Four ways to deal with head lice and nits

Parents dread discovering an infestation of the itchy menaces, but with the right approach you can stop them in their tracks

Act fast

“People are not treating an infestation at the earliest stages,” says Ian Burgess, the director of the Medical Entomology Centre in Cambridge, whose research is cited in the Nice guidelines for this persistent problem. “We quite often find people with hundreds and occasionally thousands of lice,” he says.

Dee Wright says: “If you check your child’s hair and find a bunch of nits [eggs], you should be combing immediately, rather than waiting to spot a live one. It’s good to do a weekly check.”

Comb with Care

“Lice are movement-sensitive and scraper when you touch the hair,” warns Wright. Dividing the head into sections helps avoid missing any. Detangle the hair first and use conditioner. Metal combs, especially, can shred individual hairs, says Burgess. “We have even come across pseudo nits, where the comb has peeled back little knots that look and feel like nits,” he says. “So if you’re going to comb, you need to use a lubricant and do it carefully.”

Forget chemical pesticides

Burgess says that we have known about pesticide-resistant lice in the UK and US since 1995, yet chemical pesticide treatments are still sold – and frequently recommended by pharmacists and prescribed by doctors. “GPs aren’t listening,” he says. “It’s hardly surprising there are a lot of lice.”

Play the long game

Silicone-based shampoo treatments, otherwise known as physical pesticides, may effectively smother the lice, but some of the dreaded nits can survive. “We looked at nearly 1,895 case records,” says Burgess. “Most of those who had baby lice appear after a treatment had them within the first week, but the longest case was 13 days.” Either treat again a week or so later, or keep combing for a few weeks to catch any late hatchers.

A heads-up for finding head lice

An email from the American Academy of Dermatology came to my inbox as a reminder about detecting head lice, one of the common scourges of younger school kids.

So, I figured it might be worth reviewing detection tips and techniques to start the academic year off with a burst of paranoia, along with what teachers the kiddos get, who will pick on them, etc.

This discussion is only about detection and diagnosis, not treatment, which is a long subject by itself. Somebody declared September lice prevention month. Whoopee.

Pediculus humanus capitis, the head louse, has been with hominids since before doctors had offices or caves were heated. The incidence of it in any population seems to rise and fall over periods. There is a suspicion that heads that are infested produce some obscure sort of immunity in the group or “herd” (Think of a playground full of urchins wrestling, etc, as the herd.).

Head lice are medically harmless. They carry and transmit no diseases. They cause itchy noggins and paranoid parents and teachers. For the older hands (and heads), not so much. Been there, done it. If there is enough scratching, some lucky bacteria can infect the scalp a bit. In the United States, the predominant populations infested are pre-school and elementary-age children, their caretakers and household members.

Reliable data about how many kids get lice are not available, but guesstimates are 6-12 million children ages 3-11, according to the Centers for Disease Control. A few studies suggest girls might be more “blessed.” For reasons that are a total mystery, occurrence in African-Americans is much less common.

Infestations can be asymptomatic, or not create itch for four to six weeks. Itch is by far the most common feeling, primarily along temples, back, scalp and behind ears. The lice don’t inhabit the upper crown area very frequently, again a mystery. The lice do not migrate to other body areas, nor do they jump from person to person or to any animals. They like people exclusively.

The life cycle of a louse has three stages. First is the egg, or nit, an old word for exactly that. They are 0.8 by 0.3 mm and hard to see. With the baby inside, the color is kind of caramel to white. After hatching, it is more white.

The mom lays up to eight nits a day and cements them to the base of hair shafts with a substance stickier than any glue we have made. They hatch in about one week. Then they become nymphs the size of pinheads with the same shape as adults. After three “molts” they become mommy and daddy lice, with six legs, about the size of sesame seeds and appear gray-white to tan. They can live up to 30 days in the host’s cranial penthouse, feeding on blood several times a day. Without food, they die in one to two days.

