The Familiy's Role and Resources for the Management of Head Lice
The below information is intended to educate our school community on head lice and is not to be used for self-diagnosis or as a substitute for consultation with a health care provider. If you have any questions about lice or are concerned that you may have an infestation, consult with your healthcare provider.
Quick Facts about Head Lice
- Incidence – Head Lice are a common occurrence in children. An estimated 6 to 12 million infestations occur each year among U.S. children 3 to 11 years of age. It is likely that at any given time at any given school in the US, there are students with head lice.
- Transmission – Head lice are almost always transmitted by direct head-to-head contact of humans. Such contact can be common among children during play at school, home and elsewhere (e.g., sports activities, playgrounds, camp, and slumber parties).
- Lice do not jump, fly or crawl very far from the scalp.
- The spread of lice by indirect contact through shared inanimate objects may occur but is very uncommon. Head lice feet are specially adapted for holding onto human hair, making it difficult to attach firmly to smooth or slippery surfaces like plastic, metal, polished synthetic leathers, and other similar materials. Inanimate objects pose a very low risk for indirect transmission however it is prudent to not immediately share fabric items or head hygiene items (i.e. brushes) that touch the head.
- Viable nits do not transmit lice. Eggs cannot be transmitted from one head to another, nor can they fall off the hair shaft. Even if hair with a viable nit falls off, it will not hatch at temperatures lower than the human head.
- Because there is little head-to-head contact at school, there is no greater risk of getting head lice at school versus anywhere else. An infestation is usually IDENTIFIED at school, not GOTTEN there.
- Health Risks - Lice are a nuisance bug but do not spread disease & are not considered a health risk.
- Symptoms - An itchy scalp is the most common symptom of having head lice and the itching may continue after treatment.
- Where they live - on human heads close to the scalp; they do not live in the environment such as a classroom or on animals.
- Head lice are dependent on a person’s body temperature, moisture and blood to live.
- They cannot survive off of the human body for very long.
- Lice do not burrow into the scalp.
- Head lice are not associated with hygiene; anyone with clean or dirty hair or house can get head lice.
- People of all races, hair types, colors and length can get head lice.
- Treatment - It can be hard work to get rid of head lice. A child with an active head lice infestation has likely had the infestation for a month or more. See below for more on treatment options.
- Head Lice- small parasitic insects that live on the scalp and neck of the human host
- Louse- singular of lice
- Nymph - young, recently hatched louse
- Active Infestation- finding a live louse or nymph on the scalp and/or a viable nit within 1/4 inch of the scalp
- Pediculosis- an active infestation of head lice
- Nit- an egg of a female louse, attached to the hair shaft
- Non-viable nit- An empty egg sac found on the hair shaft more than 1/4 inch from the scalp
- Viable nit- an egg found on the hair shaft closer than 1/4 inch from the scalp
- Ovacide- a chemical which kills lice eggs/nits
- Pediculicide- chemical which kills nymph stage and adult lice
Advice for Families on Preventing Head Lice
Teaching (and frequently reminding) children to not touch heads with others and not to share things that touch their head is the best defense against head lice. Hair that is bound close to the head can also be helpful. There are many retail items that suggest they prevent lice however none of these have been subjected to proper research for efficacy and are therefore not recommended.Preventing head lice may not be possible,but preventing an overwhelming infestation is!Your school nurse recommends thatALL families check their student's head regularly (monthly) for signs of head liceas treatment is easiest when found early.
Help for Families in Identifying Head Lice
Lice may be difficult to find because they are very small (2-4mm), move quickly, and avoid light. Use of a fine-toothed louse comb may facilitate identification of live lice. If crawling lice are not seen, finding nits within ¼ inch of the base of hair shafts suggests the person may be infested and is often the first visible sign. Nits are however often confused with other particles found in hair such as dandruff, hair spray droplets, and dirt particles. Unlike these particles, nits are a distinct oval/teardrop shape and are attached at an angle to the hair shaft (rub your fingers over it to check for this). Nits cannot be flicked off like other particles.Nits that are attached more than ¼ inch from the base of the hair shaft are older (they were laid within a ¼ inch and the hair has grown) and are almost always non-viable (hatched or dead). To find nits or lice, inspect all part of the head close to the scalp under bright light (natural light works the best). Head lice and nits are visible with the naked eye although use of a magnifying lens may be helpful.
