Many of us can recall a childhood head lice trauma – or knew of one close to home. If you’ve had children in pre-school or elementary school, you’ve likely experienced an outbreak at least once.

Facts and Statistics

The head louse (Pediculus humanus capitis) is an insect that spreads only through hair-to-hair contact, though it can temporarily hitch rides on Unlike many other biting insects, it does not jump or fly.

Head lice is extremely common, both in America and across the world. The Centers for Disease Control and Prevention estimates that 6 million to 12 million infestations occur each year in the United States among children aged 3 to 11.

Identification of Lice

Lice are not difficult to find if you know what to look for. Their eggs, called nits, are especially easy to spot since they do not move…and can’t be easily removed by brushing or shaking them off. Nits resemble tiny yellow, tan, or brown dots before hatching – in some ways, like dandruff. Lice lay them on hair shafts close to the scalp, where the temperature is ideal for keeping warm until they hatch. You can even spot evidence of nits once they have hatched, as the shells remain attached to hair strands and look whitish and faded.

Live lice are less common than nits, which is why most pediatricians or teachers will advise you to search for them rather than for adult lice. An adult head louse is about the size of a sesame seed.

Lice usually take between 8 and 10 days to hatch. This makes it important to find them early, before a new generation can begin and reignite the outbreak cycle. If left untreated, the cycle of hatching and reproducing will repeat itself every 3 weeks or so, so it’s important to respond right away once you spot any evidence of lice. These insects live on blood, and will die within a day or two after being removed from a person’s scalp, so the best protocol for getting lice out of a home or school is immediate treatment.

Significantly Increased Risk of Lice for Children and Their Families

There’s a reason you associate lice with childhood. Head lice infestations in the U.S. are most common in day care centers, preschools, elementary schools, and among family members who live with the children and staff members in these places. If you or your family will be traveling abroad, try to limit close contact with other children who may have lice, especially in underprivileged or unsanitary areas.

Schools that experience outbreaks of lice will send out a letter to all parents letting them know there has been an infestation and giving instructions on how to treat affected children, and any family members who might also have gotten lice. You should follow your individual school’s instructions carefully, but make sure you are taking all necessary precautions on your own as well.

Lice and Disease

Lice can be an annoyance because itching can cause loss of sleep. Sometimes excessive scratching can sometimes increase the chance of a secondary skin infection. This makes it prudent to take precautions in other countries where lice are common, especially in areas where crowding and sanitation are an issue, such as refugee camps, impoverished villages, or underfunded hospitals. Nevertheless, head lice are not known to spread disease in the United States.  However, they are implicated in a few diseases worldwide.

The head louse may be a carrier for relapsing fever, a disease that causes headaches, pain in muscles and joints, nausea and other symptoms. This insect has also been implicated in outbreaks of typhus, although that is much more commonly transmitted by body lice (Pediculus humanus corporis.

Treatment and Control

There are two basic responses: treatment of the infected person or persons, and treatment of the entire school or household. Getting rid of lice involves a two-step process of combing and treating affected areas with medicinal shampoos or topical applications.

Most health departments do not require reporting of head lice infestation. However, it may be beneficial for the sake of others to share information with school nurses, parents of classmates, and others about contact with head lice.

Treating People

Treating people begins with checking them carefully, going through hair strands one section at a time with a fine-toothed comb. Combs help you catch nits and adult lice and pull them off the hair, after which you can wash them down the drain. It will also help you identify whether or not lice are present.

Once identified, you can use over-the-counter or prescription medicines and shampoos. Among the most common are:

  • Permethrin rinses
  • Shampoos made with pyrethrins or piperonyl butoxide
  • Benzyl alcohol (usually in formulations of 5 percent)
  • Malathion lotion
  • Ivermectin
  • Spinosad

Lindane was once a common treatment, but it is no longer widely used after being linked to serious neurological disorders. If your physician recommends lindane, get a second opinion. In rare cases, lice may infest eyelashes in addition to hair, in which case your doctor may prescribe an ointment.

