Pediatrician Sonia Helmy, MD, gets questions from concerned parents about head lice. Below, she describes what to look for and offers advice on how to get a head lice infestation under control.
Just saying the words—head lice—can make you feel itchy. While annoying and sometimes hard to get rid of, lice are not dangerous.
What are head lice?
Head lice are small, wingless parasitic insects that feed on human blood. They primarily cling to your scalp and neck and, fortunately, can’t survive long anywhere else—adult lice die after 48 hours on things like pillows and furniture.
They find new hosts through close contact that allows the pests to crawl from one head to another: Sharing hats, combs or other hair accessories or having your belongings within close proximity to an “infected” item such as a backpack or coat.
Personal hygiene habits have nothing to do with contracting lice—they actually thrive in clean hair.
How do I know if I have lice?
Head lice are most common in children who attend day care, preschool or elementary school. And during the winter months, an increase is likely because of the need for hats, scarves and coats—perfect places for head lice to transfer from one to the other.
Some kids who have lice are relatively symptom free, while others develop intense itching of the scalp or notice a tickling feeling from the movement of lice in their hair. Others get small red bumps on the scalp, neck and even shoulders.
How to spot lice
Head lice and their nits (eggs) are found almost exclusively on the scalp, particularly behind the ears, on top of the head and near the neckline.
Adult lice are about the size of a sesame seed and lice eggs or nits are small, oval-shaped and as small as a grain of sand. Nits are often gray, tan, yellowish or white in color.
Nits are attached or glued to the lower portion of the hair shaft, close to the scalp. Their appearance is similar to dandruff, but they can’t easily be brushed away.
Self-care steps for you, your house and school
Lice love your head, so focus your efforts there. You can usually get rid of lice by following these self-care steps:
- For school-aged kids, it is usually effective to apply a non-prescription over-the-counter pesticide lotion or shampoo such as permethrin (Nix). Follow the directions closely.
- Do not use a shampoo/conditioner combo before treatment—it makes it less effective. You can condition after you rinse out the treatment, usually after 10 minutes.
- Lice can take a while to completely eliminate. The key is to comb out the nits every day, for up to three weeks, with a special, fine-toothed comb.
- It’s usually recommended to repeat the treatment after seven to 10 days to kill any lice that have hatched since the first treatment.
- Clean all clothing that’s been worn in the two to three days before the discovery of the lice.
- Wash and dry all bedding in the hottest temperature tolerated by the fabric.
- Vacuum couches and carpets, but don't go to extreme measures—it’s not necessary to spend a great deal of time and money trying to rid your house of lice.
- Stuffed animals can be washed and dried in a pillowcase, but if they’re especially loved or fragile put them in a sealed plastic bag for two weeks as a precaution.
- It’s a good idea for each family member to have their own hairbrush and comb—treat all exposed with the shampoo/lotion or in a dishwasher.
- Be sure to tell your school and friends who’ve been around your child so they may check for lice and begin treatment if needed.
When to call your doctor
Contact your doctor if you have a child under the age of 2, you are pregnant or breastfeeding or the above treatment has failed after a full cycle.
Head lice are common and prevalent any time of the year, especially in a school setting. It’s a good idea to check your child’s head once a week.
If there’s an outbreak at your child’s school, keep your child’s hair pulled back in a ponytail or braid to help reduce the chance of spreading. Remember, lice move by crawling; they can’t hop or fly—reduce your risk by avoiding head-to-head contact with a person already infested with lice.
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