Resources:

• Myths About Head Lice – great article discussing the misinformation, myths and mismanagement of head lice.
• Head Lice 101 – Quick reference guide.
• Head Lice 101 Presentation – an overview for parents, teachers and communities.
• Head Lice: Don’t Let It Keep You Up At Night – what you should know about lice.

The Nurse’s Role:

• Nurse will examine the hair of any child complaining of an itchy head
• When lice and/or nits are identified, the parents or guardians will be notified and advised on how to proceed.
• The student may remain in school.
• The nurse will examine your child’s hair upon return to school and again within two weeks.
• Please feel free to consult with the nurse as needed.

*We are aware that this is a sensitive issue and will take every measure to protect your child’s privacy.

*The best control is to check your child once a week and remind him/her to keep their heads away from friends and classmates.

Head Lice (Pediculosis)

What are head lice?

Also called Pediculus humanus capitis (peh-DICK-you-lus HUE-man-us CAP-ih-TUS), head lice are parasitic insects found on the heads of people. Having head lice is very common; as many as 6-12 million people worldwide get head lice each year.

Who is at risk for getting head lice?

Anyone who comes in close contact with someone who already has head lice, contaminated clothing, and other belongings. Preschool and elementary-age children, 3-10, and their families are infested most often. Girls get head lice more often than boys, women more than men. In the United States, African Americans rarely get head lice.

What do head lice look like?

There are three stages of lice: the nit, the nymph, and the adult. Nit: Nits are head lice eggs. They are hard to see and are often confused for dandruff or hair spray droplets. Nits are found firmly attached to the hair shaft. They are tiny, oval and usually yellow to white. Nits take about 7-10 days to hatch. Nymph: The nit hatches into a baby louse called a nymph. It looks like an adult head louse, but is smaller. Nymphs mature into adults about 7 days after hatching. To live, the nymph must feed on blood. Adult: The adult louse is about the size of a sesame seed, has 6 legs, and is tan to grayish-white. In persons with dark hair, the adult louse will look darker. Females lay nits; they are usually larger than males. Adult lice can live up to 30 days on a person’s head. To live, adult lice need to feed on blood. If the louse falls off a person, it dies within 2 days.

Where are head lice most commonly found?

On the scalp behind the ears and near the neckline at the back of the neck. Head lice hold on to hair with hook-like claws found at the end of each of their six legs. Head lice are rarely found on the body, eyelashes, or eyebrows.

What are the signs and symptoms of head lice infestation?

• Tickling feeling of something moving in the hair.
• Itching, is caused by an allergic reaction to the bites.
• Irritability.
• Sores on the head caused by scratching. These sores can sometimes become infected.

How did my child get head lice?

• By contact with an already infested person. Contact is common during play at school and at home, sleep-overs, sports activities, at camp, or on a playground.
• By wearing infested clothing, such as hats, scarves, coats, sports uniforms, or hair ribbons.
• By using infested combs, brushes, or towels.
• By lying on a bed, couch, pillow, carpet, or stuffed animal that has recently been in contact with an infested person.

How is head lice infestation diagnosed?

By looking closely through the hair and scalp for nits, nymphs, or adults. Finding a nymph or adult may be difficult; there are usually few of them and they can move quickly from searching fingers. If crawling lice are not seen, finding nits within a 1/4-inch of the scalp confirms an active infestation and should be treated. If you only find nits more than 1/4 inch from the scalp, the infestation is probably an old one and does not need to be treated. Even then, the nits should be removed. If you are not sure a person has head lice, the diagnosis should be made by a health care provider, school nurse, or a professional from the local health department.

This fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health care provider. If you have any questions about the above or think that you may have a parasitic infection, consult a health care provider.

Treating Head Lice

How do I treat a head lice?

By treating the person infested with head lice, and other infested family members, and by cleaning the house.

Treatment: Requires using an over-the-counter (OTC) or prescription medication. Follow these treatment steps:

1. Apply lice medicine, also called pediculicide according to label instructions. If your child has extra-long hair, you may need to use a second bottle. WARNING: Do not use a cream rinse or combination shampoo/conditioner before using lice medicine. Do not re-wash hair for 1-2 days after treatment.
2. Have the infested person put on clean clothing after treatment.
3. If a few live lice are still found 8-12 hours after treatment, but are moving more slowly than before, do not retreat. Comb dead and remaining live lice out of the hair. The medicine may take longer to kill lice.
4. If, after 8-12 hours of treatment, no dead lice are found and lice seem as active as before, the medicine may not be working. See your healthcare provider for a different medication; follow treatment directions.
5. Nit (head lice eggs) combs, often found in lice medicine packages, should be used to comb nits and lice from the hair shaft. Many flea combs made for cats and dogs are also effective.
6. After treatment, check hair and comb with a nit comb to remove nits and lice every day. Continue to check for 2-3 weeks until you are sure all lice and nits are gone.
7. If using OTC pediculicides, retreat in 7-10 days. If using malathion, retreat in 7-10 days only if crawling bugs are found.

