The No-Panic Parent’s Guide to Managing Lice

Just hearing the word “lice” can make anybody’s head suddenly feel itchy and send a parent into a tailspin of horrified panic. Head lice is a common problem for many school age kids and their families, affecting 6 to 12 million people annually. They can be found just about anywhere - schools, daycare, and homes - and they are not picky when it comes to any one group of people. Lice are equally happy living in clean hair as much as dirty hair and personal hygiene has nothing to do with getting head lice.

As a parent, it can be quite horrifying to get that call or email from school telling you your kid has lice. While lice are contagious and can be very annoying, they pose very little health risk and have not been shown to spread disease. So before you decontaminate your entire household and turn your world upside down, dive in to this practical guide on how to deal with those pesky bugs.

What are Head Lice?

Head lice are tiny parasitic insects that infect the skin and scalp areas. The louse (singular form of lice) lives off small amounts of blood from the scalp. Lice lay their eggs, also known as “nits”, very close to the scalp along the hair shaft.

The key to managing lice is understanding their life cycle. Head lice can live up to 28 days and they develop in 3 phases: the nit or egg, the nymph, and the adult louse:

  • Nits (eggs) are typically pearly white or grey, oval-shaped, and usually found stuck to the hair shaft close to the scalp. They typically hatch in 6 to 9 days.

  • Nymphs are typically greyish-white and look like a small version of the adult. They become adults within 7 days of hatching.

  • Adult louse are usually beige in color and the size of a sesame seed. They can lay up to 10 eggs per day.

How Do You Get Lice?

Lice do not fly or jump - they crawl. The most common way to get lice is through prolonged head-to-head contact. While lice can be spread through the sharing of brushes, hats, pillows, and furniture, the risk of catching lice this way is very, very low.

How Do I know If I (Or my child) has lice?

The most common symptom of lice is an itchy scalp or rash caused by the skin’s reaction to lice saliva. However, sometimes it takes up to 4 to 6 weeks to develop a reaction, which means many people can have lice but experience no symptoms. The easiest way to know if your child or family member has lice is to sit them down in a well-lit spot and and comb through their hair looking for live lice or nits. Be aware that lice can be fast moving and tend to shy away from light. Nits, on the other hand, are often found stuck to the hair and within 1 inch of the scalp.

Treating Lice

Most of the time, lice can be treated at home. There are a few instances in which an office visit is a good idea, including concerns about lice in a newborn, or if the skin on the scalp looks infected - red, swollen, or with drainage.

The first line of treatment for most adults and kids over the age of 2 months old is an over-the-counter treatments using 1% permethrin or pyethrins. It is important to note that most medications kill lice but do not kill nits. Successful treatments require medication followed by careful combing of the hair to remove lice and nits. One approach to lice and nit removal is called the Wet-Comb Method.

The Wet-Comb Method

With a little conditioner or combing gel (usually included in most over-the-counter treatment kits), you make start the process of banishing those pesky lice! Following these simple steps to get the job done:

Step 1: Generously apply conditioner or combing gel to the scalp and full length of your child’s dry hair.

Step 2: Untangle the hair with a brush or wide-toothed comb

Step 3: Using a fine-toothed head lice comb (available at most pharmacies), carefully comb along the scalp through to the ends of the hair.

Step 4: Wipe the comb after each stroke on a white paper towel and check carefully for nits or lice

Step 5: Comb each section at least 5 times.

Step 6: Wash the hair as normal when finished.

Repeat the wet-comb method every 2-3 days until the person is nit- and lice-free for at least 10 days.

Containing the Spread

While you may be tempted to throw out every stuffed animal, wash your entire wardrobe, and do away with your furniture, I encourage you to pause and take a more practical approach. The truth is, lice generally don’t survive more than 1-2 days away from the host and nits can only survive up to a week. By following these practical tips for frequently used household items, you can keep it from spreading and save yourself a lot of hassle:

  • Machine wash and dry clothes and bed linens used within 1-2 days of treatment.

  • Soak brushes and combs in hot water (not boiling) for 10 minutes.

  • Avoid excessive household cleaning or use of pesticides and sprays. It is reasonable to do limited vacuuming of areas where the person may have recently sat including furniture and carpets.

  • Clothing or items that can’t be washed can be sealed up in a bag for 2 weeks.

Keeping Kids in School

While many schools and camps follow a “no-nit” policy and will often send kids home with any signs of nits or lice, the American Association of Pediatrics and the Centers for Disease Control have recently recommended that children should not be restricted from school for lice or nits. It is reasonable to allow a child to finish the school day, go home and be treated, and return to school.

Doc Dispels Common Myths About Head Lice

Parents should be reassured that personal hygiene has nothing to do with the problem

Although lice do not cause serious physical harm, they can result in a lot of emotional distress because many people still mistakenly believe they are a sign of poor hygiene, an expert explains.

