We all get that creepy-crawly feeling when we have to think about lice. Unfortunately, the reality is that lice are a common and annoying part of childhood. Fortunately, head lice in children do not cause lasting health problems – just some stress for kids and parents. Reading through Ovia’s helpful guide for dealing with lice can help you stay calm and make a lice survival plan.
What are lice?
Lice are tiny bugs (insects without wings) about the size of a sesame seed (2–3 millimeters long). Their bodies are usually pale and gray, but their color can vary. One of these tiny bugs is called a louse.
Lice are parasites which means they need human blood to survive. They can’t survive without their human host (you or your children) for longer than one to two days.
There are three kinds of lice – one that lives on your hair and scalp, a second type mostly found on the body, and then pubic lice, which infest pubic hair around the genitals and spread through sexual contact. Fortunately, each type tends to like a different part of the body. So while it is possible to spread lice from one part of the body to the other, it is rare. Because younger children typically only have hair on their heads, head lice are the most common kind of lice parents and caregivers will encounter, and they are what we’ll be talking about here.
How are nits different from lice?
Lice eggs are called nits. Lice lay and attach their eggs to hair strands close to the scalp with sticky glue in their saliva. Nits can be hard to see because they are very tiny — the size of a knot in sewing thread. They are oval and usually yellow or white-colored. Nits are easiest to spot around the ears and the nape (back) of the neck along the hairline. Nits can be mistaken for dandruff, but unlike dandruff, you can’t easily brush them out of your hair. After the eggs hatch, the empty egg shells stay on the hair shaft.
An adult female louse can lay up to 10 eggs a day. It takes 12 to 14 days for newly hatched eggs to reach adulthood and start reproducing. The cycle can repeat every three weeks if head lice are left untreated. As you can imagine, this would quickly lead to a very uncomfortable situation!
How do lice spread?
When your family is mid-lice infestation, it may feel like lice have magical spreading powers. In reality, they cannot fly, jump, or hop. Lice can only crawl through head-to-head or head-to-body contact when children, family members, or caregivers play or interact closely. Aside from close physical contact, lice and their eggs also spread when people share hair brushes, hats, scarves, sports helmets, clothing, or even headphones.
Less commonly, lice can crawl from one piece of clothing or bedding to another, for example, when hung up or stored side-by-side in lockers, closets, or on hooks. Lice can also spread between pillows, blankets, and stuffed toys when left close to one another. Because lice can live for 1 to 2 days off of the human body, it is possible to catch lice by sitting or lying on a bed or cloth-covered furniture recently used by someone with lice. Are you feeling creepy, crawly, or itchy yet?
How common are lice?
Very. Up to 12 million infestations happen annually in the U.S. among children three to 11 years old. Head lice are most common among preschool children attending daycare, elementary school children, and household members of children with lice. Head lice do not discriminate — they can infect any hair strand on anyone’s body. A lice infection has nothing to do with personal hygiene, lice do not prefer dirty or clean hair — they just want a blood meal. Lice infestations are more common in long hair and in Caucasian people. In addition, lice are more common in those with longer hair than in those with shorter hair.
Are lice harmful?
Not generally. Physically, lice are more of an annoyance and inconvenience than a threat to you or your child’s health. Head lice cannot transmit disease. Scratching can lead to small red bumps that can sometimes get infected with bacteria. Discomfort can interrupt sleep. Sometimes treatment with lice medications can cause skin sensitivities, redness, itching of the scalp, or stinging eyes if the medicine runs into the eyes, but treatment is always recommended because lice will not go away on their own, and they will multiply!
A lice infestation can be traumatic, causing increased family stress and emotional distress due to the stigma of lice. As any parent who has dealt with lice will tell you, a lice infestation can require significant time, effort, and resources to get under control. How painful is it to tell your young child that you can’t snuggle or cuddle with them until their lice are gone? Or that they can’t sleep with their beloved stuffie or blanket for two whole weeks while it has a sleepover in an airtight garbage bag?
It is helpful as a parent if you try to check some of your frustration or disgust with lice so that your sensitive child does not feel ashamed or guilty. Instead, it can be helpful to remind your child that lice love everyone, having lice is not anything to be embarrassed about and that having lice does not mean something is wrong with them or their family.
What are the symptoms of head lice?
Are you noticing your child scratching their head more often recently? Time to do a lice check because itching is the most common symptom of a lice infection in children. Don’t wait around — the more time the lice have to lay nits, the itchier you will be!
Remember, though, if your child only has a mild infection, they may not yet be itching. Also, it may take four to six weeks after lice get on the scalp before the scalp becomes sensitive to the lice’s saliva and begins to itch. Besides itching, the other symptoms you or your child might notice are:
- A tickling feeling from the movement of hair moved by crawling lice.
- The presence of lice or nits on your scalp, body, and clothing.
- Lice eggs (nits) on hair shafts.
- Sores or scabs on the scalp, neck, and shoulders caused by scratching.
