How to know if your child has lice

How to tell if your child has head lice

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Photo credit: iStock.com / KevinDyer

When you became a parent, you probably never imagined yourself hunting for lice in your child's hair. But that's just what you (or someone) will have to do if you suspect that your child is infested.

When the bad news comes from a school

Many schools do regular lice checks during the school year, examining every child's head. If they find lice, they'll let you know. Be sure to do your own checking, though, to confirm their finding.

You may instead get a note warning that someone in your child's class or school has lice. That's your signal to check your own child's head. It's best to do this as soon as possible, because the sooner you find the lice, the easier they are to handle. And if you do find lice, you'll need to check (and possibly treat) the whole family.

How to inspect your child's head

The sesame-seed-size creatures and their teeny-tiny eggs are quite hard to spot. To find out whether you need to take action, try the following two- to three-step process.

Lice survival guide for parents

If you can't spot them via a visual inspection (step 2), try wet combing (step 3). A 2009 study in the Archives of Dermatology found that "wet-combing" accurately identified active head lice infestations in 90 percent of cases. In contrast, visual inspections accurately identified 29 percent.

You'll need really good light and a pair of strong drugstore reading glasses or a magnifying glass (unless you have the eyes of an eagle). If you move on to step three, you'll also need a metal lice comb and some hair conditioner.

Step 1: Look for the signs and symptoms of head lice

Your child may have one or more of these symptoms:

• A tickling feeling on the scalp
• A sensation that something is moving in the hair
• Itching caused by an allergic reaction to lice bites (kids may scratch or rub their scalp, especially around the back of the head or ears)
• Sores on the head caused by scratching
• Irritability
• Trouble sleeping (lice are more active in the dark)

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How to treat your child for lice

Watch pediatrician Lisa Dana show how to do a lice shampoo and comb-out on your child.

Step 2: How to search for lice, stage one (dry hair)

1. Check your child's scalp.
   Part the hair in various places and check the scalp behind the ears and at the nape of the neck. You may notice sores or a rash where your child has been scratching.

2. Look for movement in the hair.
   You're not likely to see the lice themselves. They're very small, move quickly, and avoid light, so they're difficult to spot.

3. Look for lice eggs, known as nits.
   These tiny white or yellowish tear drop-shaped sacs are attached to the hair near the scalp (within a quarter inch if they haven't yet hatched). Nits may be easier to feel than to see: They'll feel like grains of sand.
    
4. Make sure the "nits" you see are really nits.
   Nits are often hard to distinguish from dandruff or flakes of hair products. The difference is that nits stick to the hair like glue while dandruff and other flakes are easily removed from the hair shaft.

5. Make sure the nits you find are still alive.
   If the only nits you find are more than a quarter inch from the scalp, they may have already hatched and your child may no longer be infested. (Nits can only hatch in the warmth right next to the scalp. After they hatch, the empty egg remains attached to the hair and grows farther and farther from the scalp. ) Only viable nits – those very close to the scalp – or live lice are proof of a current infestation.

How to get rid of lice in your home

Watch pediatrician Lisa Dana show how to get rid of lice in the house.

Step 3: How to search for lice, stage two (wet hair)

You'll need to go on to this step if you can't tell whether there's an infestation by looking at your child's hair and feeling it, the way you did in step 2. Studies have found that a lice comb is the best tool for finding live lice. (A flea comb may also work.) The teeth on a regular comb are too far apart to nab the tiny lice.

1. Wet your child's hair.
2. Pour on lots of conditioner.
3. Comb the hair out in sections, from the roots to the ends, with a lice comb.
4. If there are lice in your child's hair, you should see them on the comb.
   (Shaking the comb out into a plastic bowl after every swipe can help you see them better.)

If you determine that your child does have lice, check the other kids and adults in your house. You'll need to treat everyone to effectively rid your family of lice. If you follow these steps and you're still not sure, have your child checked by a doctor or at a lice salon.

Reviewed by pediatric dermatologist Anthony J. Mancini, M.D., head of the division of dermatology at Children's Memorial Hospital in Chicago.

Next: How to get rid of lice in your child's hair

Go back to the Head Lice Survival Guide for Parents

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Kate Marple

Kate Marple is a writer and editor who specializes in health, pregnancy, and parenting content. She's passionate about translating complicated medical information into helpful pregnancy and parenting advice that's easy to understand. She lives in San Francisco with her family.

Head Lice: What Parents Need to Know

​By: Dawn Nolt, MD, MPH, FAAP

Head lice are a common problem, especially among school-aged children and their families. The lice 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. 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. (See "Head Lice Medicines," below).

Read on for information to help you 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't survive more than 1 day without a blood meal.

What are nits?

Lice lay and attach their eggs to hair close to the scalp. The eggs and their shell casings are called nits. Lice eggs 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 7 to 12 days, depending on the surrounding temperature. 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 9-12 days after hatching.

