Your Child Has Head Lice: Now What?

Finding lice or nits (head lice eggs) on your child’s head can be stressful, but there’s no reason to panic — head lice are straightforward to manage and treat. 

“Head lice are a common issue we see in school-age children,” says Tammy Page, DNP, FNP-C, a board-certified family nurse practitioner at Beaufort Memorial Express Care and Occupational Health. “It’s important for parents to know that lice are not a reflection of poor hygiene or cleanliness at home.”

This guide walks you through how to confirm whether your child has lice, what to do first and when to see a healthcare provider.

What Are the First Signs of Lice?

Some children with head lice may have no symptoms. Others might itch, complain of something crawling on their scalp or develop sores from scratching. 

Still, the order in which these symptoms appear may vary. 

The most common symptom is an itchy scalp. Bites from lice can cause an allergic reaction that leads to itching and scratching. However, your child may not develop scalp itching for four to six weeks after lice first settle in and start biting.

Other signs and symptoms your child might have include: 

• A tickling sensation, as if something is moving in their hair
• Seeing tiny white, tan or yellow-brown specks. These are nits, which often attach themselves close to the scalp, especially behind the ears and at the nape of the neck. 
• Spotting adult lice or nymphs (baby lice). These are very small and may look like sesame seeds. However, they can be hard to see because they avoid light. 

Read More: Ouch! Something Bit Me

What Causes Head Lice? Not Poor Hygiene

Head lice spread mainly through close, head-to-head contact, not from a dirty home or not showering or bathing. 

Lice can spread by sharing hats, scarves, hair ribbons, combs or brushes, or by lying on bedding or furniture recently used by someone with an active infestation, but that’s less common than direct contact.

“This is one of the biggest misconceptions about lice,” Page says. "Lice can’t jump or fly. They crawl, so they’re most likely to spread when kids’ heads touch during play, sleepovers or sports.”

How to Kill Head Lice Quickly

A good first step is to call your child’s healthcare provider, especially if you have a young child. They can recommend a specific over-the-counter treatment or suggest a prescription option before you spend any money. They can also give you advice about applications. 

Over-the-counter lice medications, used exactly as directed, are often effective enough to kill an active infestation. Some medications kill both lice and their eggs and require a single treatment. Others only kill live lice and need a second application to kill newly hatched nymphs. Follow the package directions closely, including how long to leave the medication on and how to rinse it out. 

After treatment, use a dedicated nit or lice comb to remove nits and any remaining lice. Check your child’s hair and use the comb every 2 to 3 days for the next 2 to 3 weeks to catch anything treatment may have missed.

How Long Can Lice Survive?

Lice and nits need to feed on blood from the scalp to survive. Adult lice can live on a person’s head for about a month, but they’ll die within a day or two if they can’t feed. 

In addition, lice won’t go away on their own. An adult louse can lay multiple eggs (nits) each day, and those nits mature within two weeks. Unless you treat the lice, this cycle can continue every three weeks.

Cleaning Bedding, Clothing and Stuffed Animals

You don’t need to deep clean your entire home, but taking some targeted steps can help avoid reinfestation:

• Start by machine washing and drying any clothes, bedding, hats and towels that your child used in the two days leading up to treatment. Use hot water at 130°F and ensure a high-heat drying cycle. 
• For stuffed animals or other non-washable items, place them in a sealed plastic bag for two weeks to eliminate any potential lice. 
• Soak any combs and brushes in hot water (at least 130°F) for 5 to 10 minutes.

While it’s a good idea to vacuum floors and furniture where your child has been, remember that the chance of catching lice from carpet or furniture is quite low, so you don’t need to stress about extensive cleaning.

When to See a Provider for Head Lice

See your child’s provider if an over-the-counter treatment hasn’t worked after the recommended number of applications, or your child’s scalp becomes significantly irritated or shows signs of infection. A provider can also help confirm the diagnosis if you’re not sure what you’re seeing is actually lice.

Talk to your child’s school about their lice policies. The American Academy of Pediatrics and the National Association of School Nurses no longer endorse “no-nit” policies before a child can return to school. A child can typically return to school once treatment has started, since successful treatment kills the crawling lice that actively spread the infestation.

Read More: The Sick Kid Conundrum

The Bottom Line on Head Lice

Head lice are common and treatable, and they’re not a sign of poor hygiene. Many cases clear up with appropriate treatment and thorough nit-combing, and your child can typically return to school the day after treatment begins.

Here’s a quick run-down of what to do if you suspect your child has lice:

1. Check for specks firmly attached to the hair shaft.
2. If you see nits or adult lice and need assistance, call your child’s provider to discuss treatments. 
3. Use over-the-counter medications as directed. 
4. Comb out nits every 2 to 3 days for 2 to 3 weeks after treatment.
5. You may want to wash recently used bedding and clothing in hot water, and bag non-washable items for two weeks.
6. Check other household members and, if necessary, repeat the steps above for them.

If head lice keep coming back, over-the-counter treatments haven’t helped, or your child develops significant scalp irritation, a Beaufort Memorial provider can help determine the next step. Explore immediate care options today.