Just to make things complicated, itching caused by head lice can last for weeks, even after the lice are gone. And a previous lice infestation does not prevent it from happening again, sadly some daycares and schools can get stuck in a tough cycle where lice is brought home again and again.
How do you check for lice?
Live lice are hard to find. They avoid light and move quickly. So instead, try looking for nits, especially along the hairline at the back of the neck and behind your child’s ears. Here are some other lice-hunting tips from the American Academy of Pediatrics:
- Seat your child in a brightly lit room or in direct sunlight outside
- Part their hair
- Look for crawling lice and nits on your child’s scalp one section at a time
- Use a fine-tooth comb (such as a louse or nit comb) to help you search the scalp section by section
If you’re unsure if your child has lice, ask their school nurse, healthcare provider, or local health department official to double-check for you.
How do you treat head lice?
There are commercial services that you can hire to comb nits out of your child’s hair. They are trained in exactly what to look for and how to remove the nits, but this is definitely something you can do yourself too.
There are both over-the-counter and prescription medications for treating lice. Check with your child’s healthcare provider before beginning any head lice treatment because each medication and shampoo has certain risks and benefits — and some may not be suitable for children under 2. The most effective way to treat head lice is with a combination of head lice medicine and the comb-out method (explained in detail below). There are no studies showing that home remedies, such as petroleum jelly, mayonnaise, or margarine work to treat lice. It can be dangerous to use medications approved for animals or liquids like gasoline or kerosene. Do not use multiple lice medicine treatments at the same time.
Shampoos with a chemical called permethrin or pyrethrinare usually the first options for treating lice. They are both toxic to lice, but not nits. It’s important to read the instructions very carefully and follow them exactly. Don’t be surprised that you need to repeat the process after a certain number of days — this is to get lice at all stages of their lifespan and avoid treatment failure.
There are also many effective prescription medications, lotions, and shampoos. Your pediatric provider may recommend one of these as a first option, and it may even be less expensive than an over-the-counter shampoo if you have insurance coverage. It may also be less expensive to use a highly effective prescription medication once instead of possibly needing to re-treat if an over-the-counter shampoo doesn’t kill all of the lice and nits. Again, it’s really important to follow directions carefully and thoroughly no matter what you choose to use.
After each treatment with head lice medicine, try to use the comb-out method every 2 to 3 days for 2 to 3 weeks to help remove the nits and eggs. The comb-out-method, according to the American Academy of Pediatrics, is a four-step process:
- Step 1: Wet your child’s hair
- Step 2: Use a fine-tooth comb (louse or nit comb) and comb through your child’s hair in small sections
- Step 3: Wipe the comb on a wet paper towel after each comb-through; examine the scalp, comb, and paper towel carefully
- Step 4: Repeat steps 2 and 3 until you’ve combed through all of your child’s hair
Some healthcare providers recommend applying a conditioner or a mild soap such as Cetaphil to help the nit comb slide more easily through your child’s wet hair, but others believe that it makes the hair strand too slippery and that you might miss nits. If you are struggling with pain, tears, and long-hair tangles, a little extra “slip” could make the comb-out method less of a battle. Combination shampoo-conditioner lice treatment products are less effective than plain medicated lice shampoos and are therefore not recommended. Always wait to shampoo your child’s hair again until 24-48 hours (1-2 days) after a lice treatment.
Be sure to follow these important safety guidelines when using over-the-counter and prescription chemical lice treatments:
- Follow the directions on the package exactly as written.
- Don’t put conditioner on before using the lice treatment. Conditioners can act as a barrier that keeps the head lice medicine from sticking to the hair shafts, reducing the effectiveness of the treatment.
- Never let children apply the medicine themselves.
- Always rinse off the medicine over a sink, not during a shower or bath. Try to keep the medicine from getting onto other skin areas.
- Never use a blow dryer after most treatments because they are flammable.
- Use warm (not hot) water to rinse off the medicine.
- Never place a plastic bag or shower cap on a child’s head.
- Do not leave a child alone with medicine in their hair as it can drip into their eyes.
- Store medicine in a safe place (a locked cabinet, out of sight and reach of children).
- Check with your child’s healthcare provider before beginning treatment or a second or third medicine. You may need to repeat the same medication or switch to a new one.
Annoyingly, several lice species are now resistant to commonly-used lice treatment medications. This makes it even more important to contact your provider for guidance and support.
Some nonprescription (available over-the-counter) products claim to repel lice and prevent them from crawling onto your child’s head. The FDA classifies lice-repellent products made from essential oils such as rosemary and tea tree oil as “natural.” The U.S. Food and Drug Administration (FDA) does not test the safety and effectiveness of so-called natural products. More research is needed to prove the safety and effectiveness of claims made by non-prescription lice-repellent shampoos and hair sprays.
