Few things freak parents out more than head lice. Since head lice are very common in children, our offices get a lot of calls. About head lice. From freaking out parents.

Sure, lice do bite, and these bites can cause scalp itching and irritation in some kids and disturb sleep in others. But with parents it causes panic. Part of that is due to the commonly held (and totally false) belief that lice infestations occur in poor, dirty, or unhygienic populations. In fact, head lice like clean hair and don’t discriminate based on socioeconomic status. Another reason is just the thought of little bugs crawling in our hair. Another is the fear of being fingered as the source of another child’s infestation.

Head lice are tiny wingless parasites that live in our hair and feed on small amounts of blood from our scalp. They do not fly or hop, skip, or jump from one person to another.  Rather, they are contagious through very close person-to-person contact. (Pets do not transmit lice, so leave them out of it!) Lice will die after a day or two if they crawl away from a human scalp. Each louse lays 3-5 eggs (nits) per day, and these nits (tiny in size, ovoid in shape, whitish-grey in color) attach to the base of hair shafts, very close to the scalp. Nits found away from the scalp are either non-viable or old, already-hatched nits. Nits hatch within 1-2 weeks of being laid, and adults live on the scalp for about a month before dying. Understanding the life-cycle of lice, the rationale of treatment becomes clear: Kill the adult lice that are laying eggs on the first day of treatment, and then kill any hatching lice over the next two weeks.

The first step in treatment is to make sure your child really has lice. Just because a child in the classroom has lice doesn’t mean your child has it. Adult, egg-laying lice are very small but can be seen if you take the time to  wet your child’s hair and carefully look, with good lighting and a magnifying glass (or strong reading glasses), deep to the scalp. Use a fine-tooth comb and patiently look at each area of the scalp, especially the back of the head and behind the ears. Removing adult lice (as well as any visible nits) from a wet scalp with the comb, is really the only way to ensure treatment success. Using an approved over-the-counter or prescription lotion or shampoo can help cure an infestation but it’s not a replacement for physically evicting the adult lice and combing out nits. (By definition, nit-picking is tedious!) Surveillance of the scalp with the fine-tooth comb in wet hair (using conditioner to help the comb slide through easier) every 2-3 days for the next two weeks should ensure resolution. Most lice products recommend a second application one week after the first to kill any young lice that may have hatched after the first treatment.

Diagnosis and treatment of head lice in children takes careful observation, a systematic plan of treatment, and patience in executing that plan. Like anything else, call the office if you have any concerns. Just don’t panic!

More from the CDC regarding the treatment of lice here.


(Image: CDC)