Head Lice

What are head lice?

Head lice are tiny, crawling insects that live in the hair on a person’s head. The lice feed on blood sucked from your scalp and lay eggs (called nits) that firmly attach to the hair exposed at your skin’s surface (hair shafts). An infestation of head lice is pediculosis.

Who does head lice affect?

Head lice can affect anyone but occur most often among children between the ages of 3 to 11 years old, along with their families. Children are more at risk, as they make head-to-head contact with other children when playing together and may share items that have contact with their hair.

How common are head lice?

Head lice infestations are common, affecting an estimated 6 million to 12 million people each year. Lice are most common among school-age children who are more likely to have close contact with each other or share combs, brushes, hats and other objects that touch the hair.

What are the symptoms of head lice?

The most common symptom of head lice is itching, especially on the back of your head and neck and near your ears — areas where lice are more likely to live.

Symptoms of head lice include:

• Feeling like something in your hair is moving (tickling).
• Itching.
• Sores from itching and scratching.
• Difficulty sleeping.

Head lice are most active at night, which can disrupt sleep.

Frequent itching can break the skin on your head, which can lead to an infection.

How does a person get head lice?

A person gets head lice because the insects crawl from person to person by direct contact or by sharing items — including combs, brushes and hats — with another person who has head lice. Poor hygiene doesn’t cause head lice.

How does head lice spread?

Head lice can’t fly or jump, so they spread by crawling from person to person during close contact. Although rare, head lice can spread through personal items like towels, sheets, hairbrushes or hats.

Animals and pets can’t get or spread head lice to humans.

How do you find and diagnose head lice?

A diagnosis of head lice is made by visual inspection. If you look closely at your child’s hair on their scalp, you may be able to see the tiny white nits attached to the hair shafts. Nits resemble dandruff but aren’t as easy to brush or shake off the hair. Adult lice can move around quickly and are difficult to see.

You can check for lice at home if you suspect your child has head lice by running a fine-toothed comb or a special head lice comb slowly through your child’s hair to locate nits or head lice.

How do you treat head lice?

Treatment for head lice includes using over-the-counter medicated or prescription shampoos, lotions or creams that eliminate head lice. Over-the-counter medicated shampoos contain a substance called pyrethrin or permethrin that kill lice and nits.

Lice and nits attach to the strands of your hair and can be hard to remove unless you use a fine-toothed comb to loosen them. After using a comb or brush, soak the comb in hot water for 10 minutes.

Make sure you follow the directions on over-the-counter medicines. The treatment is only successful if you follow the instructions on how to apply the treatment, how long you should leave it in your hair and how often you should repeat the treatment.

Treating resistant “super lice”

Over the years, some lice (called “super lice”) evolved so that the over-the-counter treatments don’t effectively kill the lice. Powerful prescription drugs are available that can eliminate super lice with one dose.

Talk with your healthcare provider if the first treatment for your head lice isn’t working. They’ll make a recommendation if treatment for super lice is necessary.

How do I get rid of head lice with shampoo?

Follow these steps to get rid of head lice with an over-the-counter medicated or prescription shampoo:

• Read the instructions on the treatment label.
• Apply treatment to your scalp and rub the product throughout the hair on your head. Don’t apply the product to other hair on your body.
• Follow the treatment’s recommended instructions for how long you should leave the treatment on your hair before rinsing it out.
• After rinsing the treatment out of your hair, use a fine-tooth comb to remove dead lice and nits.
• Reapply the treatment as advised by the treatment’s instructions or your healthcare provider.

It takes several treatments to completely remove lice and nits from your hair. It could take up to three weeks to get rid of all lice and nits.

Make sure all members of your household check and receive treatment for head lice if one member of your household has head lice, as lice easily spread from person to person.

How can I prevent head lice?

The best prevention is to not share combs, brushes, towels or hats with others and to avoid physical contact with someone who has lice. It also helps to examine and treat all members of your household who have contact with a person with lice.

Take time to teach your children about head lice and advise them to:

• Avoid head-to-head contact when playing.
• Not share hats or items that they put on their head with others.

If someone in your household has head lice, you can prevent the spread of head lice by:

• Washing clothes, bedding and fabrics with hot water and dry them with a hot cycle in the dryer. If there are items like a hat or stuffed animals that you can’t wash or dry, seal those items in a plastic bag for two weeks.
• Soaking hairbrushes and combs in hot water for up to 10 minutes after use.
• Vacuuming areas of your home and around furniture where a person with head lice might have sat or played.

What can I expect if I have head lice?

Head lice is a temporary irritation that effectively goes away with treatment of a medicated shampoo, lotion or cream. It may take several treatments to completely get rid of head lice, so be sure to follow instructions on the treatment’s packaging or as advised by your healthcare provider.

Head lice can’t spread disease, but they can make your scalp itchy. Frequent itching could break the skin on your scalp, which could lead to infections. If your child has lice and can’t stop scratching, contact your healthcare provider for additional treatment options to prevent them from damaging the skin on their scalp.

How long does head lice last?

With effective treatment, head lice will completely go away after two to three weeks. The duration is dependent on how many lice made a home in your hair. Make sure you follow the instructions on your medicated shampoo, lotion or cream to get rid of lice quickly. Lice can live up to 30 days or longer on your head if left untreated.

When can my child go back to school after having head lice?

Children who have head lice don’t have to stay home from school. But as head lice spread from close contact, it’s important to tell the school, daycare center or your child’s babysitter if your child has head lice. Remind your child to avoid making head-to-head contact with other children during playtime.

Other parents must be made aware of a confirmed head lice case so that they can check and treat their children as needed.

How do I take care of myself?

Symptoms of head lice can create disturbances in your sleep pattern and cause excessive itching and discomfort. Treat head lice at the first sign with over-the-counter medicated shampoo, lotion or cream and follow the instructions to make sure it’s effective. If you notice your head lice get worse and don’t go away with over-the-counter treatment, talk with your healthcare provider about stronger prescription treatment.

Lice don’t always go away after one treatment and it could take a couple of weeks to completely get rid of them. Following the treatment’s instructions leads to the best outcome.

When should I see my healthcare provider?

Call your health care provider if over-the-counter treatments fail to work or if there are signs of an infection. Signs of infection include:

• Fever.
• Sores that won’t heal on your head.
• Pain or tenderness on your head.
• Redness or swelling on your scalp.

What questions should I ask my doctor?

• What type of treatment do you recommend for my head lice?
• What do I do if the head lice don’t go away after treatment?
• Do I have super lice?
• Do I need a doctor’s note to send my child to school if they have head lice?

Do home remedies make head lice go away?

There isn’t any scientific evidence that at-home remedies, like using salt or other food products like olive oil or mayonnaise, get rid of head lice. The only recommended treatment for head lice is over-the-counter medicated or prescription shampoos, lotions or creams.

Is head lice the result of poor hygiene?

No, infestation with head lice doesn’t occur because someone has poor hygiene. Head lice spread from person to person during close contact or from sharing items that touch a person’s hair who has head lice. Anyone can get head lice regardless of hygiene.

A note from Cleveland Clinic

Hearing that your child has head lice can be a stressful experience. As children are in close contact with each other in school and daycare, head lice easily spread. It also means that there’s a chance other members of your household could get head lice as well. Make sure you follow the treatment as recommended by the instructions on the treatment product or from your healthcare provider and educate your family on head lice to prevent others from getting and spreading it. Following instructions and repeating treatment as necessary eliminates head lice quickly and effectively.