Heading off head lice

Back-to-school season can be an exciting time for parents and children who are eager for a new adventure or to reconnect with old friends. But when your little darling comes crawling home with an itch that just can't be scratched away, you may find yourself in the throes of an all-too common battle with head lice.

Head lice outbreaks are most common during summer and back-to-school season. Children ages 3 to 11 are most affected - with an estimated six million to 12 million infestations each year in the United States. Live lice are roughly the size of a sesame seed and reddish-brown or tan in color, and they attach to a child's scalp, where they feed on blood. These six-legged wingless parasites attach with their claws, and usually cause little red bumps on the scalp. Lice can't fly or hop; they spread by crawling - usually from head to head or from shared personal objects, including brushes and combs, coats, hats and scarves, and towels. Girls tend to be more susceptible, as they are more likely to share personal items with their friends. To be clear, personal hygiene and household cleanliness are not factors for spread of lice.

Though they don't carry or spread disease, lice do lay eggs called nits, which are the size of dandruff flakes and can be silver, yellow or tan in color. Nits attach close to the scalp, at the base of the hair shaft, and must be removed by hand or with a fine-toothed comb. Head lice are a nuisance, to be sure, but they pose no short- or long-term medical harm.

How do you know if your child has lice?

Lice and nits are hard to spot with the naked eye, which is why your child's symptoms likely will tip you off. Symptoms include a tickling sensation that something is moving around in the hair or along the scalp; itching and redness or little red bumps; or the existence of what may look like dandruff flakes that are not easily removed by brushing the hair. Your child also may have difficulty sleeping, as lice tend to feed at night.

You may check your child's head and hair under bright light with a fine-toothed comb and a magnifying glass. Live lice move quickly, however, and can be hard to spot. If you can't locate a live louse - a single adult - then look for nits attached a quarter-inch or less above the base of the hair shaft. If you are unsure, you may bring your child to your health care provider or, if available, your child's school nurse.

How do you treat lice?

Over-the-counter and prescription lotions and shampoos are available to treat lice, with varying treatment courses and times. Some formulations are chemically stronger, so check with your health care provider before applying a treatment to your child's hair and scalp. According to the Centers for Disease Control and Prevention, some lice have become resistant to certain forms of treatment. Consult your health care provider if you followed all directions for treatment and the lice remain. Nits may not be removed with certain treatments, and you may have to pick them out individually, by hand, or comb through hair with a fine-toothed comb to pull them out. It is common to treat the hair and scalp more than once in order to kill any newly hatched lice from remaining nits.

How do you treat the environment?

Wash your child's bedding in hot water and dry on a high-heat setting. Clothing that was worn close to the time of the lice infestation should be washed in hot water and also dried with high heat. Brushes, combs and barrettes can be disinfected with medicated shampoo or water near to boiling, or hotter than 130° F. If you cannot wash or disinfect an item, secure it in a garbage bag for at least 10 days, which will allow new nits to hatch and lice to die. Without a food source, lice die within 24 hours. Vacuum thoroughly, and if using a bag vacuum cleaner, dispose of the bag in plastic trash bag.

Other children living in the house should be checked for lice, and their bedding and clothing may be washed the same way as well.

You do not need to fumigate your house or treat pets, as they cannot catch or spread lice.

How can you prevent getting or spreading lice?

  1. Encourage your child not to share his or her personal items with other children, including hats and scarves; combs, brushes and hair accessories, such as headbands and barrettes; helmets; towels; and blankets, pillows and stuffed animals.
  2. Encourage your child to place his or her personal belongings in a designated cubby or locker, rather than sharing storage with a classmate.
  3. Do not share towels or bathing suit cover-ups after swimming in a pool. Lice can survive by clinging to the hair shaft or scalp under water, and chlorine does not kill lice. They are unlikely to spread, however, in the water.
  4. Be vigilant if someone at your child's school or daycare facility has lice; know what you're looking for, and check your child's head every two to three days for signs of live lice or nits. It can be helpful to wash and condition your child's hair, and then use a fine-toothed comb to look through the hair while it's still damp.

Should a child miss school because of lice?

Once you treat your child with an anti-lice shampoo, they should be fine to return to school, according to the American Academy of Pediatrics. Though nits remain and may take longer to kill off, the child still can return to school, as nits are not contagious. Some schools have a no-nit policy, so check first with your school district. If your school does have a no-nit policy, you may contact your child's health care provider to discuss what to do.

For more information on preventing or treating lice, visit the Centers for Disease Control and Prevention and the American Academy of Pediatrics.