Information on Head Lice

What are head lice?
Head lice are insects that live on the hair, eyebrows and eyelashes. An adult louse is about the size of a sesame seed and can range in color from translucent (clear) to brown. Lice and their eggs (nits) are usually found in the hair behind the ears and near the nape of the neck. It is generally easier to see the nits that are usually dark grey, smaller than a grain of sand, and are firmly attached to the hair shaft. The nits hatch in 7-10 days (white nits are empty shells from which a louse already hatched).

What are symptoms?
Itching is the most common symptom. Small red dots are possible bites. Scratching can lead to infection.

Who can get head lice?
Anyone may be infested. Head lice infestation is common in child care and school-aged children. Having head lice is not a sign of uncleanliness.

How are head lice spread?

By direct hair to hair contact with someone with head lice. Head lice do not fly or jump, they only walk.
By sharing combs, brushes, hats, clothes, or sleeping with someone with head lice.
Head lice do not live on pets.

How are head lice treated?
Only those persons who are infested and their bed mates should be treated. However all persons living in a household where there are head lice should be examined daily for 10 days. There are several head lice treatments available including:

Permethrin (NIX®) - A 10 minute hair rinse available without a prescription. NIX® has been shown to be the most effective treatment against head lice.
There are other treatments available by prescription or over-the-counter, however, they are less effective.
Follow the package directions! Use the LiceMeister™ or a similar comb. Most lice shampoo kit combs are ineffective and should be discarded.

Infested persons should be treated over a sink rather than in the shower or bathtub to avoid live lice remaining on the body and causing re-infestation. Remove the infested person's shirt and provide a towel for eye protection before starting the treatment. Put on clean clothing after treating and removing the nits.

Removing the nits:

Currently the LiceMeister™ comb (available from the National Pediculosis Association) or equal is the most effective comb for mechanically removing nits.
For easier combing, wet hair with equal parts white vinegar and water, apply a towel soaked in a vinegar/water solution for 30-60 minutes. Apply lice treatment first, then comb out nits. Over-the-counter products specially made for removing nits are also available.
Combing is best when the hair is damp.
Some nits may need to be removed by picking them out with the fingernails, or by cutting out the individual shaft of hair.
Use natural lighting or flashlight, magnifying glass, and wooden disposable applicator stick.
Part hair into four sections.
Start at top of hair. Lift one inch wide tuft of hair up and away from scalp with the applicator stick.
Place nit comb close to scalp.
Comb slowly away from scalp to end of hair, combing entire length.
Fasten nit-free strands out of the way.
Dip metal combs in hot water.
Repeat for each section.
Soak comb in lice shampoo solution or bleach water solution (1 tablespoon bleach per quart of water) for 10 minutes or in very hot water (>130°) for 1 minute.
Check daily for nits/lice for the next 7-10 days. Recommend comb out again the next day with regular shampoo.
Follow product directions for re-treatment. Not using the proper nit removal comb is the most common reason for continued presence of lice.

What about Re-treating?
No treatment has been shown to be 100% effective, and so re-treatment may be necessary. Look for head lice and unhatched nits on all household members for 7-10 days following treatment, but only retreat those persons who are still infested. Please remember to use these treatment shampoos only as directed on the bottle or package insert.

Please adhere to the following:

Do not fumigate homes, schools, or other buildings.
Do not use insecticides - they may be harmful to family members.
Do not treat pets for lice and do not use lice sprays on mattresses or furniture.

Additional Control Measures

Vacuum mattresses, furniture, car seats, etc.

Using heat:

Wash in hot water and dry on high heat all towels, pillows, sheets, blankets, and clothing recently used by infested persons. (Not necessary to do this with all the clothing belonging to the person.)
Use a hand-held blow dryer on the hottest setting to go over unwashable but heat tolerant items, or set in sun in a closed car or black plastic (headphones, mattresses, furniture, car seats, etc.).
Soak personal items such as (combs, brushes, etc.) in very hot water (>130°) for 1 minute.

Using cold:

Seal in plastic and freeze personal items (combs, etc) for 24 hours.

Using isolation:

Persons with head lice should not share articles that come in contact with the head, neck, or shoulders (combs, brushes, hats, coats, towels, etc).
Avoid direct physical contact with individuals who are infested with head lice.

Stuffed Animals and Bed Toys

Generally lice and nits are not found on stuffed animals and other toys that children sleep with. If you are concerned:

Bag the toys and put them in the freezer for 24 hours, or
Toss the animals in the dryer for about 10 minutes to kill the lice.

NOTIFICATION OF CLOSE CONTACTS, SCHOOLS, AND/OR CHILD CARE IS IMPORTANT.

A Note to Day Care centers
To decrease any problems of head lice spread in your center, remember to keep each child's personal articles separate.

Use separate containers for each child's coat, hat, blanket, etc.
Have each child use a personal blanket for naps.
Bedding in cribs, cots, or mats should be used exclusively by each individual child or it should be cleaned and sanitized before being used by another child.
Keep children limited to fewer areas of the house.
Cover chairs and couches with large blankets or bedspreads so they can be washed daily.
Discourage sharing of hair brushes, combs, hats, and wigs.

If you have followed the recommended treatment guidelines and you are still having problems with head lice you may need to contact your family physician for guidance.

The LiceMeister™ comb is available from the National Pediculosis Association, PO Box 610189, Newton, MA 92161, (617) 449-6487. Their internet address is www.headlice.org. An equivalent comb may also be purchased at local drug stores or pharmacies.