When your head starts to itch, what’s the first thing that comes to mind?
Since grade school, many of us have been groomed to think “head lice,” the dreaded term indicating that your head is infected with thousands of little scalp-eating bugs.
Just thinking about an itchy head kind of makes you scratch at your scalp, doesn’t it? While an itchy head often just means that your scalp is dry, head lice is nothing to scoff at. They can spread quickly, infecting dozens of kids at a time. Take, for instance, one school district in Pennsylvania.
Dauphin County rests about an hour and a half outside of Philadelphia and Baltimore. It’s home to Hershey, the land of chocolate and Hersheypark, and it’s also the home of the Harrisburg School District, where a recent “unprecedented” head lice outbreak took place.
In 2017, a handful schools in Harrisburg saw over 250 children get infected with head lice, forcing the closure of one of the schools for two days.
The Fosse School, which caters to kindergarten through fourth grade, closed for a Thursday and Friday because over 140 students came down with head lice. Not only that, but almost 50 percent of the students didn’t attend school the following Monday (due to lice or other reasons).
Soon after, another school—the Downey School, which has kindergarten through eighth graders—reported about 100 cases of head lice. A third school in the district, also serving younger children, reported having about 20 cases of head lice at around the same time
To help address the massive outbreak of head lice within their schools, the district’s public relations coordinator said they were in communication with various health departments in the city and around the state “to better understand the origin and scope of this unprecedented lice outbreak.” And that is often the best prevention to outbreaks of head lice: education of what it is and how to stop it before it can infect dozens of children.
The goal is to get ahead of the problem and make sure kids don’t have to miss a lot of school. But before we get into how to stop the head lice, let’s first look at exactly what head lice are and how many people are affected by them.
What Are Head Lice and How Do They Spread?
If you’ve ever encountered head lice, you know what to expect. They’re tiny, come in the hundreds when they infect your scalp, and it’s a bit difficult to identify them without digging through your hair follicles. So before we get into how to identify lice and how we prevent it, let’s discuss what exactly lice are and how they get on our head in the first place.
Head lice—known as pediculus humanus capitis to the scientific community—are small, wingless insects that feed on human blood. They live their whole lives attached to the human scalp, though adults can live for about a day or two not attached to the host, which allows time to move from one scalp to the next. There are two other forms of lice—body lice and pubic lice—that live and thrive on various parts of the body.
Head lice live among your hair because the warm temperature underneath it is a perfect breeding ground. They move through five different stages in their lives and look a little different in each stage. (You most definitely want to identify head lice in their earliest stage.)
These stages are:
Eggs: These are known as nits. Females can lay up to four eggs per day, meaning the population of head lice can quadruple every day they’re on your head. They are attached to your scalp or the base of your hair with a secreted glue-like substance when they are laid and look opaque with a light brownish hue to them. It’s hard to know eggs are attached to your head if you aren’t looking for them, which is why head lice is usually identified once a large population is already hatched on your head. Nits take about 7 to 10 days to hatch.
Nymphs: Head lice live three different stages of life in their nymph stage. Head lice are still not adults when in the nymph stage. During these stages, head lice become more visible and yellow as they eat blood from your scalp. This period lasts about seven days.
Adults: A week after hatching, most head lice are full-on adults. They become a lighter white-ish or tan-ish color and are about the size of a sesame seed. Once they are adults, they can live on a human scalp for about a month at most. Either way, the longer a female lives on your head, the more massive the population can get.
All head lice have six legs, are usually less than three millimeters long, and have a long abdomen.
We mentioned earlier that head lice are wingless creatures. In addition to that, they can’t hop, so the only way they get from scalp to scalp is by crawling. It doesn’t take long for lice to move from body to body, and all it takes is close head-to-head contact (especially among young children) to do so.
According to the CDC, places where this is most common include:
The CDC also notes that head lice can transfer from body to body through clothing (hats, hair accessories, etc.), grooming products, and places where your head may be resting, like pillows and couches. This is a less common way to move around, though, because of the short lifespan of lice when they’re not attached to someone’s scalp.
By the way, when you’re referring to just a single insect (and not a group), it is known as a head louse.
Who Gets Head Lice, By The Numbers
Head lice are one of the most common parasite infestations in the United States, especially among children. The CDC reports that anywhere from 6 million to 12 million children between the ages of 3 and 11 get infected with lice every year. This age range—those in preschool all the way up until late elementary school or early middle school—is the most common age group affected by lice.
When it comes to gender, studies have shown that girls are more likely to suffer from a head lice infestation than boys, though the reasons for this aren’t explicitly stated. (Some believe that girls have more close head-to-head contact than boys, which is the primary cause of transmission.)
A report by the American Academy of Physicians says that “all socioeconomic groups are affected, and infestations are seen throughout the world.” The group also says that hair length and the frequency of shampooing and brushing doesn’t affect the likelihood that someone is infected by lice.
Despite this, the CDC says that head lice is far less common among African Americans than any other race in America. They note that the most common forms of lice found in America “may have claws that are better adapted for grasping the shape and width of some types of hair but not others.”
While children are the most common population affected by head lice, it’s not impossible for adults to contract head lice. This is because they may be in close proximity to infected children, specifically if they work in daycares, schools, hospitals, and other locations with large populations of children.
As one woman explained when she discovered “a city of lice” living in her hair after having an itchy scalp for months, she found that one of her kids had head lice eggs in his hair. But he actually didn’t give it to her, because it was the other way around. And she believes that she may have gotten it from other adults, too, pointing to her frequent plane trips and being in close proximity to hundreds of adults at a time.