• Adult louse. An adult female louse can 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 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 that 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, hats and sports helmets.

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 their 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 (such as a louse or nit comb) to help you search the scalp section by section.

What is the comb-out method for lice?

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 (louse or nit 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.

How do you treat head lice?

Check with your child's doctor before beginning any head lice treatment. The most effective way to treat head lice is with head lice medicine. After each treatment, using the comb-out method every 2 to 3 days for 2 to 3 weeks may help remove the nits and eggs.

Head lice medicine should be used only when it is certain that your child has living head lice. Remember, check with your child's doctor before starting any head lice medicine. Also, when head lice medicines are used, it is important to use them safely as directed.

Here are some safety guidelines for lice treatments:

• Follow the directions on the package exactly as written.

• Never let children apply the medicine. Medicine should be applied by an adult.

• Always rinse the medicine off over a sink and not during a shower or bath, so the medicine doesn't run off the head onto other areas of skin. Place your child's head over a sink and rinse the medicine off with warm water (not hot water).

• Never place a plastic bag on a child's head.

• Do not leave a child alone with medicine in his or her hair.

• Store medicine in a locked cabinet, out of sight and reach of children.
  

• Check with your child's doctor before beginning a second or third medicine. Your child may just need to repeat the same medication, or switch to a new one.
  

• Ask your child's doctor if you have any questions or if treatments you have tried have not gotten rid of lice.

Warning about dangerous home remedies for lice

Never use dangerous products like gasoline or kerosene or medicines made for use on animals! Also, do not use home remedies, such as petroleum jelly, mayonnaise, tub margarine, essential oils or olive oil, because no studies prove they work.

What head lice medicines are available?

Check with your child's doctor before beginning any treatment. See chart, below, for a list of head lice medicines approved by the U.S. Food and Drug Administration.

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 sealed in a plastic bag for 2 weeks or dry-cleaned..

• 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 be checked and treated for head lice if necessary.

About school "no-nit" policies

Some schools have "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.

More information

• Head Lice Treatment Myths & Realities
  
• Controlling Head Lice & Reducing Stigma
  
• Lice-Head (KidsDoc Symptom Checker)
  
• Head Lice (AAP Clinical Report)
  
• Head Lice Prevention & Control (CDC)
  
• Head Lice Management in Schools (National Association of School Nurses)
  

About Dr.

Dawn Nolt, MD, MPH, FAAP is a Professor of Pediatric Infectious Diseases at Oregon Health & Science University Doernbecher Children's Hospital in Portland. Dr. Nolt currently serves as medical director of the antimicrobial stewardship program and the department of infection prevention and control at the hospital. She is a member of the American Academy of Pediatrics, and previously served on its Committee on Infectious Diseases. Outside of the hospital, Dr. Nolt enjoys spending time with her husband and daughter, discussing the positive impact of superheroes, both in comic books and real life.

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

How to understand that you have lice?

Recommendations

Pediculosis is a very unpleasant disease. People shudder at the mere thought that they can pick up lice somewhere. It is even more unpleasant to imagine that someone will notice insects on you before you yourself know about your illness. We tell you how to understand that lice are wound up and get rid of them very quickly. We will also tell you how to prevent pediculosis, because this is the best scenario.

How to tell if you have lice - symptoms

There are people who only imagine something white in their hair, already begin to scratch furiously and imagine that they have lice. This phenomenon even came up with a name: phthiriophobia, or pediculophobia.

Of course, it is not necessary to lead to phobias. But a certain amount of vigilance won't hurt either. After all, becoming a victim of parasites is not so difficult. You can catch them:

• on a bus or subway during rush hour;
• at a concert or other public event;
• in a hotel, hostel, sanatorium, sleeping car - from insufficiently well processed bed linen;
• in the hospital - from roommates;
• from upholstered furniture where the infected person was sitting;
• in the pool - right on the water;
• in the open wardrobe of any institution or institution - from one coat to another.

Phthiriasis (pediculosis pubis) can be contracted through sexual contact.

But most often adults are infected with head lice by children. They themselves easily find "passengers" in pre-school and school educational institutions, children's health camps, just in close contact with each other during games and head-to-head activities.

Therefore, it is impossible to completely exclude the possibility of contracting head lice, and it is better to listen to your feelings, regularly examine yourself in the mirror.