Treating the Home Environment

While a louse will die within a few days of being removed from a person’s head, it can survive temporarily on pillows, blankets, furniture, and clothing. This makes it critical to remove them from all surfaces with thorough cleaning. Steps include:

  • Remove all sheets, shams, stuffed animals, mattress covers, blankets and other bedding, and wash thoroughly using the hottest setting your washing machine offers, then dry on high heat.
  • Wash all towels in the same manner.
  • Vacuum mattresses and furniture thoroughly.
  • Fluff all pillows in the dryer on the hottest setting for about half an hour, as well as all comforters.
  • Remove anything you cannot wash, such as backpacks or certain types of jackets, from the home and seal them tightly in a plastic bag for 2 weeks or more.
  • Wash and dry all clothes on the hottest settings.
  • Boil hair brushes and combs for several minutes to completely kill lice or nits that may be on them.
  • Vacuum all carpets and the inside of your car thoroughly, especially headrests and the insides of car seats.
  • Mop all floors.

While these steps can be labor-intensive, skipping any of them makes re-infestation more likely. Also note that these tasks must be done in tandem with treating individuals, otherwise lice are much likelier to return.

Preventing Further Outbreaks

While you as a parent or guardian cannot control what happens at school, you can do your part to eliminate the spreading of lice and to prevent further outbreaks. You can fight infestations proactively by keeping long hair tied up tightly in ponytails or braids. Lice do not like to burrow and prefer loose hair, so this measure will help significantly in eliminating them.

Conduct a periodic inspection on hair, even if you have not received a warning from your school that there may be an infestation. Don’t share brushes or cold weather gear between your own children, and discourage them from sharing these items with anyone else. Maintain separate brushes and articles of clothing for each person at home.

Insecticide vs. Natural Lice Control Methods

As you may notice from commonly used products available to control head lice, including shampoos and lotions, contain insecticides like permethrin and synergized pyrethrins are common in shampoos and lotions than can be purchased over-the-counter. If you use one of these products, follow their directions to the letter – carefully note amount of product to use, how often to use it, and whether your hair should be wet!

Because head lice maintain an intimate relationship with their host human and don’t survive long once they are removed, control should be focused on treating the person – not the environment. In other words, only use insecticidal products on the infested individual. Never treat furniture, bedding, floor or walls inside a school or home with products designed to control head lice. Only clean these areas – never apply insecticide

While many “natural” remedies against head lice are online, do be aware that the evidence is anecdotal and that the agricultural extensions of many major universities advise against them. There are no scientifically proven “natural” preventative treatments or protective shields to guard your scalp from head lice. In fact, many of them may irritate the scalp and skin and damage hair.

When to See a Doctor

Lice is a very common problem in the U.S. and almost never causes serious issues. Like mosquitoes, lice have saliva to which many people are allergic, which can cause extreme itching. But

scratching continuously can lead to certain infections, and some children with sensitive skin scratch for days or weeks after lice are eliminated completely. If you think you need a prescription, make a doctor’s appointment.

A louse on another part of a host’s body is not a head louse, but a body louse.  Body lice live in clothing and can transfer from there to myriad parts of the body, and have been established as carriers for certain diseases. If you see lice on another part of the body, visit a doctor immediately and follow the recommended course of personal treatment, then disinfect the home in the same manner as you would for head lice.

Consulting Other Professionals

Head lice do not infest homes; they infest the people living in them. Without a human host, lice die very quickly. While lice may be found close by in places like bedrooms, it isn’t effective to treat houses or apartments. The louse problem will go away on its own if you treat the people carrying them.

Many cities have salons that specialize in the treatment of lice outbreaks. They will either visit schools to treat children en masse, or you can bring your children in for personal treatments.

These salons also provide education about avoiding further outbreaks, so it may be worthwhile to consult them if you have been affected by more than one infestation.