So just because your child has lice and you’ve gotten it under control, that doesn’t mean that you or another older family member can’t contract it or be the root cause of the head lice itself.
Signs and Symptoms of Head Lice
As you may have discovered by now from reading this article (or from your own unfortunate experience), head lice make themselves a presence on your child’s scalp through all the blood they suck. For the first couple weeks of living on the head and before the population is at a noticeable level, your child may be asymptomatic. But during all this time, you or your child could have transferred head lice to dozens of people.
This is why it’s important to identify head lice as soon as possible, and in order to do this, you and your child need to know the signs and symptoms of having lice:
Itching and scratching: This is the most easily identifiable sign. Lice cause a lot of itching and scratching at the scalp because of the saliva they secrete when laying eggs. That saliva causes an allergic reaction on our scalp, which is bothersome and itchy. You may also be scratching at an annoyance from these tiny insects latching onto your scalp for weeks and weeks. If you see your child frequently scratching their hair, you should check them for lice immediately (discussed more in a later section).
Feeling something moving: Head lice move all around your head while they live there to find the premium real estate for blood sucking. Because of this, they move around frequently, especially as the population on your head grows. The scalp is a very sensitive area, so you or your child should be able to feel something moving from one area to the next. Head lice moving across the scalp may also cause a tickling sensation that could result in scratching the area.
Sores or wounds on the head: You may have open wounds, irritations, or sores on your scalp, whether it be from the constant sucking of blood from the head lice or because of the reactive scratching from their presence. There may be no lice in the area the sore is located, but that doesn’t mean the lice have died off or left your head. They probably just moved to a new location.
Sleeplessness: The itching and scratching sensation may be so bad that it wakes you up or prevents you from sleeping in the first place. The CDC says lice are most active in the dark, so their movement and activity can keep you up at night.
Head lice aren’t known to carry or transfer any disease, but all the itching and scratching they cause can have derivative effects. Various diseases and viruses can enter your bloodstream from under your fingernails and through open wounds caused by the irritation of head lice. Despite this, the CDC says that head lice “are not considered a health hazard,” but rather they are an extreme annoyance to us all.
How to Search for Head Lice
Once you notice you or your child may have head lice, the search for confirmation is vital so you know what to do next. There are no blood tests or difficult examinations to run to see if you have head lice. Rather, it’s simply done by someone checking your head.
This process (and identifying the lice) looks like the following:
Wet the hair of the child whose head you are searching. This helps slows down the lice and makes it harder for them to escape your eye. (This step is better for when you are at home. If you’re at school conducting a search, you can leave the hair dry for now.)
Use a fine-tooth comb to sift through the hair down to the scalp. You should be doing this process with a bright light. It helps give a clearer picture of what is on the scalp.
Sift through the hair and check for any sort of movement. The lice will be moving away from the light. The head lice may end up on the comb, too. As we discussed in an earlier section, hatched lice are about two-to-three millimeters long and look like tan or white specks. The eggs are light brown and opaque. They will be less than an inch away from the scalp and attached to the hair.
You can tell the difference between lice and other not-threatening things like dirt and dandruff by how easy it is to remove the object from the scalp. Dirt will be very easy to move, where it may seem like lice are glued to the scalp.
If you still can’t identify any lice, put a large amount of conditioner or shampoo into the hair when it is wet. Sift through the liquid with the fine-tooth comb again. Lice should appear within the liquid.
It’s best to have a second party conduct the search. This doesn’t have to be a healthcare professional, and can be an adult like a parent, spouse, or family friend. Searching your own head with a comb and a mirror can cause inaccuracies in the testing. If you still aren’t sure if lice is present or not, contact a healthcare professional, preferably someone who has experience working with kids and has diagnosed lice before.
If someone at school notices your child or someone in their class is itching their head often, the school nurse may decide to give a quick examination to make sure the head lice hasn’t spread around the class or school (like it did in those schools in the Harrisburg School District) and confirm the diagnosis for you.
How To Prevent Head Lice (Again) and Where To Report It
There isn’t exactly a prevention plan for head lice aside from minimizing head-to-head contact, which is hard to stay on top of, especially with kids. Washing your head more often doesn’t stop lice from latching to it, and brushing more doesn’t interrupt lice either.
If you have any suspicions that your kid has head lice (see: Signs & Symptoms), the best “prevention” is to have a lice comb ready for immediately sifting through your child’s head to make sure you are as ahead of the problem as possible. Remember, female head lice can lay three to five eggs a day, meaning the population on your child’s head can quintuple every day it goes unnoticed.
Also, just because your child gets head lice once, it doesn’t mean they won’t get head lice again. Some steps you can take to help prevent the recurrence of head lice revolve around cleaning. These include:
Wash all clothes, sheets, pillowcases, and anything else you and your family have worn and slept on over the previous couple days. Use the hottest setting of water. Send suits and other items that can’t be put in the washing machine to the dry cleaners.
Vacuum bedrooms and other carpeted areas where lice may be hiding until they find their next victim.
Soak hair brushes, combs, and other things used to treat hair in rubbing alcohol or hot water for an hour.
Items like pillows and stuffed animals can be placed in a sealed bag for up to two weeks. This helps make sure that all head lice and their eggs die.
You are not required to report head lice to any sort of authorities or medical associations, but there are some people you need keep in mind and inform should you or your child encounter lice:
Your child’s school
Co-workers who you work in close proximity to
Parents of your kids’ friends, especially if they’ve hung out recently
There is no need to be embarrassed by head lice, and letting someone else know of its presence can help save the next person from getting it.
If you have any questions about head lice, such as how to identify it and how to treat it, contact a local healthcare professional for advice.