If cost is an issue during treatment, there may be some unexpected and welcome resources from your pediatric provider, school nurse, or local public health department. Having lice (even more than once) is not your fault, and it’s okay to ask for support!
A viable option for some families is shaving hair. Lice and nits cannot survive without a friendly environment. While it’s not an option for some people, it is worth mentioning as an effective and inexpensive treatment strategy if members of your family already shave their heads.
How do you keep lice from spreading within my family?
You’ll want to wash your child’s clothes, towels, hats, and bed linens in hot water and dry them on high heat if they were used within two days before head lice were found and treated, according to the American Academy of Pediatrics. You don’t need to throw away clothing, helmets, or other personal items. Seal all things that can’t be washed in a washing machine in a plastic bag for two weeks or take them to be dry-cleaned. Head lice eggs (nits) cannot hatch and usually die within a week if they aren’t in conditions similar to those found close to the human scalp. Giving stuffies and blankets a plastic bag vacation will kill any lice that were already present, or that might hatch from any nits that may be present on the items. Wash all combs and brushes (especially the nit comb) in hot soapy water after use. Store them separately in a ziploc bag and check them for any signs of life before the next use.
According to the CDC, routine house cleaning (vacuuming of carpeting, rugs, furniture, car seats, and other fabric-covered items) and laundering of linens and clothing worn or used by the infested person will help to prevent lice from spreading within your household. Lice are unlikely to survive on hard surfaces. Fumigant spray and fogs can be toxic if inhaled or absorbed through the skin. They are not necessary to control head lice, according to the CDC. Do not spray pesticides or pay to fumigate your home because this can expose your family to unnecessary and dangerous chemicals.
Perhaps the hardest part of containing the spread is avoiding close contact. People with lice shouldn’t lay in other people’s beds, hug, or cuddle them. While this may be impossible to totally avoid, any reduction will reduce the likelihood of spread in your family.
Prevention is the best medicine for lice, so check all household members and close contacts for several weeks after the initial louse is found just to make sure – the last thing you want is to pass the lice back and forth to one another over and over.
Can you prevent lice?
Not entirely. So, first, take a deep breath and go easy on yourself. Just because you or your child have lice does not mean you are dirty or did something wrong. Unfortunately, it’s hard to prevent the spread of head lice among children in childcare and school settings.
That said, there are some steps you can take to minimize the chances you will have to do battle with lice during your family’s early childhood years. The Mayo Clinic suggests these lice prevention strategies:
- Ask your child to avoid head-to-head contact with classmates during play and other activities.
- Teach your child not to share hats, scarves, coats, combs, brushes, hair accessories, and headphones.
- Tell your child to avoid hanging their clothing in shared spaces where hats and clothing from more than one student are hung (such as a shared hook, closet, or locker) if possible.
Regular checks for head lice are an excellent way to spot them before they have time to multiply and cause an infestation (when lice are present in large numbers). You can help your preschool-aged child get used to a nit comb (which can sometimes pull hair) and the process of looking for lice just like you helped them adjust to brushing their teeth. If your child has long hair and their school notified you about a classroom lice outbreak, consider having them wear their hair braided or pulled back under a hat to make it harder for lice to crawl onto their hair.
Does my child need to stay out of school or daycare if they have head lice?
No. Each childcare provider or school may have different policies regarding lice and preventing outbreaks. However, because head lice don’t cause serious health problems for children, the American Academy of Pediatrics and the National Association of School Nurses believe schools should not exclude children or make them miss school because they have head lice. As we all witnessed with the COVID-19 pandemic, exclusion from school can adversely affect students emotionally, socially, and academically.
Feeling any calmer about lice now that you know more?
Knowledge is power! Try not to let a sesame-seed-sized bug take away your power or drive you crazy. Having lice is stressful, overwhelming, and can be expensive. But you don’t have to battle lice alone. Ask your child’s provider if you have any questions or if treatments you have tried have not gotten rid of lice.
Reviewed by the Ovia Health Clinical Team
“Head lice management in schools”. National Association of School Nurses. National Association of School Nurses. June 2020. https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements/ps-head-lice
“Head lice: Treatment. Frequently asked questions”. CDC. CDC. September 17, 2020. https://www.cdc.gov/parasites/lice/head/gen_info/faqs_treat.html
“Lice.” Mayo Clinic. Mayo Clinic. June 30, 2022. https://www.mayoclinic.org/diseases-conditions/lice/symptoms-causes/syc-20374399
“No panic guide to the treatment of head lice”. Johns Hopkins Medicine.Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/no-panic-guide-to-head-lice-treatment
Nolt, D. “Head Lice: What parents need to know”. healthychildren.org. American Academy of Pediatrics. September 26, 2022. https://healthychildren.org/English/health-issues/conditions/from-insects-animals/Pages/Signs-of-Lice.aspx
“Parasites; Head lice; Epidemiology & Risk factors”. CDC. CDC. October 15, 2019. https://www.cdc.gov/parasites/lice/head/epi.html