Lice: Overview


Few phrases can make a parent recoil faster than “head lice.” Nobody wants their child anywhere near someone who has been diagnosed with them or—heaven forbid—have to treat a case crawling on her kiddo's scalp.  But guess what? Head lice are actually no big deal. Yes, they are tiny, wingless parasites that like to live in hair and off the blood in our scalps (seriously gross). But, head lice are not an actual health threat, and public health experts around the country want us all to calm down, breathe, and not overreact when our child comes home with that dreaded note from the daycare center or school nurse declaring: "there has been a case of head lice in your child's classroom."  

“If your child gets head lice, stay calm,” says Barbara Frankowski, M.D., a pediatrician in Burlington, VT and former chair of the American Academy of Pediatrics (AAP) Council on School Health. Coming home with a case of them is as inevitable as scraped knees or the common cold, says Dr. Frankowski. “It’s a normal risk of being a healthy, active social child.”

In July 2010, a clinical report for the AAP, co-authored by Dr. Frankowski, issued new guidelines for schools, stating that since lice don’t spread disease, and since by the time a case of lice has been discovered it’s already been present for at least a month, no child should miss school because of them and recommended that no-nit policies be abandoned. (Typically a child is sent home as soon as head lice are discovered and cannot return to the classroom until he has been treated and the nurse has checked his head for nits, the small dandruff-like egg casings that stick to the hair.) This has proven controversial, with some parents and teachers saying that a child with lice disrupts the classroom- despite attempts at confidentiality -- and that an infected child should be shielded from teasing by being kept home. It’s yet to be seen how many schools will adopt the AAP’s guidelines.

The upshot is this: if your child gets lice, don’t panic. Instead read our guide to spotting and stopping the buggers – without bugging out.

Lice: Symptoms

A very itchy scalp. An allergic reaction to the saliva of lice causes itching, but only after an initial exposure period. A child who has never had lice won’t start itching until several weeks into the infestation. But when he starts to scratch his head with vigor, or reports a tickly feeling, it’s time for a lice check.

Nits. The tiny un-hatched lice eggs are about the size of a pinhead and are tan-colored if they are alive or darker if not (if hatched, their discarded shells are white and more visible). Unhatched, they are usually attached to the hair close to the scalp and are difficult to remove  (hence the term nit-picking -- more on that later!). Nits, which don’t move, are usually easier than actual lice for a parent to detect.

Adult lice in the hair.  Look for tan-colored or brown bugs about the size of a sesame seed. They frequently hang out in the hair behind the ears, and on the hair above the nape of the neck and will crawl quickly away from light. If your child doesn’t have a lot of them, they might be hard to spot.

Because it is easy to mistake dandruff or other debris in the hair for lice, experts recommend getting a diagnosis from your pediatrician or the school nurse before starting treatment. 

Lice: Causes

Lice have been around since prehistoric times; they’ve even been spotted on Egyptian mummies. They are not as contagious as most people think; they’re spread by direct contact between individuals (such as when your child is huddled over her desk working on a group art project, or snuggled close to her buddy during story time). They can also be spread by sharing personal items such as combs, brushes, or hats. Contrary to popular belief, they cannot jump or fly from one person to another, and contracting lice has nothing to do with hygiene or how often you wash your hair, says Joseph A. Bocchini Jr., M.D., chairman of the department of pediatrics at Louisiana State University Health Sciences Center in Shreveport and the other author of the AAP’s clinical report. 

Lice: Diagnosis

Your pediatrician or school nurse will part your child’s hair to get a good view of the scalp, where she’ll be on the lookout for adult lice or nits. She may use a special light in a darkened room to help her see the little buggers better, or may catch them on a piece of tape, and examine them under a microscope. 

Lice: Prevention

There’s not much you can do to keep lice from finding its way onto your child’s head other than asking him not to share combs, brushes, hats or earphones. But since lice much easier to treat if caught early, why not make a good comb-through a weekly ritual? Done well (with a little detangler beforehand), it can even be a pleasurable experience for your child and help them cooperate if (or more likely when) they do bring lice home. 

Lice: Age-by-Age Guide

Baby to Toddler

Although lice is most common in preschool and school-age kids, smaller children can get it too, often from daycare or infected older siblings. When infestation does occur, it can be hard to treat since this age group isn't known for their ability to sit still, and some treatments are not appropriate for children under 3. If you suspect your baby or toddler has lice, talk to you doctor about the most age-appropriate way to deal with it.

Preschool to Grade School

Lice often first strikes during the school years – think of it as a big kid rite of passage.  Since you’re likely to still be washing and combing your young child’s hair anyway, it’s a good idea to always be on the lookout for nits or lice in the hair behind the ears and at the nape of the neck. “If parents do that once a week, they are more likely to pick up an infestation early when it would be easier to deal with,” says Dr. Frankowski.