Detecting the buggers is the trick and not always easy.

Compared to pubic or body lice, the numbers of crawling, creeping adults is relatively sparse. The best areas to look for them are sides and back of scalp. Magnifiers help. Wetting hair might make them more visible. There are really fine-toothed nit combs to use.

Start at the base the hairs and slowly pull out. The nits with embryos tend to be closer to scalp, empty egg shells farther out. Flakes of dandruff or chunks from hair products are easily confused with nits. The big difference is, when you pull your finger along the hair shaft, nits won’t come off, the other stuff will. That is one reliable sign I’ve found over the years. Finding a live louse is finding the gold medallion for diagnosis. In any self-respecting dermatology office, there is almost always a microscope. You can snip the hair off look for the embryo in the egg. If gone, the lid or operculum is open and shell empty.

There are scads of businesses that will examine heads for $20-30 a preening. You have to decide how much that peace of mind is worth. Prevention is common sense in eliminating contact from head to head or sharing clothing, combs, etc. No monumental efforts are needed. Really. Treatments can be over the counter or at your smiling dermatologist’s office. Some concoctions treat only live lice, and some treat both lice and nits. Resistance to certain chemicals has built up in a few louse populations as well.

That’s the nitty gritty of lice detection. Some very phobic folks indulge almost obsessively in nit-picking, or picking the eggs off, one by one. The businesses created over this kind of activity are incredible and bordering on predatory.

I hope this gives you a head’s-up to find head lice if you think they’re there. When I was derm resident in the 1970s, one of our sons had scalp itching. His mother asked me if he had lice. I looked and said nope. Our son then saw the young, new staff dermatologist there, who did find them. I learned a lot.

Back to School: A guide for Head Lice

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:

• School

• Playgrounds

• Your home

• Birthday parties (especially sleepovers)

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.

Parents warned over new breed of ‘super head lice’ resistant to over-the-counter treatments

Experts say people are wasting their cash forking out on products designed to kill the so-called "super lice" that no longer work.

The pesky bugs are a common problem, particularly preying on the scalps of school kids, aged four to 11.

But they have managed to evolve to become resistant to some of the treatments sold at chemists, scientists say.

Ian Burgess, of Insect Research & Development Limited, said when Lyclear Creme Rinse hit the market it "swept the board".

But, he warned, it leaves insecticide in a sufferer's hair.

While that may sound an appealing prevention measure, he said the bugs have slowly learned biologically to cope with it.

Global problem

Mr Burgess said that bugs coming into contact with the insecticide and surviving the encounter is a "worldwide phenomenon".

Research by Journal of Medical Entomology (JME) revealed that 98 per cent of head lice are now resistant to common treatments.

The 2016 study of 48 US states found that head lice were able to grow gene mutations, which helped them resist insecticides, also known as pyrethrins, pyrethroids, and permathrins.

Professor Craig Williams, of the University of South Australia, has been researching ways to outwit nuts.

Speaking to 7NEWS, he said: "Super lice would be the name we would give to lice that have become resistant to some of the treatments to kill them."

He likened the spread of the super-strength lice to antibiotic resistance - the more we use insecticides, the bigger the problem becomes.

His solution? Stick to the old trusty method.

"Cheap hair conditioner and a nit comb, and manually comb them out," Prof Williams said.

HEAD LICE FACTS

• Head lice are tiny insects that live in hair.

• Typically, they grow up to 3mm long, making them are difficult to spot.

• They can cause an itchy scalp and general discomfort as the parasites live by feeding on human blood.

• Nits are particularly common in school children aged between 4-11.

But here's some facts you might not have heard about nits...

• They can’t fly, jump or swim

• They are very unlikely to be spread by items such as combs, hats or pillows

• They don’t have a preference for dirty or clean hair – nor short or long

• They are specific to people – you can’t catch them from animals

• Once they have been removed from hair, head lice will usually die within 12-24 hours

Superbugs

Dr Sarah Jarvis, GP and clinical director of Patient.info, told The Sun Online warned of problems in recent years with topical head lice treatments.

