Child with head lice being treated by a nurseNo one wants their children to have head lice. Although it is common for school-age children to contract lice, it is troubling nonetheless for children and their families. Lice can be contracted whether the hair or the child’s environment is dirty or clean. Estimates show that 12 million people1 are infected with lice each year and the majority of them are children aged 3 to 12. Thankfully, lice do not carry illnesses, but they must be addressed immediately to prevent their spread through homes, schools and families. Adults can contract lice too, but children are more apt to because they play together, touch heads, share hats and head gear.

What are lice?
Head lice are tiny bugs that feed on the blood of the scalp. They grow fast and multiply quickly which is why it is so important to treat head lice aggressively. According to the Centers for Disease Control2, the life cycle of lice is as follows:

Egg or nit. Eggs, or nits, hatch in 6 to 9 days. Eggs are usually found within 4 to 6 mm of the scalp and do not survive if they are farther away. The eggs are tiny; approximately the size of a knot in a strand of thread. The eggs are white and can be mistaken for dandruff. After they have hatched, the shell of their eggs can remain in the hair.

Nymph. The nymph looks like an adult head louse but is much smaller (about the size of a pinhead [1.5 mm]). Nymphs become adults about 7 days after hatching.

Adult louse. An adult louse can multiply fast and lay up to 10 eggs a day. It takes only about 12 to 14 days for newly hatched eggs to reach adulthood.

This cycle can repeat itself every 3 weeks if head lice are left untreated.

How do I know if my child has head lice?
Itching behind the ears and at the back of the neck are the most common signs that head lice may be present. When you check the source of the itching you may actually see the lice crawling around on the scalp. You may also see the eggs, called nits, clinging onto the hair near the scalp. You can tell if they are nits because they will be difficult to remove from the hair; they can’t be brushed off like dandruff. There may be lice on the scalp for a month before any symptoms emerge, and the symptoms may last for a few weeks after the lice have been eradicated.

As mentioned, lice feed on human blood (very vampire-y) and, if left untreated, will multiply almost exponentially and could cause anemia and fatigue.

Will other family members automatically get lice?
No, you can prevent other members of the family, especially other children, from getting the lice by aggressively treating the lice (see lice treatment below) and by following these steps:

  • Do not allow children to share hats, combs, headbands, or any other type of headgear.
  • Soak all combs, brushes, barrettes, bobby pins, etc. in bleach.
  • Washing objects in hot water and drying them on high (hot) heat for at least five minutes will kill lice and their eggs because they cannot survive temperatures greater than 128.3 degrees Fahrenheit3. Wash and dry the following:
    • All the bed linens, blankets, and bedspreads on all the beds in the child’s room.
    • All of the child’s clothing, including outerwear like coats, earmuffs, hats, scarves, that were worn within two days of the discovery of the lice.
    • Towels used by the child.
    • All stuffed animals and anything else that has fake fur or dense, soft fabric with a pile, like fleece.
  • Vacuum all carpeting and upholstered furniture thoroughly.
  • If items can’t be cleaned, put them in a sealed plastic bag and leave them there for two weeks.

Be careful when using lice medications
Medications that treat lice include insecticides and they can be dangerous if not used properly. Before you begin treatment, whether it is with over-the-counter or prescription medications, it is important to be aware of the following cautions:

  1. Check with your physician before using any treatments to ensure that they are appropriate for your child.
  2. Do not use conditioner on the hair before using lice medication. Check with your physician to see when your child can wash his or her hair after the application of lice medicine.
  3. Use any and all treatments only as directed. Do not use the medication more frequently or in a higher dose than directed on the package.
  4. Make sure to keep all medications out of your child’s eyes. If they do get into the eyes, flush the eyes immediately.
  5. If you have used one treatment two or three times and it does not seem to be working, the lice may be resistant to the treatment. Call your doctor if this happens.
  6. Do not use several different lice medications at the same time unless your physician has instructed you to do so.
  7. Medications can take a while to kill the lice. You may see a few live lice eight to 12 hours after treatment. If they are moving more slowly than before do not repeat the treatment. However, if they are moving around as before the treatment may not be working and you should check with your physician.

After the treatment use a nit comb to remove dead lice and eggs from the hair. This is a meticulous process that requires carefully sectioning of the hair and combing each and every hair with the fine-tooth nit comb. Repeat this process every couple of days to make sure that any remaining eggs are removed so they cannot restart the lice infestation.
Always have the child put on clean clothes after the treatment. Remove the clothing worn during the treatment, along with any towels etc. used and wash them in hot water and dry them on high temperature.

Treatments for head lice
Over-the-counter medications:
The medications that have been approved by the Food and Drug Administration (FDA) for the treatment of lice contain specific active ingredients. When you purchase lice medication, read the label and make sure you see one of these ingredients4:

  1. Pyrethrins combined with piperonyl butoxide.
  2. Permethrin lotion, 1%

Prescription medications:

  • Benzyl alcohol lotion, 5%
  • Ivermectin lotion, 0.5%
  • Malathion lotion, 0.5%
  • Spinosad 0.9% topical suspension

These medications may come as oral medications, topical creams or prescription shampoo. After each treatment for lice removal, comb your child’s hair thoroughly using a nit comb as described above. Continue to check your child’s hair thoroughly for two to three weeks after it appears that all the lice have been treated to make absolutely sure re-infestation has not taken place.

Can my child go to school?
Whether or not your child can go to school while you are treating the lice depends upon the school’s policy. Some have a “no-nit” policy which means that as long as there are eggs in your child’s hair, he or she cannot attend school. Usually an examination by the school nurse is required before the child can return to class. It is a good idea to discuss lice with your child’s school and inquire as to what actions they take to ensure that lice do not spread through the school.

Lice are tenacious and you will have to be thorough and consistent in treatments in order to rid your child’s scalp of them. If the lice do return, even after successful treatment, check with a physician for help in ridding them once and for all.