Head lice during pregnancy and breastfeeding can be treated with pediculicides including permethrin, malathion, and ivermectin. There are studies providing evidence that these agents do not increase the risk of birth defects. 1-3 Therefore, the use of these agents is not likely to cause birth defects during pregnancy and they are unlikely to pass into milk in breastfeeding mothers.
Malathion and ivermectin may be reserved for resistant cases. Permethrin is preferred for breastfeeding and pregnant mothers because it is non-toxic, and there is minimal absorption through the skin. Absorption of a 5% permethrin cream is less than 2%.4 For effective elimination of lice, bedding and clothing should be removed and washed in hot water, nails and toenails need to be cleaned and treated, eggs in the hair should be removed with a fine comb. All persons in contact with lice should be treated to prevent spreading. Most importantly, a second treatment with permethrin detergent is required after 10 to kill any remaining nits and lice. Studies suggest that metal combs works better for removing eggs, than the cheaper plastic varieties.
If you simply don't want to use one of these insecticides, then check out the website on Cetaphil, the hand lotion that when applied and dried on the hair, seems to kill lice pretty well.
1. Kennedy D, Hurst V, Konradsdottir E, Einarson A: Pregnancy outcome following exposure to permethrin and use of teratogen information. Am J Perinatol 2005;22:87-90.
2. Thomas D, Goldhaber M, Petitti D et al: Reproductive outcome in women exposed to malathion. Am J Epidemiol 1990;132(4):794-5
3. Pacque M, Munoz B, Poetschke G, Foose J, Greene BM, Taylor HR. Pregnancy outcome after inadvertent ivermectin treatment during community-based distribution. Lancet. Dec 15 1990;336(8729):1486-1489.
4. Pharmaceutical Manufacturer Prescribing Information.