It’s one of the notifications parents dread receiving from school or daycare: your child or someone in their class has a confirmed case of head lice. Not only are viruses like the common cold shared between kids in close quarters, but head lice are too.
Lice are very common in school-aged kids. They occur most often in children between 3 and 12 years of age. For many parents a case of head lice is just as scary as a virus. But don’t panic. Head lice are frustrating, but they’re harmless and relatively easy to treat with the right tools.
How To Know if Your Child Has Lice
Lice are tiny, wingless insects that live among human hairs and feed on small amounts of blood drawn from the scalp. They are about the size of a sesame seed (about 2 to 3 mm long) and can be seen by the naked eye though are sometimes difficult to spot because they try to avoid light and can crawl quickly. Their tiny tan-colored eggs, called nits, are found firmly attached to the hair shaft within a few inches of the scalp, hatching one to two weeks after they are laid.
It is much more common to see nits in a child’s hair than live lice. The live adult can only survive up to two days off the scalp, and it’s more common for people to contract lice through head-to-head contact than indirectly. Indirect spread through contact with personal belongings like combs, brushes, hats or helmets is much less likely to occur and lice found on these items are likely to be dead or injured. It’s important to know that lice do not hop or jump — they can only crawl. Head lice are also specific to humans so they cannot be transferred between humans and pets.
An itchy scalp is the hallmark symptom of a case of head lice. However, the itching may not always start immediately and may sometimes be delayed for weeks as a case of head lice develops.
If you suspect a lice infestation in your child or they had contact with another child who is infected, check for lice and nits using a fine-tooth comb on the scalp, behind the ears, and around the nape of the neck. A magnifying glass and bright light may help.
Over-The-Counter Treatments
If you do find lice or nits, stay calm. For kids, a parent’s strong reaction to their child having lice may be worse than the lice themselves. There are several over-the-counter treatments available that include guidelines to help rid your children and home of lice. Since these treatments are insecticides, be sure to follow the age guidelines and instructions for application closely.
After treatment, it is important to remove the nits from your child’s hair using a fine-tooth comb and repeat the treatment as directed in the package insert. This can help prevent re-infestation and resistance to treatment.
If over-the-counter treatment and removal of nits isn’t effective, talk to your doctor. There are prescription shampoos available.
Of note, most topical agents that are FDA-approved for treatment of head lice should be regarded as safe to use in pregnant or lactating persons. These formulations have little systemic absorption so risk is minimal to a fetus or breastfeeding child.
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Environmental Interventions
If a child is found to have head lice, all household members should be checked and those with lice or nits within 1 cm of the scalp should be treated. Treatment of family members who share a bed with the child with an infestation, even if no live lice are found, should be treated.
It is also good idea to clean hair care items and bedding of those with head lice if they have been in contact with the head within two days before treatment. Hair care items should either be soaked in rubbing alcohol for at least an hour followed by a wash in warm soapy water or thrown away and replaced. Other items to consider are clothing, car seats, stuffed toys, headgear, furniture or carpets.
To clean, machine washing with hot water should be used because lice are killed by exposure to temperatures greater than 130 degrees Fahrenheit for five minutes or more. For items that cannot be placed in a washing machine, they can be vacuumed to remove an infested person’s hairs that might have viable lice attached. Items that cannot be washed can be bagged in plastic for two weeks.
Preventing Head Lice
Lice are spread mainly through head-to-head contact so the key in prevention is to teach children and adolescents not to share personal items such as combs, brushes, hats and pillows. Otherwise, regular surveillance by caregivers can be helpful in early detection and treatment of infestations and preventing further spread.
If you are overwhelmed by discovering your child has lice or have any questions regarding diagnosis, treatment or prevention, be sure to talk to your pediatrician.
