A Parent’s Guide to Dealing With Head Lice

Pediculus humanus capitis is a long name for a tiny but fearsome insect: the head louse. Children are particularly susceptible to getting lice—and spreading it to family and classmates. The good news is, Patty Sabey, MD, a pediatrician with Stanford Medicine Children’s Health, is here with advice on how to deal with those pesky parasites.

What are head lice?

Head lice are very small bugs that love to hang out in hair, including brows and eyelashes. These little pests set up camp close to the scalp so they can feed off their host’s blood. They do not jump or fly but crawl from one head to another.

“It’s this microscopic bug you can see visibly. The adult is about a sesame seed size, and they just hang out on the human scalp. They can attach to human hair, and it’s just this tiny microscopic companion of the human species,” Dr. Sabey said.

Head lice can affect people at any age, but they most frequently infect children ages 3 to 12 years. They are especially common among young children who share close quarters, such as in day cares and schools.

“They typically spread from hair-to-hair contact, or head-to-head contact,” Dr. Sabey explained. “So, if you have young children in a day care or preschool setting where they’re wrestling each other on the floor or they take a nap and they have head-to-head contact, if their sleeping cots are next to each other or head to head, the lice can spread that way.”

Symptoms of head lice

Along with the telltale itching, lice bites can cause bumps and sores on the scalp. In many cases there will also be visible lice and/or evidence of their eggs (also known as nits: tiny white or yellow specks in the hair close to the scalp). Dr. Sabey said that a close examination of your child’s scalp with a fine-toothed comb should be enough to confirm if he or she has lice.

“The best place to look for them is behind the ears or just above the neck, and with good lighting, and you have to really look close to the scalp because usually lice love to hang out close to the scalp,” she said. “If they’re too far away from the scalp, they don’t survive for very long.”

What to do if your child has lice

According to Dr. Sabey, lice can be treated with over-the-counter topical medication that is available at pharmacies and grocery stores. There are even some salons that specialize in treating lice outbreaks. Most kids won’t need to see a doctor, but in the case of a stubborn or particularly aggressive infestation, there are prescription medications available.

“What we tell families is, if you’re worried about head lice, you can try the over-the-counter medications,” she said. “If that’s not effective, and the child continues to have symptoms or you continue to discover lice or nits, then see your doctor and consider getting a prescription-strength medication.”

Dr. Sabey said that follow-up treatments may be needed to completely get rid of the lice. It’s also a good idea to clean any bedding, clothing, or fabric items that your child has used.

“Most of the time, we need to treat again in a week because it takes about a week for the lice egg to hatch,” she said. “We also recommend any items that the child has used in the last 48 hours, either bedding or stuffed animals and items that can be laundered, they should wash those items. Things that cannot be washed should be put in a plastic bag or container and stored away for a couple weeks before the child uses those items again.”

Despite the nuisance, lice don’t generally pose a significant health risk or have long-term complications, Dr. Sabey shared. Once the lice are treated, your child should be able to go back to school the next day. However, she also cautioned, due to the highly transmissible nature of lice, everyone in the household should get checked.

“[It] can be a recurrent problem, and probably the more common scenario is that one person in the family gets head lice, technically everyone should get checked. But if it’s not discovered first round and the first person gets treated, but then another child gets head lice, then it can recirculate in the household,” she said.

How to prevent lice

While it may not be possible to prevent all cases of head lice, there are a few things you can do to help stop the spread:

• Avoid sharing personal items like helmets, hair grooming tools, or hats.
• Periodically check your child’s hair for lice and nits.
• Keep long hair tied back in a braid or ponytail.
• Regularly wash your child’s clothes and bedding in hot water to kill any potential lice.

Head lice are not a reflection of cleanliness or personal hygiene. They are a common issue that can affect anyone, so there’s no need to feel embarrassed or stigmatized if your child encounters them. Dr. Sabey encourages parents to reassure children that it’s still OK to play with friends and to remind them to be kind because head lice can happen to anyone.

“If someone just had head lice, then be a little more careful. You’re still friends with them. You can still play with them, but try not to share a hairbrush with them or share a hat,” she said. “I think it’s OK to let kids be kids and play the way they feel comfortable. But generally, as we talk to our children, we can reassure them that just because you have head lice, or you had head lice, or your friends have head lice, it’s not a bad thing. It’s part of the human experience.” For more advice from Dr. Sabey, read “Tips for Feeding Picky Eaters During Distance Learning,” and to learn more about head lice, check out “Head Lice in Children