She said: “Head lice are tiny brown-grey insects, about the size of a sesame seed, which thrive on the scalp.

"Nits are the white eggs they hatch from. These stick to the hair – usually close to the scalp – and are often still seen after treatment has killed all the lice.

"There are two main treatments for head lice. The first is strictly physical – wet combing using conditioner and a specially designed ‘bug busting’ comb.

"It’s time consuming and needs to be repeated several times - repeated every few days until you’ve had three sessions in a row where you have not seen any live lice.

"However, it is very effective when done properly and can be used regularly to check for new infestations.

"The second is to use topical treatments - lotions etc - to kill the bugs. These are divided into two main types.

"The first are chemical insecticides, which poison the lice. There have been lots of problems in recent years with head lice becoming resistant to these chemical insecticides.

"The second type is the physical insecticide. These work by smothering the lice and we have seen far less resistance to these treatments.

"Your pharmacist can advise on the treatments recommended in your area.”

What are head lice, how do I get rid of them, what treatments are available and what do the eggs look like?

Head lice can be a major frustration, especially when it comes to our kids - but what is the best course of treatment?

MANY of us will remember being searched with a ‘nit’ comb in our younger years  - but even adults can become infested with the contagious critters.

Here's everything you need to know about head lice, including the best treatment options to get rid of them.

What are head lice?

Head lice are tiny insects that live in hair.

Typically, they grow up to 3mm long, making them are difficult to spot.

They can cause an itchy scalp and general discomfort as the parasites live by feeding on human blood.

Nits are particularly common in school children aged between 4-11.

But it isn’t just kids that can suffer with the itchy critters as researchers recently revealed an explosion of head lice infestations in centrally-heated, draught-free homes across the UK and USA.

Even though head lice are largely harmless, they can live in the hair for a long time if not treated and can frustrating to deal with.

What do head lice look like?

The lice themselves tend to be very small and a whitish or grey-brown color

They can range in size and anywhere between the size of a pinhead to that of a sesame seed.

You may also be able to spot eggs in your hair.

These are white, brown or yellow circular shells that attach themselves to strands of the hair.

How do you treat head lice?

The lice can be frustratingly difficult to get rid of, but don’t despair, it can be done.

A variety of treatments to get rid of head lice are available to buy from pharmacies, supermarkets, as well as online and you don't usually need to visit your GP to tackle the problem.

The main treatments are:

• Lotions or sprays - While these can be very effective, certain varieties aren’t suitable for pregnant or breastfeeding women, or for kids under two

• Use a specially designed comb - This is can be done by everyone and is relatively inexpensive. However, several repetitions will be needed to do a thorough job.

If you’re not sure which method is for you, it is well worth chatting to a pharmacist who will be able to advise your best options.

How are head lice spread?

You catch head lice via direct head to head contact, where they climb from one person's hair to another's (they cannot jump, swim or fly). They are very unlikely to be spread by items such as combs, hats or pillows and are specific to people - you can't catch them from animals.

Contrary to old wive's tales, head lice have no preference for dirty or clean hair – nor short or long.
Once they have been removed from hair, head lice will usually die within 12-24 hours.

Are head lice and nits the same thing?

No. While many kids in the playground may refer to suffering with head lice as ‘having nits’, the nits are not the lice themselves.

Nits are the eggs, or more specifically egg cases, of the lice.

How can I prevent myself from catching head lice?

It is very difficult to stop the bothersome bugs from spreading.

A study found that 98% of head lice are now resistant to common treatments.

Regular combing may catch the problem early – but lotions and sprays for removing the bugs should only be used if you currently have the lice.
Avoiding head-to-head contact is your best bet.