Treat the household: Head lice do not survive long if they fall off a person. You do not need to spend a lot of time or money on special house cleaning activities and products.

Follow these steps to help avoid re-infestation by lice that have recently fallen off the hair or crawled onto clothing or furniture.

1. To kill lice and nits, machine-wash all washable clothing and bed linens that the infested person touched during the 2 days before treatment. Use the hot water (130 F) cycle. Dry laundry using high heat for at least 20 minutes.
2. Dry clean clothing that is not washable, (coats, hats, scarves, etc.) OR
3. Store all clothing, stuffed animals, comforters, etc., that cannot be washed or dry-cleaned into a plastic bag; seal for several days.
4. Soak combs and brushes for 1 hour in rubbing alcohol, Lysol*, or wash with soap and hot (130 F) water.
5. Vacuum the floor and furniture. Do not use fumigant sprays; they can be toxic if inhaled or absorbed through the skin.

Prevent Reinfestation: Lice are most commonly spread directly by head-to-head contact and indirectly and rarely through contaminated clothing or belongings. Teach your child to avoid playtime and other activities that are likely to spread lice.

• Avoid head-to-head contact common during play at school and at home (slumber parties, sports activities, at camp, on a playground).
• Do not share clothing, such as hats, scarves, coats, or hair decorations.
• Do not share infested combs, brushes, or towels.
• Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with an infested person.

FAQ

My child has head lice. I don’t. Should I treat myself to prevent being infested?

No, although anyone living with an infested person can get head lice. Check household contacts for lice and nits every 2-3 days. Treat only if crawling lice or nits (eggs) within a 1/4-inch of the scalp are found.

Should my pets be treated for head lice?

No. Human head lice do not live on pets.

My child is under 2 years old and has been diagnosed with head lice. Can I treat him or her with prescription or OTC drugs?

For children under 2 years old, remove crawling bugs and nits by hand. If this does not work, ask your child’s health care provider for treatment recommendations. The safety of head lice medications has not been tested in children 2 years of age and under.

What OTC medications are available to treat head lice?

Many head lice medications are available at your local drugstore. Each OTC product contains one of the following active ingredients.

Pyrethrins

(pie-WREATH-rins): often combined with piperonyl butoxide (pie-PER-a-nil beu-TOX-side): Brand name products include A-200*, Pronto*, R&C*, Rid*, Triple X*. Pyrethrins are natural extracts from the chrysanthemum flower. Though safe and effective, pyrethrins only kill crawling lice, not unhatched nits. A second treatment is recommended in 7-10 days to kill any newly hatched lice. Treatment failures are common.

Permethrin

(per-meth-rin): Brand name product: Nix*. Permethrins are similar to natural pyrethrins. Permethrins are safe and effective and may continue to kill newly hatched eggs for several days after treatment. A second treatment may be necessary in 7-10 days to kill any newly hatched lice. Treatment failures are common. There are new organic products available every year.

What are the prescription drugs used to treat head lice?

Malathion (Ovide*): Malathion has been re-approved for the treatment of head lice infestations. Malathion treats both lice and head lice eggs. When used as directed, malathion is very effective in treating lice. Few side effects have been reported. Open sores from scratching may cause malathion to sting the scalp. Lindane (Kwell*): Lindane is one of the most common products used to treat head lice. When used as directed, the drug is probably safe. Overuse, misuse, or accidentally swallowing Lindane can be toxic to the brain and other parts of the nervous system. Lindane should not be used if excessive scratching has caused open sores on the head.

Which head lice medicine is best for me?

If you aren’t sure, ask your pharmacist or healthcare provider. When using the medicine, always follow the instructions provided. New products appear annually. Do the research to determine which product best suits your needs.

Should household sprays be used to kill adult lice?

No. Spraying the house is NOT recommended. Fumigants and room sprays can be toxic if inhaled or absorbed through the skin.

Should I have a pest control company spray my house?

No. Vacuuming floors and furniture is enough to treat the household. *Use of trade names is for identification purposes only and does not imply endorsement by the Public Health Service or by the U.S. Department of Health and Human Services.