Don’t pull your hair out over head lice

So-called “super-lice” are big news now, just in time for children to go back to school. While that news may be somewhat overblown, as any parent who has been through one will tell you, a lice infestation can be a time-consuming and worrisome health issue. One of the bigger concerns for parents is that if their child is diagnosed with lice, they will have to stay home from school or daycare, something that recent guidelines have stated is NOT the case.

Here are six important facts about lice to keep in mind:


Anyone can get lice.


Lice are not related to cleanliness. Anyone can get lice if they are in prolonged, close contact with someone else with lice. Lice only infect people—not pets—and cannot hop or fly. They spread by crawling from one scalp to another scalp. It is very uncommon to get lice from hats or brushes or combs since they cannot survive off the scalp for more than 24 hours.



If your child has lice, she’s actually had them for a while.


The characteristic itch on the scalp, back of the neck or behind the ears is an allergic reaction to lice saliva. It often takes three to four weeks for that reaction to start.



Regular scalp checks are the best way to help keep lice away.


According to the American Academy of Pediatrics, here’s how to check your child for lice:

  • Check your child in a brightly lit room.
  • Part the hair and check your child’s scalp.
  • You are trying to find either crawling lice or eggs (called nits) on the hair. Live lice are small insects (OK, that’s a little gross, we admit), about the size of a sesame seed (2 to 3 mm). They are hard to see because they move fast and avoid light. Nits are quite small (less than a millimeter) and appear pearly/white, almost like a grain of uncooked rice. They will be firmly attached to the hair shaft very near the scalp.
  • You can also wet the hair, and comb it out with a fine-toothed comb. After combing you can wipe the comb on a wet paper towel, and check the comb and the paper towel for nits. 

Nits can be confused with dandruff or dirt, so if you are unsure check with your pediatrician.



Your best bets for treating lice are lotions and combs.

head_lice_combing_Nielskliim_shutterstock_271941740_640x360If your child has lice the American Academy of Pediatrics recommends treatment with one of several topical lotions that will kill the lice and possibly even kill the eggs.

The first choice is an over the counter (OTC) lotion containing 1 percent permethrin. This choice is generally very effective, but if it doesn’t work there are prescription lotions that have each been tested and are safe to use on children. Depending on your pharmacy and insurance plan, some of these lotions can each be expensive.

Sometimes parents decide to avoid any chemical treatments, and although there are other options, none has been proven to work. One approach is to pick out all of the eggs by combing damp hair with a fine-toothed comb. This can be challenging because of the time it takes to remove eggs from each hair shaft over many days, especially if a child has fine, long hair.

Other methods include suffocation, meaning the application of either petroleum jelly or other thick preparations such as mayonnaise or olive oil. This method is rarely effective, and the ointments can be hard to remove from the child’s hair. Never use kerosene or gasoline or products meant for animals on your child.

All household members should be checked for lice and nits and treated accordingly. Given that most household members are in close contact with one another, it is prudent to have a low threshold for treating all household members, even parents.

You might have seen recent news stories suggesting that a) treatment-resistant lice are more common than ever, and b) parents shouldn’t use the usual first-line, over-the-counter  treatments anymore. To those stories I offer one caveat: The study behind them was funded by the maker of a prescription lice treatment. Let the reader beware.



Lice are not very hearty.


Lice can’t survive off the scalp for more than a day, so they can’t live for very long on any objects. Also, since they can’t hop or fly from person to person, they are only contagious by scalp-to-scalp contact. This is good news.

To rid your home of lice, you don’t need to do multiple deep cleans or throw away items. And you don’t need to spray with any pesticide. You just need to clean objects that have been near a child’s head for the past three days (e.g., hats, towels, pillow cases, stuffed animals, hair care items). Lice can’t survive in heat, so any item should be washed in hot water and dried in a hot drier. Any item that can’t be washed can be dry cleaned, vacuumed (in the case of furniture) or sealed in a plastic bag for two weeks.



Children with lice CAN go to school.


According to the American Academy of Pediatrics and the National Association of School Nurses, lice and nits are no reason to exclude a child from school, daycare or any activity. These organizations have taken this position for two reasons:

  • As I mentioned above, by the time your child gets diagnosed she likely has had lice for three to four weeks, and likely got them from school or daycare. Thus, excluding a child from school or childcare does very little to prevent the spread of lice.
  • Head lice are not a dangerous medical illness that would warrant any kind of quarantine.


Susan Laster, MD, is a pediatrician at in private practice in Brookline, Mass., and a member of the Pediatric Physicians Organization at Boston Children’s Hospital (PPOC).