Head Lice: What Parents Need to Know

Head lice are a common problem that usually affects school-aged children and their families. They can attach to the hair of anyone's head. It doesn't matter if the hair is clean or dirty. Head lice are also found worldwide in all different places, such as in homes or schools or the country or city. And it doesn't matter how clean, dirty, rich, or poor the place or person is. 

Though head lice may be a nuisance, they don't cause serious illness or carry any diseases. Head lice can be treated at home, but it's important to check with the doctor first. 

Here is information from the American Academy of Pediatrics to help parents and caregivers check for, treat, and prevent the spread of head lice.  

What are head lice?

Head lice are tiny bugs about the size of a sesame seed (2–3 mm long [mm stands for millimeter]). Their bodies are usually pale and gray, but their color may vary. One of these tiny bugs is called a louse.  

Head lice feed on small amounts of blood from the scalp. They can usually live 1 to 2 days without blood meal.

Lice lay and attach their eggs to hair close to the scalp. The eggs and their shell casings are called nits. They are oval and about the size of a knot in thread (0.8 mm long and 0.3 mm wide) and usually yellow to white. Some nits may blend in with some people's hair color, making them hard to see, and are often confused for dandruff or hair spray droplets. Nits attach to the hair with a sticky substance that holds them firmly in place. After the eggs hatch, the empty nits stay on the hair shaft.  

What is the life cycle of head lice?

Head lice live about 28 days. They develop in 3 phases: egg (also called a nit), nymph, and adult louse.  

• Egg or nit. Eggs or nits hatch in 6 to 9 days. Eggs are usually found within 4 to 6 mm of the scalp and do not survive if they are farther away.

• Nymph. The nymph looks like an adult head louse but is much smaller (about the size of a pinhead [1.5 mm]). Nymphs become adults about 7 days after hatching.

• Adult louse. An adult louse can multiply fast and lay up to 10 eggs a day. It takes only about 12 to 14 days for newly hatched eggs to reach adulthood.

This cycle can repeat itself every 3 weeks if head lice are left untreated. 

How common are head lice?

Head lice are most common in preschool- and elementary school–aged children. Each year millions of school-aged children in the United States get head lice. However, anyone can get head lice. Head lice are found worldwide.  

How do head lice spread?

Head lice are crawling insects. They cannot jump, hop, or fly. The main way head lice spread is from close, prolonged head-to-head contact. There is a very small chance that head lice will spread by sharing items such as combs, brushes, and hats.  

What are symptoms of head lice?

Itching on the areas where head lice are present is the most common symptom. However, it may take up to 4 to 6 weeks after lice get on the scalp before the scalp becomes sensitive to the lice saliva and begins to itch. Most of the itching happens behind the ears or at the back of the neck. Also, itching caused by head lice can last for weeks, even after the lice are gone.  

How do you check for head lice?

Regular checks for head lice are a good way to spot head lice before they have time to multiply and infest (are present in large numbers) your child's head.  

• Seat your child in a brightly lit room.

• Part the hair.

• Look for crawling lice and for nits on your child's scalp a section at a time.

• Live lice are hard to find. They avoid light and move quickly.

• Nits will look like small white or yellow-brown specks and be firmly attached to the hair near the scalp. The easiest place to find them is at the hairline at the back of the neck or behind the ears. Nits can be confused with many other things such as dandruff, dirt particles, or hair spray droplets. The way to tell the difference is that nits are firmly attached to hair, while dandruff, dirt, or other particles are not.

• Use a fine-tooth comb to help you search the scalp section by section.

What is the comb-out method?

The comb-out method can be used to help check for nits and head lice or to help remove nits and head lice after head lice treatment. However, the comb-out method usually doesn't work on its own to get rid of head lice.  

Here is how you use the comb-out method: 

• Step 1: Wet your child's hair.  

• Step 2: Use a fine-tooth comb and comb through your child's hair in small sections. 