Head lice bite into the scalp to feed on blood, but these bites are usually not painful. Still, a lice infestation can strike fear in families for a number of reasons, including the stigma of being deemed "dirty."

A lice infestation, however, is not a reflection of a person's cleanliness, according to Dr. Andrew Bonwit, a pediatric infectious disease expert at Loyola University Health System in Illinois.

"Personal hygiene and socioeconomic status have nothing to do with having or transmitting head lice. The head louse is an equal-opportunity pest," explained Bonwit in a university news release. "The infestation is usually a nuisance and almost never a serious problem in itself."

There are other common misconceptions about lice, Bonwit pointed out. In order to ease parents' fears, he dispelled the following myths:

  • Myth: Pets spread lice. "Animals are not known to carry head lice nor to transmit them to people," Bonwit said.

  • Myth: Sharing personal items spreads lice. "Although it's probably best not to share such items as combs, hairbrushes and hats, these do not seem to transmit the pest," Bonwit added. "Transmission of lice seems to occur only by direct head-to-head contact from one person to another."

  • Myth: Kids with lice should be sent home from school immediately."The American Academy of Pediatrics does not endorse 'no-nit' policies that exclude children from school because nits are present," Bonwit noted. "In fact, even the presence of mature head lice is not considered a valid reason to exclude children, only a cause for prompt referral to the physician for treatment."

  • Myth: Lice carry disease. "Head lice do not transmit serious infectious disease," Bonwit explained.

Although lice often cause a big stir, they are tiny and often hard to spot. "Lice are very small, about the length of George Washington's nose on a quarter," said Bonwit, who is also an assistant professor of pediatric infectious disease at Loyola University Chicago Stritch School of Medicine. "The lice produce eggs, called nits, which become strongly cemented to the host's hair shafts."

Nits look like small, dark spots on the side of the hair shaft. Although the infestation isn't painful, it can be itchy, Bonwit cautioned. "Sometimes the patient has been so itchy that he or she scratches the scalp to the point of minor skin infections and even causing some enlarged lymph nodes on the back of the neck or behind the ears," he said. "While these changes may alarm parents, they aren't directly harmful."

The U.S. Centers for Disease Control and Prevention reports that up to 12 million lice infestations occur each year in the United States among children aged 3 to 11 years.

"Parents and school staff may become understandably upset by outbreaks of head lice, but it is important to remember that if the problem occurs, it is treatable, although repeat applications of medicine are usually needed," Bonwit said.

The most common lice treatment is over-the-counter or prescription shampoos or lotions that must be applied to the scalp, left on for a specified time, then rinsed off. Often a fine-toothed comb is also needed to remove nits to prevent further infestation.

"The life cycle is about seven days from the laying of the eggs to the hatching, so a second insecticide treatment is recommended, after the first application," Bonwit advised. "If the treatments are used as directed, problems other than scalp irritation are unlikely to occur."

Kids shouldn’t be sent home for lice, but schools can’t ignore the issue either

Last night, my 3-year-old daughter made soft, singing noises while she dipped a plastic boat in and out of the bubbles of her bath, oblivious to my actions of raking a fine-toothed metal comb through her mop of curls that reach her shoulders when they are wet.

Just a few months ago, the sight of a hairbrush in my hand caused her to shriek. Bath time was a battle. I was certain her first memories would be the pain from my tugging tangles out of her hair. Then, that fateful day came when the sun shone on her little forehead, still from sleep in her car seat. I bent over to carefully unbuckle her and saw the telltale bug crawling through her blond curls. Head lice.

I was no stranger to this terror. My oldest daughter seems to attract them. Maybe it is her mass of light-brown hair, so thick I can barely get a comb through it. Maybe it is her many invitations to sleepovers with several friends where they try on five different outfits. When I first discovered my oldest had them, my youngest was a newborn. I was on my own, barely making ends meet, scrambling to find work I could do at home to pay rent. Dropping $20 on a tiny bottle of shampoo that claimed to kill the bugs that had invaded our house was an expense I could not afford. Plus, I had to wash and dry everything I could — including stuffed animals — on high heat, vacuum, and repeat a week later. I bagged most of it instead.

My oldest had been in kindergarten that year, and I faintly remembered a line in the classroom newsletter telling me they had a report of lice. There was not any mention of ways to check for it, or how to prevent it. This was several years ago, when the school nurse came around with her flashlight to check every head. I knew if she found any, she would send those kids home because of the district’s “No Nits” policy. So, I didn’t worry. Lice happened to other people. Not my daughter, who stayed in the bath so long, her fingers wrinkled before I convinced her to get out of the tub.

