Few words strike fear into parents quite like “head lice”. Finding tiny insects or eggs in your child’s hair can feel overwhelming, but the good news is that head lice are common, treatable, and do not pose a serious health risk.
If your child comes home from school scratching their head or you receive that dreaded note about lice in the classroom, here’s what you need to know.
What Are Head Lice?
Head lice are tiny insects that live on the scalp and feed on small amounts of blood. They cannot jump, hop or fly. Instead, they spread through direct head-to-head contact, making school-aged children especially susceptible.
Having head lice has nothing to do with cleanliness. Lice are just as happy living in clean hair as in dirty hair, and anyone can get them.
What Are the Signs?
The most common symptom is an itchy scalp, although some children have no symptoms at all.
Look for:
Persistent itching, especially behind the ears and at the back of the neck
Live crawling lice
Tiny eggs (called nits) attached firmly to the hair shaft close to the scalp
Small red bumps from scratching
Finding nits alone does not always mean your child has an active infestation. Empty egg casings can remain attached to hair long after the lice are gone. Live crawling lice confirm an active infestation.
How Are Head Lice Treated?
Several over-the-counter products are available and remain a reasonable first step for many families. Carefully follow the instructions on the package, since proper application is essential for successful treatment.
Because some lice have developed resistance to commonly used medications, treatment doesn’t always work the first time. If live crawling lice remain after treatment, or return despite carefully following directions, your child’s healthcare provider may recommend a prescription medication.
Some prescription treatments work against both lice and eggs and may require only one application.
Removing nits with a fine-toothed comb can also help, although not every treatment requires extensive combing. Follow your healthcare provider’s recommendations based on the treatment being used.
Should Everyone in the Family Be Treated?
No.
Check everyone in the household carefully but treat only those with live crawling lice or evidence of an active infestation. Treating family members “just in case” is unnecessary.
It’s also helpful to notify close contacts so they can check themselves for lice.
Do I Need to Clean My Entire House?
Fortunately, no.
Head lice survive only a short time away from the human scalp. These simple cleaning measures are all that’s needed:
Wash bedding, recently worn clothing, and hats used during the two days before treatment.
Soak combs and brushes in hot water for several minutes.
Vacuum upholstered furniture and carpets if desired.
There’s no need to use insecticide sprays, foggers, or extensive household cleaning, since lice do not survive long off the scalp.
What About School?
Children do not need to miss extended periods of school because of head lice. Current recommendations no longer support “no-nit” policies that require every egg to be removed before returning to class.
Once treatment has begun, children can usually return to school, even if some nits remain.
Can We Prevent Head Lice?
Complete prevention of head lice is not possible, but you can reduce the risk by encouraging children to:
Avoid prolonged head-to-head contact during play.
Avoid sharing hats, hairbrushes, combs, headphones, or hair accessories.
Check hair promptly if a close contact develops lice.
The Bottom Line
Head lice can be frustrating, but they are not dangerous and they do not spread disease. Most infestations resolve quickly when you apply proper treatment, exercise a little patience, and use accurate information.
If over-the-counter products are not working, your child continues to have live crawling lice after treatment, or you’re unsure whether you see lice or something else, contact your child’s healthcare provider. They can confirm the diagnosis and recommend the most effective treatment.
Dr. Mike Patrick is an Assistant Professor of Pediatrics at the Ohio State University College of Medicine and Medical Director of Interactive Media for Nationwide Children's Hospital. Since 2006, he has hosted the award-winning PediaCast, a pediatric podcast for parents. Dr. Mike also produces a national podcast for healthcare providers—PediaCast CME, which explores general pediatric and faculty development topics and offers free AMA PRA Category 1 Credit™ to listeners.
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