Head Lice

Main Symptoms

• Itching of the scalp is the main symptom
• Nits (white eggs) firmly attached to hair shafts near the skin. Unlike dandruff or sand, nits can't be shaken off the hair shafts
• Gray bugs (lice) are 1/16-inch long, move quickly, and are difficult to see
• A scalp rash may be present. The back of the neck is the favorite area
• The nits are easier to see than the lice because they are white and very numerous
• The nits (eggs) hatch into lice in about 1 week

See More Appropriate Topic

• If it doesn't look like lice, see INSECT BITES or RASH, LOCALIZED AND CAUSE UNKNOWN

Call Your Doctor within 24 Hours (between 9 and 4) If

• Scalp looks infected (e.g. pus, soft scabs, open sores)

Call Your Doctor during Weekday Office Hours If

• You think your child needs to be seen
• Diagnosis of head lice is uncertain
• Head lice or nits recur after treatment
• You have other questions or concerns

Parent Care at Home If

• Head lice and you don't think your child needs to be seen

Home Care Advice

1. Lice Shampoo
   • Buy an anti-lice shampoo. You won't need a prescription. Ask your pharmacist to help you select a product (e.g. Nix, Clear, A-200, Pronto or RID).
   • Pour about 2 ounces of the shampoo into the hair. Follow the shampoo instructions carefully. Be sure to work the shampoo into all the hair down to the roots. Leave the shampoo on for a full 20 minutes or it won't kill all the lice (10 minutes is not enough). Then rinse the hair thoroughly and dry it with a towel.
   • Repeat the anti-lice shampoo in 1 week to kill any nits that survived.
2. Remove the Dead Nits: Remove the dead nits by backcombing with a fine-tooth comb or pull them out individually. The nits can be loosened from the hair shafts using a mixture of half vinegar and half warm water applied for 30 minutes under a towel wrap. (Wait at least 3 hours after the lice shampoo before applying this solution) Even though nits are dead, most schools will not allow children to return if nits are present.
3. Contagiousness of Lice: Your child can return to day care or school after 1 treatment with the anti-lice shampoo. Check the heads of everyone else living in your home. If any have scalp rashes, sores, or itching, they should be treated with the shampoo even if lice and nits are not seen. Reemphasize not sharing combs and hats. Also notify the school nurse or day care center director so she can check other students in your child's class/center.
4. Expected Course: With treatment, all lice and nits will be killed. A recurrence usually means another contact with an infected person or the shampoo wasn't left on for 20 minutes or the treatment wasn't repeated in 7 days. There are no lasting problems from having lice and they do not carry other diseases.
5. Call Your Doctor If
   • New lice or nits appear in the hair.
   • Scalp rash lasts > 1 week after the anti-lice shampoo.
   • Rash clears up and then returns.
   • Sores start to spread or look infected.