When I found lice last spring, I sent an email to my daughter’s teacher. I half expected her to tell me that, even though I had used the shampoo and spent an hour combing her hair, my daughter would have to stay at home until the nits were gone. The school nurse called me instead.

“We don’t send students home anymore,” she cheerfully said, explaining that only 10 percent of lice are transferred at school. Because of this, they no longer checked students, did not call parents to pick up their children and did not notify the parents there had been a report. My daughter’s teacher did not send out a note, email or even include the infestation in the newsletter that week.

I applauded the idea of not sending children home. Low-income families don’t need the added hardship of missing work on top of the expense of ridding themselves of lice and nits, along with the stigma their kid would experience of being the one with cooties. The expense of lost wages, in addition to the added expense of laundry and buying shampoos and kits, could mean less rent money, not just an inconvenient afternoon. But shouldn’t there be a system in place to notify parents in the chance their child is part of that 10 percent?

As kids are back in school, connecting with friends, and putting their heads together, either by taking selfies or studying, lice transferring from one head to the next seems inevitable. But there was no mention of that possibility in the student handbook my daughter’s school sent home.

In deciding to allow students who have lice to come to school, the flip side should be educating parents on what to look for, how to prevent them and how to get rid of them without spending $50 on chemical-laden shampoos, salon treatments and loads of laundry. Keeping lice out of schools should be a herd immunity type of attitude. Schools should send home brochures with a plastic comb attached in an envelope. If every parent knew that the best way to prevent lice from spreading is by looking for them, cases decrease dramatically.

Nobody wants to admit their kid is the one with lice. Not only because of the work involved in getting rid of them, but because lice are still associated with dirt, grime, neglect and often poverty. Yet, when stomach bugs run rampant, we all accept that it will run its course and we will be spending a day doing laundry along with everyone else. If parents admitted they are part of the 6 million to 12 million cases of lice reported a year, maybe it’ll be on par with stomach bugs, and not shrouded in secrecy.

More than that, I want a way for parents to notify the school their child has lice, anonymously if needed. I want to get a text message every time this happens so I know to check more than once a week for a while. If parents know how many times others are finding lice on their kids’ heads, maybe other parents will not hide their own discoveries in shame.

Dealing With Lice Is Political Hot Potato For School Officials

No nit and no lice policies are imprudent, as they are based on misinformation, hysteria and intolerance rather than on science. The discovery of lice or their eggs on students should not cause them to miss school.

Exclusionary policies for lice were adopted early in the last century when body lice and infections they transmitted caused global epidemics. More recently, body lice and head lice were recognized as distinct in their biology, epidemiology, medical and public health significance. Body lice can spread disease but are restricted mainly to indigent adults. Head lice, which do not spread disease, are relatively trivial and serve as occasional nuisances that mainly affect young children. They do not cause epidemics.

Exclusionary policies are so entrenched that most folks believe they must be necessary and effective. Inertia is a strong force, and any effort to even suggest changing the policies is met with vigorous resistance by a misinformed, aggressive and highly vocal minority. The result is a political hot potato that causes angst among school administrators. Those who seek to pursue policies based on science and evidence-based practice tend to relent to the intense pressure and venom hurled by dissenting parents. 

Louse exclusion policies are discouraged by the American Academy of Pediatrics, the National Association of School Nurses and by the Centers for Disease Control and Prevention. Many school systems have consequently eliminated or modified their procedures. Instead of the feared epidemics, the change has resulted in relative calm, greater emphasis on education, fewer unnecessary absences and treatments, and cost savings for parents and schools. Kids will continue to have lice regardless of a school's policy, be it no nit, no live lice or one that says "all kids are welcome." 

The New York City Department of Education and Department of Mental Health and Hygiene were leaders in 2007 when they replaced their no-nit policy with a no-live-lice strategy. The next step, allowing children even with live lice to stay in the classroom, is long overdue.

Siblings and Head Lice: Tips

April 10 is National Siblings Day, and we are using the day to call attention to the fact that siblings are often the channel used by head lice to spread.

“The closer in age siblings are, the more likely it is for them to spread lice to one another.”  “That’s because they are likely to spend more time together and share rooms, hair accessories, and clothing that might carry hair with lice.”

According to a study of Norwegian school children, an infested sibling increases the odds of a child contracting head lice by 36 percent. In some school districts, if a student is found to have head lice, any siblings at the school are also checked.

Lice spread primarily through head-to-head contact. When siblings share a bed or bedroom, and one has head lice, others are likely to get lice, too. Lice don’t fly or jump, but if a louse is on a shaft of hair that falls on a jacket or hat or hair brush, it will crawl onto the next head it can find in a matter of seconds.

“Lice can’t live anywhere but on a human head,” Desmond said. “It is a matter of survival to get on the nearest head.”