It makes me itchy just thinking about them. You too, probably. But learning about these little guys makes it a bit easier to tolerate when your child comes home with them someday!

What are lice?

The human louse feeds on our hair. And, they travel from one head to the next by crawling. No, they don’t fly (they are wingless). And lice really like it if you share combs, hairbrushes, or hats with another person—that way they can be easily transported to a new home on someone else’s head.

Are lice a sign of poor hygiene?

Head lice do not care whether you are rich or poor, have stellar hygiene or bathe once a week. They are equal opportunity creatures. Do not be embarrassed if your child gets an infestation. Grossed out, yes. Embarrassed, no.

How do I look for head lice in my child?

Adult lice are brown and large enough to be seen but they move very quickly. So, it’s much more common to diagnose head lice by finding their white eggshells (called nits). The nits stick firmly to the hair shaft close to the scalp. (Unlike dandruff, that easily brushes out or moves when you shake your head.) You’ll find them mostly behind the ears and the back of the neck. Start looking if your child is suddenly scratching his head for no other good reason (they are pretty itchy!).

How are lice treated?

1. Start with tried and true over the counter remedies like Rid or Nix (1% permethrin or pyrethrin). Do one treatment, and then repeat 7-10 days later.
2. Don’t obsess about cleaning the entire house!
3. Any items that are used in the hair (brushes, combs, hair clips) can be placed in an airtight plastic bag for four weeks and then they are ready for use again.
4. The problem: lice are becoming increasingly resilient and resistant to treatment. Other options include: prescription Ulesfia (benzyl alcohol) wash or Ovide (malathion). Some doctors also prescribe a higher potency permethrin product called Elimite. There are also other over the counter options. Tea tree oil and Cetaphil lotion may also treat head lice, but the evidence that they work is more anecdotal than scientifically proven.

Does my child need to stay home until the lice are treated?No. Kids often get sent home from school when lice are detected. However, the American Academy of Pediatrics reiterated this week their position on this outdated strategy: kids should not be excused from school due to head lice.

Lice are an infestation, and they have usually been alive and well on a child’s head for at least four weeks before the itchiness occurs and diagnosis is made. And they do not spread when children are sitting at their desks and learning. So, kindly ask your school to check out the AAP’s website at aap.org if they have any concerns.

Ari Brown, MD