What do head lice look like?

It is usually easiest to find head lice on the scalp behind the ears, and near the neckline at the back of the neck. Occasionally, lice fall onto a person's eyebrows and eyelashes.

There are three stages in the lifecycle of head lice, and each stage looks different.

• Nits - Each day, a female louse lays three to six eggs, called nits. Nits are oval-shaped and very small - about the size of a knot in thread. Firmly attached to the hair shaft, nits often appear yellow or white, although they can sometime appear to be the same color as a person's hair. Nits are hard to see, and people sometimes mistake dandruff, scabs, and hair spray droplets for nits. Nits are also hard to remove.
• Nymph - Within seven to 10 days, a nit hatches into a baby louse called a nymph. A nymph has six legs and is tan to grayish-white in color. Nymphs feed on blood and mature into adults in about nine to 12 days.
• Adult - The adult louse is about the size of a sesame seed, has six legs, and is tan to grayish-white in color. It may look darker in people with dark hair. Adult lice feed on blood from the scalp, and each adult can live about 30 days on a person's head. An adult louse will die within one or two days if it falls off the person.

Adult lice avoid light and can move quickly. They may be hard to see on the scalp. Parents may use a louse or nit comb to find eggs/nits.

What should I do if I think my child has head lice?

Please contact your health care provider to discuss the need for evaluation and possible treatment.

How do you treat (get rid of) head lice?

Many head lice medications are available over-the-counter. Your health care provider may prescribe others.

Are there any side effects from using chemical treatments for head lice?

According to the U.S. Centers for Disease Control and Prevention (CDC), chemical treatments for head lice are generally safe and effective when used correctly. Some treatments may cause an itching or a mild burning sensation caused by inflammation of the skin on the scalp. Most products used to treat head lice are pesticides that can be absorbed through the skin. Use any lice-killing medicine only as directed.

Check with your health care provider if you have used a lice-killing product two to three times, following label directions, and there are still live crawling lice visible. Your health care provider may recommend a different treatment.

Treatment Information

Shampoos, Crème Rinses, or Lice-killing Lotions:

To treat for head lice using a shampoo, conditioner, or lice-killing hair lotion, follow these steps:

• Before applying treatment, remove clothing that can become wet or stained during treatment.
• Do not use hair conditioner or combination shampoo/conditioner before using lice medicine.
• Apply lice medicine according to the label instructions. Pay close attention to how long the product should be on the scalp.
• Put on clean clothing after treatment.
• Do not re-wash hair for one to two days after treatment.
• You may wish to comb dead lice and any remaining live lice out of the hair using a nit comb, which you can buy at your local drugstore. (A flea comb made for cats and dogs may work.)
• After treatment, check the hair every two to three days and continue to use a nit comb to remove any nits or lice you see.
• Use the lice medicine again in seven to 10 days according to product instructions. Do not use sooner than seven days after the first use, as this may cause scalp irritation or other harmful side effects.
• Check the hair once or twice a week for two to three weeks after you think all lice and nits are gone. This can help prevent being re-infested with lice.
• Ask your heathcare provider about the need to treat anyone who has shared a bed with the person who has head lice.

Lice combs:

Follow the instructions from the manufacturer for all combs if provided. Metal combs are often better at removing lice than plastic combs. The scalp of the person with lice may need daily 30 minute to 1 hour combing sessions for several days in order to remove all crawling lice and any nits/eggs that are ¼ inch or closer to the scalp.

Other treatments:

S.C. DHEC does not recommend for or against use of herbal or botanical treatments for head lice. School districts may opt to allow these treatments, and may opt to identify which products are acceptable for treatment in order for a child to return to school.

Home remedies, such as oils, shortening, vinegar, etc., do not consistently clear head lice infestations. These are not recommended.

Kerosene, gasoline and industrial pesticides should NEVER be used to treat head lice.

Are there any side effects from using chemical treatments for head lice?

According to the U.S. Centers for Disease Control and Prevention (CDC), chemical treatments for head lice are generally safe and effective when used correctly. Some treatments may cause an itching or a mild burning sensation caused by inflammation of the skin on the scalp. Most products used to treat head lice are pesticides that can be absorbed through the skin. Use any lice-killing medicine only as directed.

Check with your health care provider if you have used a lice-killing product 2-3 times, following label directions, and there are still live crawling lice visible. Your health care provider may recommend a different treatment.

Should children be screened for head lice at home?

Home screening for lice can be effective in controlling ongoing infestation and transmission. To check for lice, look through your child’s hair with a fine comb, looking particularly behind ears and the base of the neck. Look for live lice and nits (egg casings). Be aware that many people often confuse nits with dandruff, hair gel, shampoo residue, or dust. Most nits are within a few centimeters of the scalp.

If you think your child may have lice, you may wish to contact your school nurse or health care provider regarding possible evaluation and treatment options.

What can parents do to stop the spread of head lice?

AAP encourages parents to be proactive by regularly checking their children’s head for lice. Children should also be checked if they show symptoms of head lice, such as itching or tickling in the scalp or hair.

The steps listed below can help prevent the spread of head lice:

• Avoid head-to-head (hair-to-hair) contact during play and other activities at home, school, and elsewhere (sports activities, playground, slumber parties, and camp).
• Do not share clothing such as hats, scarves, coats, sports uniforms, hair ribbons, or barrettes.
• Do not share combs, brushes, or towels. Disinfect combs and brushes used by an infested person by soaking them in hot water (at least 130° F) for 5-10 minutes.
• Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with an infested person.

If someone in your home has head lice, the steps listed below can help prevent the spread to other members of your household:

• Machine-wash all washable clothing and bed linens touched by the person with head lice in the two days before treatment. Use the hot water cycle for washing and the high-heat dryer setting. Dry the laundry using the hot cycle for at least 20 minutes.
• Dry clean clothing that is not washable (coats, hats, scarves, etc.)
• Place clothing, stuffed animals, comforters, or other items that cannot be dry cleaned or washed into plastic bags. Seal the bags for two weeks.
• Check the scalps of all household members of the person with lice. Treat anyone with live lice or eggs that appear to be ¼ inch or closer the scalp.