Head lice: Just thinking about it is enough to make you itch. Although they’re not dangerous, these tiny insects are certainly frustrating and can spread easily — especially at your child’s school. If your kiddo comes home itching, make sure you’re able to identify the signs of head lice with these tips from pediatrician Jason Sherman, DO.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
There are many misconceptions about how lice spread and how they’re treated. These misconceptions only help feed into the anxiety of parents whose children have lice or who have been exposed to lice.
Here are some lice facts you need to know:
- Lice do not spread easily. They also cannot survive more than 24 hours off a human scalp.
- Lice cannot jump. They can only crawl, and as a result, most transmission is only by direct contact. The spreading of lice can happen through the sharing of brushes and hats, but the easiest way lice spread is by head-to-head contact.
- Children do not need to be sent home from school for head lice infestations. The American Academy of Pediatrics guidelines recommend letting the parent of the child know about the lice diagnosis, but refraining from sending the child home that day or restricting him or her from attending school. A child with head lice has likely had the infestation for at least a month, and studies have shown that lice are not likely to spread within classrooms.
- Lice affect people in all socioeconomic classes. Lice often carry a social stigma, and in reality, it’s not a reflection on cleanliness. Anyone can get lice! If children are excluded from school and activities, this perpetuates the belief that lice are harmful.
The basics about lice
Lice are tiny insects that live in hair, bite, and can multiply quickly, laying up to 10 eggs a day. And lice don’t discriminate! Anyone can get lice, regardless of age, social status, race or gender.
Luckily, lice don’t spread disease contrary to popular misconception, but they do itch!
Lice are parasites that live off human blood. They leave their saliva where they bite, which makes the bite itch. Children may scratch lice bites until they bleed. Like any open wound, lice bites can become infected.
Signs of head lice
Constant scratching — especially behind the ears or on the back of your little one’s neck — is a sure sign you need to investigate. Also, if your child mentions feeling like something is moving in or tickling their hair, you should take a closer look. Finally, if you notice small open sores on your child’s head while bathing, it’s best to check it out.
Some visual cues of a lice infestation include:
- Seeing nits, or little white lice eggs that look like dandruff in your child’s hair. They stick to the roots and the hair shaft. White substances in the hair are often confused for nits. Many people often confuse nits with dandruff, hair gel, shampoo residue, dust or even glitter.
- Finding live insects on the scalp. Adult lice resemble brownish-gray, crablike bugs that are about the size of a sesame seed. They move fast.
- To check for lice, look through your child’s hair with a fine comb, looking in particular behind the ears or base of the neck.
How to treat lice
You should only treat your child for head lice if you see live lice or viable eggs. Make sure to check all the members of your family for infestation, and treat everyone at once.
If your child is under two, consult your pediatrician.
For older children, first-line therapy is available over the counter: Permethrin (Nix) or pyethrins (RID) are generally well-tolerated and have high rates of cure. These treatments do not kill the eggs, and so need to be repeated nine days later. Ask your pharmacist, or your doctor may prescribe a stronger medicated shampoo, lotion or rinse to kill the lice.
Hair combing should be done while wet and after a treatment with pediculicides to remove any residual nits. Specialized combs are sold for this, but any fine comb will do. This task is somewhat time-consuming, but will help remove the nits.
Don’t use anything to try to chemically loosen the nits, such as acetone, bleach or vinegar. This may cause harm and hasn’t shown any benefit. Finally, don’t use home remedies such as mayonnaise, olive oil, petroleum jelly as these don’t work.
Prescription therapies may be necessary if the first round of over-the-counter treatment is ineffective. If you’ve gone through a treatment course and haven’t had success, talk to your doctor to see if a prescription is necessary.
Remember: Don’t cover any treatment on your child’s head with plastic. If you need to protect a pillow or other surface, cover the surface with a towel or old blanket that you can easily wash.
Is a cleaning spree necessary?
When it comes to cleaning your house after a lice outbreak, remember that lice only live 24 to 48 hours off of the scalp. So if your child hasn’t touched a household item recently, you don’t need to worry about it.
Sheets, pillows, clothing and other items that have close head contact should be washed in water that is hotter than 130 degrees F. If the item is something you can’t wash, such as a favorite stuffed animal, cover it or put it in a plastic bag for 48 hours.
How to prevent lice
To prevent re-infestation or contracting lice, follow these guidelines:
- Talk to your children about lice.
- Teach your children not to share combs, brushes, hats, or other items with their friends or classmates.
- Tell your children not to have physical contact with anyone they know has lice.
- Examine and treat all members of your household who have had contact with someone who’s had lice.
- Tell your child’s school, daycare center or babysitter if they have head lice.