Patient Education

Head Lice

While parents often have a strong reaction when they find out their child has head lice, they are not a health hazard nor a sign of poor hygiene. Head lice are common in school-aged children and while inconvenient, they cause no medical harm and they do not spread any disease. They are contagious (head-to-head) and should be treated.

What are signs of head lice? Unless the infestation of lice is heavy, you are more likely to see nits (lice eggs) than live lice crawling in the hair. Nits look like tiny yellow, tan or brown dots on hair shafts close to the scalp. The lice prefer this spot since the eggs are kept warm until they hatch. Nits often look like flakes or dandruff but they cannot be shaken or brushed off as the nits have a glue-like substance which makes them stick to the hair shaft. 

Nits hatch 1-2 weeks after they are laid leaving behind a shell which is white in color and remains attached to the hair shaft. This is the stage when they are easiest to spot as the hair is growing longer and they are within an inch or so of the scalp.

Many children will experience itching and scratch their scalp in response to louse bites which may be your first clue to inspect their hair/scalp more closely. It is often difficult to find nymph or adult lice (about the size of a sesame seed and tan in color) as they usually move very quickly and there aren't many of them. You will be more likely to see nits at the base of the hair and empty egg shells within an inch or two of the scalp.

How can I treat head lice? We usually recommend you start with one of the over-the-counter (OTC) lice shampoo/rinse treatments such as Nix or RID. It is important that you follow the directions on the label for these products, as they are insecticides and using it more frequently than suggested or in larger amounts may increase the risk of side effects. Treatment usually kills the lice, but itching may take a few more days to resolve. It is VERY important that you remove all of the nits/eggs with a fine tooth comb after applying the medication according to the directions. This can be a very tedious process, especially in children with long/thick hair. This where the term "nit-picky" comes from. We usually recommend repeat treatment 7-10 days after the initial application to kill any newly hatched nits. If you are looking for someone to do this job for you, there are companies that provide this commercial service such as Lice Doctors, Center for Lice Control or Lice Happens.

There are several prescription medications for resistant head lice, but we reserve these treatments for patients who have failed first line treatments with OTC products that were used correctly. One little known secret is that an easily obtainable horse de-worming medicine called Ivermectin (which is in some of the prescription products) can be very inexpensively obtained at a horse feed/saddlery story or online. You can mix the ivermectin paste with your favorite conditioner (1/3 paste, 2/3 hair conditioner), coat thoroughly, leave on the scalp for 10 minutes and then rinse in cool water. Shampoo as normal the next morning. You still have to pick out all the nits!

How contagious are head lice? Lice can't jump or fly but the can crawl and cling firmly to hair. They are usually spread when two children "put their heads together" but can also spread when combs, brushes, hats or bed linens are shared. Lice can live up to two days on a non-scalp surface. Check with your school regarding recommendations on return regulations. Most schools recommend return to school after appropriate treatment has been applied. The American Academy of Pediatrics recommends that no-nit policies regarding return to school should be abandoned.

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