken from various reference sources.  It is provided as a guideline.  No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.  Clinical decisions remain the responsibility of medical and breastfeeding practitioners.  The data presented here is intended to provide some immediate information but cannot replace input from professionals.

 Head lice are a common problem for mothers with older children. The breastfeeding mother may need to apply lotions to her children and may find herself affected too.  Head lice are spread by head to head contact. They are not a sign of poor hygiene and in fact prefer clean hair. Medicated lotions should not be used unless live lice are detected by combing. Prevention is best achieved by regular combing with a fine toothed comb. For further information see www.patient.co.uk/showdoc/23068753/

Head lice may be mechanically removed by meticulous combing of wet 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. Anecdotally use of tea tree oil is effective in killing and preventing head lice but there is no evidence from clinical trials.

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 in sufficient quantities to affect breastmilk is unlikely. If a lactating mother has to treat several children’s heads it may be sensible to use rubber gloves to protect her hands and ensure the room is well ventilated.

There are a variety of products available to treat head lice.

• Malathion Derbac M®, Prioderm®, Quelleda M®
• Permethrin, Lyclear®
• Phenothrin Full Marks ®
• Dimeticone Hedrin®

Bibliography

• Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G.Prospective follow-up of adverse reactions in breastfed infants exposed to maternal medication. Am. J Obstet Gynecol. 1993; 168:1393-9.
• Jones W Breastfeeding and Medication Routledge 2018
• Manufacturers information Lyclear SPC 2 www.medicines.org.uk
• Porto I. Antiparasitic drugs and lactation: focus on anthelmintics, scabicides, and pediculicides. J Hum Lact. 2003; 19:421-5.

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019