Here's how to tell if a person has lice:

1. Itching. Of course, if the head itches, it is not always associated with lice. But if the itching does not go away, but only intensifies, leads to scratching (wounds) - it definitely makes sense to ask someone to carefully examine your hair. If the fears are confirmed, lice, nits, bite marks will be found on the head.
2. Lice. It is impossible to detect them on yourself - they are so small that you can hardly see them in the mirror. But with a careful examination of the head of another person, for example, a child, they can be seen. You need to look behind the ears, on the back of the head along the hairline. Parasites love these places where the skin is the most delicate and thin, it is easier to bite through. When there are still few insects, they are localized here.
3. Nits. These are lice eggs. It is thanks to them that pediculosis is most often detected. The eggs are whitish and teardrop shaped. The female attaches them to the base of the hair with a reliable adhesive substance. If you notice white particles on your hair in the mirror, but doubt whether it is dandruff or nits, it is easy to dispel doubts. It is enough to run your hand over the hair: dandruff will fall off, nits will not.
4. Bites. Traces of lice bites are hardly noticeable at first. Small reddish spots are difficult to see on the scalp. But they itch unbearably, so patients (especially children) comb them to an impressive wound size.
5. Confusion, dryness, brittleness of hair. Parasites have a bad effect on the health of the hair, taking away their vitality. Does not improve the situation and the fact that the patient is constantly scratching his head. Sometimes it comes to signs of folliculitis: the hair begins to fall out, the bites darken and become like age spots, the skin becomes rough, becomes bumpy.
6. Sleep disturbances, mood swings - this is another way to understand that a child has lice. Constant itching prevents you from sleeping properly. The patient becomes irritable, uncollected. Schoolchildren have impaired concentration, nervousness appears.
7. Lice can also cause an allergic reaction. In this case, a rash, swelling and other allergic symptoms join the bite marks.
8. With advanced pediculosis, patients sometimes comb their heads to purulent wounds, as a result of which the hair gets tangled into tangles that cannot be untangled - you can only cut it off.

Several of the last signs are characteristic of extremely advanced forms of pediculosis.

What to do if pediculosis is confirmed

If the fears about parasites are confirmed, the patient must be isolated from the team. You need to be treated at home: children do not attend school or kindergarten during this period, adults do not go to work. It is also better to minimize contacts with family members, since pediculosis is very contagious.

Of course, contrary to stereotypes, insects do not jump from head to head, but run fast. For some time they can be on bed linen, bedspreads, upholstered furniture, and from these items get into the hair of healthy people.

The class teacher at the school, the kindergarten teacher should be warned about the nature of the child's illness. There is nothing to be ashamed of: anyone can get infected. And employees of educational institutions need to strengthen preventive measures, carefully examine the heads of all children in a group, class. This will help prevent further spread of the disease.

The patient's bed linen and underwear, hats should be boiled, outer clothing should be carefully examined and cleaned. Process combs, hairpins, soft toys. Things that cannot be boiled are sent to the freezer or hung outside in the winter in frosty weather.

And of course, you should immediately start treating pediculosis as soon as you have identified it in yourself or your child. Pediculicidal drugs are sold in pharmacies without a prescription. Some of them allow you to get rid of parasites in one application.

Effective remedy - Parasept

Parasept is a convenient and effective remedy for head lice, available as a spray or aerosol. The main active ingredient is dimethicone, a synthetic polymer that physically destroys parasites by blocking their spiracles. The composition does not contain toxins, therefore it is absolutely safe and recommended for use in children from 1 year old.

There is another group of drugs based on toxic effects - they affect the nervous system of lice. But over time, resistance develops to toxins, that is, the purchased drug may be ineffective. And insects cannot adapt to clogging of the respiratory organs. Therefore, Parasept is effective, regardless of the place and time of its acquisition and use.

The product box contains everything you need to treat your hair: fine comb, hair band, gloves. The product must be applied to dry combed hair, without missing a single strand. And after half an hour it is already possible to comb out dead lice, larvae and nits with a comb.

Dimethicone is the same shampoo product that makes hair “smooth and silky”. So combing will be easy and painless. After the procedure, it is enough to wash your hair with regular shampoo.

In addition to dimethicone, the composition includes oils and plant extracts, which are natural antiseptics. They disinfect bite sites, relieve inflammation, and promote speedy healing. The composition smells good, does not flow.

Prevention

It is better not to get infected with parasites at all than to look for ways to get rid of them later. For this we recommend:

• avoid crowds, crowded places;
• when staying overnight in unfamiliar places (hotels, hostels, sleeping cars of trains, etc.), carefully inspect bed linen;
• in the pool carefully remove hair under a bathing cap;
• do not use other people's combs, hairpins, towels;
• to explain to children that you should not try on other people's hats or give them your own to try on;
• donate clothes to the cloakroom in plastic bags;
• take a shower regularly, change underwear and bed linen, teach children to observe hygiene standards;
• brush hair thoroughly every morning and evening, braid tight braids for girls to school or preschool;
• carry out "preventive examinations" of the head of children and other family members.

Now you know how to find out if you have lice and not miss the obvious or indirect signs of the disease. If you find pediculosis in a child, do not panic or figure out who is to blame.

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