Head Lice: Diagnosing, Treating and Preventing

Head lice are a problem that has been around for a long time. You and your child may be upset and embarrassed about having lice. While lice can be hard to deal with, they do not cause any medical harm to you or your child.

Getting lice does not mean that your child is dirty, and it is not a sign of poor hygiene in other children when they get lice. Share with your child that anyone can get lice and that it is not something to tease or be teased about. Treating lice right away and careful checking are the best ways to take care of lice.

What are head lice?

Lice are very small insects that are gray, brown or black. They hatch from eggs called nits that attach to the hair very close to the scalp. Nits are tiny white or gray eggs about the size of a sesame seed. While dandruff or dirt from playing outside can be swept out of hair easily, nits cannot be shaken off. Lice do not carry disease and they do not live on pets. Lice do not jump or hop – they can only crawl. They are most often spread through head-to-head contact with someone who has lice. It’s less likely, but is possible, to get lice by coming in contact with items that someone who has lice has touched.

How will I know if my child has head lice?

Lice can cause itching and may leave red bumps on the scalp, behind the ears or on the back of the neck. Itching from lice can last even after the lice are gone.

How do I check my child for lice?

Look for nits and for live crawling lice. Nits are tiny white, yellow or gray specks that attach firmly to the hair close to the scalp. Live lice are hard to find because they move fast and avoid light.

• Check your child’s hair and scalp in a well-lit room. A magnifying glass may help.
• Look closely at the scalp around the ears, at the hair on the back of the neck and in the part line.

If you find that your child has head lice, check all household members for lice.

How do I get rid of head lice?

Lice can be treated using chemicals or with nonchemical methods. You can treat lice yourself, or, in some areas, there are lice removal services. Using a service can be easier, but it can also cost a lot of money.

If your child is under 2 or you are pregnant or breastfeeding/chestfeeding, talk with your child’s healthcare provider before using any chemical product to treat lice.

Chemical Treatment

You can treat lice with over-the-counter products that include shampoos or rinses. Those that have been shown to work well contain 1% permethrin (such as Nix) or pyrethrin (such as Rid).

Tips for using chemical treatments

• Never start treatment unless you know for sure that your child has lice or nits.
• Follow all the directions on the product.
• Don’t use conditioner or a combined shampoo and conditioner before using a chemical treatment.
• After treatment, rinse your child’s hair over a sink rather than in a shower or bath. This keeps the chemicals off of the rest of their body.
• Don’t use a hair dryer on your child’s hair after treatment. Some products contain flammable ingredients.
• These products may not kill all the lice and nits. The American Academy of Pediatrics now recommends re-treating in 9 days.
• If these products do not work, there are prescription products that can be used to treat lice. Talk to your child’s healthcare provider.
• Your child’s scalp may still itch after treatment. Your child may also have mild burning of the scalp after treatment.
• If your child is allergic to chrysanthemums, do not use products with pyrethrin (Rid).
• Never use gas or kerosene to treat lice.
• Do not use insecticide sprays to treat lice. They are not helpful and may expose your child to harmful chemicals.

Nonchemical Ways to Treat Lice

You can remove lice with the wet combing method and/or using a product that suffocates the lice, like a special gel.

To comb out lice and nits

1. Put a sheet or large towel on the floor. Place a chair over it.
2. Wash your child’s hair in the sink. Keep the hair wet while you work.
3. Apply lice gel if you choose to use it.
4. Divide the hair into sections and pin each section with a clip.
5. Put the nit comb as close to the head as possible and slowly pull through a thin layer of hair.
6. Wipe the comb off with a tissue after each stroke through the hair. Throw the tissues away.
7. Repeat with the rest of the sections.
8. Comb out nits daily for 2 weeks, even if you do not see nits.
9. Do not comb or brush dry hair. This may spread lice.
10. Wash all of the sheets and towels used. Wash all combs and hair clips in hot soapy water.

A machine called the LouseBuster uses hot air to kill lice. The machine requires special training. Do not use a regular blow dryer to try to treat lice in this manner. Blow dryers can spread lice.

What else needs to be done?

To keep lice from spreading to others or coming back:

• Wash all clothing, bedding and towels used in the last 3 days by anyone with lice. Use hot water (130°F, 54.4°C), then dry in the hot cycle of the dryer for at least 20 minutes. Remember to turn your hot water heater back down to 120°F (or between “low” and “medium”) to prevent scald burns.
• Dry-clean clothing, stuffed animals, bedding and items that cannot be washed. Or put items in a sealed plastic bag for 2 weeks.
• Wash combs, brushes and hair items in very hot soapy water.
• Vacuum rugs, upholstered furniture, car seats, head rests and bike and sport helmets. Throw away the vacuum cleaner bag.

How can I prevent head lice?

• Teach your child to avoid head-to-head contact at school, during sports, on the playground and when playing with other children.
• Check your child’s hair and scalp every few days if they have contact with someone who has lice.
• Teach your child not to share combs, brushes, towels, scarves, bandanas, barrettes, hats or clothing. Do not let your child refuse to wear a helmet because of fear of lice. If they don’t have their own with them, it’s better to share than to go without.
• Keep children’s coats, hats and other belongings separate from other children’s items at school.

Can my child go to childcare or school?

Check with your childcare provider, preschool or school for their policy on lice. Lice are not a health hazard, but some schools still have policies keeping kids home until they have no nits.

How long does treatment usually last?

Dealing with head lice can be tiring and frustrating. Hang in there and know that the combing and extra laundry won’t last forever.

Call your child’s healthcare provider if your child still has lice after 2 weeks of treatment, if their scalp is infected or if you have questions.