Back to school means it’s time to talk about head lice. In the United States, infestation with head lice is most common among preschool and elementary school-age children and their household members and caretakers. According to the Centers for Disease Control and Prevention (CDC), approximately one of every four elementary-level students in the United States had head lice. 

We asked Vicki Zenz LeFevre, RN, Manager of Door County Medical Center School Nurse team, to help us understand these tiny parasites, who have been living with human beings since antiquity. 

What are the facts regarding head lice and how they come to impact human health?

Head lice (pediculus humanus capitis) are a tiny grey to brown insect about the size of a sesame seed that live in human hair and feed on human blood to survive. “Dogs, cats, and other pets do not play a role in the transmission of head lice,” says Zenz LeFevre.

• Without a human host, lice can only live for about one to two days. Lice can lay eggs, also called “nits” which then hatch into new lice. 

• Head lice can be a nuisance, but are NOT known to spread disease.

• Head lice move by crawling; they cannot hop or fly. They are spread by direct contact with the hair of an infested person. Anyone who comes in head-to-head contact with someone who already has head lice is at greatest risk. 

• Personal hygiene or cleanliness in the home or school has nothing to do with getting head lice.

• Most of those with head lice do not have any symptoms; some feel itching or skin irritation of the scalp, neck and ears.

How can I help prevent the transmission of head lice?

According to the CDC, the following are steps that can be taken to 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, 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.

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

“If your school age child is suspicious for head lice, contact the school nurse,” says Zenz LeFevre. “The nurse can check your child for the presence of live lice or nits. If needed, treatment can be started after the school day. Your school district may have a policy regarding lice that will need to be followed, however, there is no need to contact your local Health Department if you suspect head lice.”

Treatment for head lice is recommended for persons diagnosed with an active infestation. All household members and other close contacts should be checked: any person with evidence of an active infestation should be treated at the same time.

According to Zenz LeFevre, there are several over the counter treatments. “Following the package instructions is of utmost importance and most will require retreatment within 7-10 days because of the life cycle of head lice.”

Combing the hair from scalp to hair tips with a fine toothed comb (special for lice) will need to be done immediately after treatment and every 1-2 days through all treatments. “This helps to ensure that live lice and nits are being removed. Most treatments will kill the lice with the first treatment, but there may be hatching of nits for a couple of days after treatment,” explains Zenz LeFevre.

In addition to scalp and hair treatment, the CDC recommends the following:

• Machine wash and dry clothing, bed linens, and other items that an infested person wore or used during the 2 days before treatment using the hot water (130°F) laundry cycle and the high heat drying cycle. Clothing and items that are not washable can be dry-cleaned OR sealed in a plastic bag and stored for 2 weeks.

• Vacuum the floor and furniture, particularly where the infested person sat or laid. However, spending too much time and money on house cleaning activities is not necessary to avoid reinfestation by lice or nits that may have fallen off the head or crawled onto furniture or clothing.

• Do not use fumigant sprays or fogs; they are not necessary to control head lice and can be toxic if inhaled or absorbed through the skin.

If, after treatments, head lice continue to be present, please consult your Primary Care Provider for guidance. At times, there may be a need for prescription topical or oral medication.

Additional References:  

    Department of Public Instruction-Wisconsin

    National Association of School Nurses