• Step 3: After each comb-through, wipe the comb on a wet paper towel. Examine the scalp, comb, and paper towel carefully.  

• Step 4: Repeat steps 2 and 3 until you've combed through all of your child's hair. 

What else do I need to know about treating head lice?

• You may want to wash your child's clothes, towels, hats, and bed linens in hot water and dry on high heat if they were used within 2 days before head lice were found and treated. You do not need to throw these items away. Items that cannot be washed may be dry-cleaned or sealed in a plastic bag for 2 weeks.

• Do not spray pesticides in your home. They can expose your family to dangerous chemicals and are not needed when you treat your child's scalp and hair properly.

• All household members and close contacts should also be checked and treated if necessary.

About "no-nit" policies

Some schools h​ave "no-nit" policies stating that students who still have nits in their hair ​​​cannot return to school. The American Academy of Pediatrics and National Association of School Nurses discourage such policies and believe a child should not miss or be excluded from school because of head lice.

Remember

Head lice don't put your child at risk for any serious health problems. Products should be used only if those products are safe. If your child has head lice, work quickly but safely to treat your child to prevent the head lice from spreading.

Separating facts from fiction as kids get ready to head back to school

It's almost time for books, backpacks, homework – and head lice?

As younger students in pre-K, kindergarten and elementary school return to tight quarters with increased head-to-head contact, experts are warning parents and teachers that head lice cases are likely to spread.

“When the kids have close physical contact in school, the incidents do clearly go up,” said Bernard Cohen, a Johns Hopkins pediatrician and head lice expert. 

Here's how head lice experts separate fact from the fiction on the pesky bugs. 

Lice are flying health risks: Fiction

There's no evidence that head lice carry disease of any kind, said Laurie Combe, the president of the National Association of School Nurses.  

“It is a nuisance and certainly causes anxiety, but it is not a known health problem,” Combe said.

Getting head lice is not an indication of poor hygiene, she said. Lice also can't propel themselves from head to head without close physical contact, or if people share a brush, hat or other item that touches the hair.

"People believe that head lice jump and they don't – they crawl," Combe said. 

What to do: The truth about lice and how to protect your kids

No-nit policies work: Fiction

No-nit policies, where students are banned from school if they have nits – baby shells of lice – in their hair, are an issue at the heart of prevention efforts. But experts say they are ineffective.

“No-nit policies have never been demonstrated in the evidence to reduce the incidence of head lice,” Combe said. “They result in unnecessary school absences and we know that seat time is critical for children’s learning.”

Half of lice cases are over-identified and children could be exposed to unnecessary treatment, Combe said. For low-income parents, she said missing a day of work to care for a child could result in a loss of wages or even firing.

And the kids themselves could be subject to stigma and shaming, Combe said.

Cohen said the real concerns are the live crawlers, not the nits. As long as students can show they have been treated and are rid of live crawlers, Cohen said there's no reason for schools to restrict kids from attending.

Lice have a hard time attaching to the hair shafts of African American children, Cohen said, possibly because of their cork-screwed shape.

Sharing clothes, hair items risky: Fact

The best way to avoid lice is to instruct kids to avoid head-to-head contact with peers and to never share personal care items such as combs, brushes and hats, according to Combe and Cohen.

“Don't share jackets and hats and hoods, use your own stuff, and let everybody else use their stuff,” Cohen said.

“Parents can proactively, periodically check their children's scalp or hair, and if they think their child has a problem, they can ask their school nurse to take a look," Combe said.

You need to disinfect your house: Fiction

Cohen said lice thrive on close, physical, head-to-head contact and need blood meals to survive. But lice spreading through inanimate objects is not usually a major cause for concern.

“The adult organisms may survive for a little while off the scalp, but the new ones that have just hatched need to have a meal pretty quickly, and if they're not on your head or a place where they can get a meal, they're not going to be viable for very long,” Cohen said. “You don't need to tear up the house, for sure.”

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.