Information for Families on Available Head Lice Treatment Options
It is important to understand that no one treatment method for head lice is 100% effective and therefore perseverance and diligence is needed to eliminate head lice. Frequent observation and manual removal are hallmark and should be part of most successful treatment regimens. This is especially important in the weeks following treatment. If viable lice/nits make it through treatment, it could take weeks before signs of a continued infestation are noticed. Once treated, parents should continue to check and remove nits daily. All household members and other close contacts should be checked, and those with evidence of an active infestation should also be treated at the same time. Parents should NOT preventatively treat those who do not show signs of infestation even if there was a concern for exposure.
Available treatment methods/options for the infested person
- Pediculicide/Ovicide - chemical preparations that are available over the counter and/or by prescription. Chemical treatment is the most widely recommended option by experts on head lice. Over the counter preparations are typically recommended to be used first followed by prescription preparations if the over the counter are not successful. There are several over-the-counter types and each has a slightly different efficacy on the live louse and nit (although none are 100%). These can be found at local drug or grocery stores. Resistance to some over-the-counter head lice treatments has been reported, but the prevalence of resistance is not known. It is important to follow the directions on the package and not to over treat. More is not better. The Centers for Disease Control and Prevention (CDC) website has detailed information on currently available pediculicides. Note that there are also age/condition restrictions on these medications.
- Naturopathic Methods - there are many naturopathic/home remedy methods available however it is important to understand that most have not had independent scientific research done and therefore cannot be recommended for efficacy. There are several local companies that employ naturopathic methods as part of a lice removal service. These are relatively expensive services but some parents with limited time to devote to head lice removal find them helpful. Strictly manual removal (which should be part of most treatment methods) would also be considered a naturopathic method and can be employed, but can be difficult due to the nature of head lice (small and elusive).
Think you are free from lice after treatment?Don’t be fooled by the louse!Families sometimes presume treatment will eliminate an infestationonly to find more evidence of lice a few months laterThe mistaken assumption is another exposure occurredwhen in reality, the lice were not completely eradicated the first time around.The life cycle of a louse is such that it can go undetected for a long period of time.Finding newly laid nits is the best indicator that there is still a problem.This is why your school nurse recommends thatALL families check their student's head regularly (monthly) for signs of head liceThis is especially true for those that have been dealing with head lice.
- Nit removal should be part of all regimens regardless of the treatment method used - There are many techniques and opinions on the best way to remove nits but elimination is imperative because most chemicals have a poor ovicidal efficacy. Here are some general guidelines:
- Lice combs (metal toothed ones work better than plastic) are useful for removing the bulk of the eggs but do not typically catch all of them (you will notice that the comb just goes right over some).
- Eggs can also be manually removed by pulling out or cutting the hair to which it is attached or by pulling the egg off the hair with the fingernails.
- The nit needs a human for warmth and food, so once pulled off it does not pose any risk.
- Hair can be wet or dry for nit removal. Wet hair can be easier to comb through but dry hair facilitates seeing the nit because of the shimmery casting.
- Nit removal should be done inspecting small amounts of hair at a time in a systematic way so that no area of the head is missed.
- Nit removal needs to be done frequently initially because even with very thorough inspections, nits will be missed and could hatch at any time.
- Nits further than ¼ from the scalp are likely not viable however removal is recommended as it can help reduce confusion during future inspections to determine if problems are continuing.
Available treatment methods/options for the environment
- Lice live on human heads close to the scalp; they do not live in the environment such as a house or on animals. Head lice do not survive long if they fall off a person and cannot feed. You don't need to spend a lot of time or money on housecleaning activities.
- Machine wash and dry clothing, bed linens, towels and other items that the infested person wore or used during the 2 days before treatment using the hot water (130°F) laundry cycle and the high heat drying cycle. Clothing and items that are not washable can be dry–cleaned or sealed in a plastic bag and stored for 2 weeks.
- Soak combs and brushes in hot water (at least 130°F) for 5–10 minutes.
- The risk of getting infested by a louse that has fallen onto a rug or carpet or furniture is very low however areas where the infested person sat or lay within 2 days before treatment can be vacuumed.
- Do not use fumigant sprays; they can be toxic if inhaled or absorbed through the skin.
Reliable Head Lice Resources for Families
- Head Lice 101 (for Parents): What Every Parent Should Know About Head Lice (National Association of School Nurses)
- Facing Head Lice: A Guide For Families (National Association of School Nurses)
- Head Lice Information for Parents (Centers for Disease Control)
- Head Lice: Every Parent’s Concern (American Academy of Pediatrics)
- Managing Presumed Head Louse Infestations at Home flowchart from Dr. Richard Pollack, from the Harvard School of Public Health.