Willows Pediatrics Blog - We Know Kids
We Know Kids
The Willows Pediatrics Blog

Lice – What Every Parent Should Know: A Primer on Diagnosis, Treatment, and Prevention

Please Note: Even though head lice may be a nuisance, before checking or treating your child it is helpful to remember they don’t cause serious illness or carry any diseases.

What are head lice?

Head lice are tiny insects. They are about 2 mm to 3 mm long. Their bodies are rectangular shaped and usually pale gray in color.  Head lice feed on tiny amounts of blood from the scalp.  Lice typically survive less than a day if not on a person’s scalp.

When a child has lice, the first thing you may notice is itching, especially in the nape of the neck or behind the ears.  If you look, you will probably see nits – these are tiny white eggs and shell casings that are attached to the hair.  Nits are oval or teardrop shaped and attach to the hair via a sticky substance that holds them firmly in place. After the eggs hatch, the empty nits remain attached to the hair shaft until they are physically removed.  It is also possible to see lice moving on the scalp, but more commonly parents see the nits first.

What is the life cycle of head lice?

Head lice live about 28 days. They can multiply quickly, laying up to 10 eggs a day. It only takes about 12 days for newly hatched eggs to reach adulthood.  This cycle can repeat itself every 3 weeks if head lice are left untreated.

How are head lice spread?

Lice cannot jump, hop, or fly – they are crawling insects. The main way head lice spread is from close, head-to-head contact. There is a very small chance that head lice will spread because of sharing items such as combs, brushes, and hats.  The main way to prevent spread of lice is to prevent head-to-head contact.

What are symptoms of head lice?

The most common symptom of head lice is itching. It may take up to 4 weeks after lice get on the scalp for the itching to begin. 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?

  • Seat your child in a brightly lit room.
  • Part the hair and look at your child’s scalp.
  • Look for crawling lice and for nits.
  • Live lice are difficult to find. They avoid light and move quickly.
  • Nits look like small white tear drop shaped specks, and are firmly attached to the hair near the scalp. The easiest place to find them is often around the hairline at the back of the neck, or behind the ears.
  • Nits can be confused with many other things, such as dandruff or hair spray droplets. Dandruff will blow off, but a nit stays attached to the hair shaft until it is physically removed.
  • Anything seen far from the scalp in individuals with long hair is not a sign of active lice; what you are noting is most like the old, inactive nit shell that has moved down.

How do you treat head lice?

  • There are a variety of over the counter head lice treatments, including shampoos and cream rinses. Most of these products (such as RID shampoo and Nix crème rinse) contain 1% permethrin that is safe and effective against most head lice.
  • When using these products, please read and follow the directions on the label.
  • Since head lice treatments may not kill all of the nits, a second treatment is recommended 7 to 10 days after the first treatment. Please contact us if your child still has head lice after 2 treatments.
  • Prescription treatments such as Ovide are also available, but they are not usually the first choice for treating head lice. If you have any questions, talk with your nurse, PA, or doctor.
  • You should comb out the nits, or physically remove them by hand, after your child’s hair has been treated. This will help ensure that any eggs not killed from the first application of lice treatment are removed and cannot restart another cycle of infestation.
  • Natural products such as olive oil have also been used, but have not been scientifically proven to work on both lice AND nits.  You can soak your child’s hair in olive oil and cover with a shower cap while he or she sleeps overnight. The next morning wash out the oil and lice.  Olive oil can asphyxiate moving lice by preventing them from getting oxygen, but it does not kill nits. (Permethrin products like RID shampoo and Nix crème rinse do kill most of the nits).  So, if you use olive oil, you must be very certain to remove all nits by hand.  Also, never coat your child’s hair with dangerous products like gasoline or kerosene, or use products that are made for use on animals.
  • The use of essential oil products, like lavender oil, is not necessary to treat or prevent head lice. The best treatments are outlined above, and the best prevention is diligently checking and treating all children who are suspected of having head lice to prevent spread.

Household Care

  • You do not need to throw away any items belonging to your child, but it is recommended that after you treat your child, you wash his or her clothes, towels, hats, and bed sheets in hot water and dry on high heat. This is to ensure that if any lice or nits are present on your child’s bedding, your child will not be re-exposed to lice when they sleep.  If your child has stuffed animals or plush toys in their bed, they can be washed too.  If stuffed animals cannot be washed, put them in airtight plastic bags (away from your child, of course!) for two weeks so that any nits that present will not be viable when you remove the stuffed animals from the bags.
  • Do not spray pesticides in your home because they can expose your family to dangerous chemicals.
  • If your child has head lice, all household members and close contacts should also be checked and treated if necessary.

What about school?

While some school nurses check for lice during an outbreak, the Academy of Pediatrics does not recommend a “no nit” policy, and believes a child should not miss school because of head lice.

Should I come into the office?

Children with lice do not always need to be seen.  If you are not sure what you are seeing on your child’s head, please make an appointment to be seen.  Also, do not hesitate to call us if you have any questions.