Health Topic

Lice, 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 (instead of this one) If

WHEN TO CALL YOUR DOCTOR FOR LICE

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

  • Age less than 3 months old.  (Reason: have your doctor recommend the safest lice medicine.)
  • 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.
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HOME CARE ADVICE FOR HEAD LICE

  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 10 minutes or it won't kill all the lice.  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 special nit  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 8 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 lice or nits are seen, or someone has the new onset of an itchy scalp rash, they also should be treated with anti-lice shampoo. Bedmates of children with lice should also be treated.  If in doubt, have your child examined.  Re-emphasize 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 10 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 for more than 1 week after the anti-lice shampoo.
    • Rash clears up and then returns.
    • Sores start to spread or look infected.
    • Your child becomes worse.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Pediatric HouseCalls Online. Copyright © 2000-2004 Barton Schmitt, M.D. FAAP

Reviewed 8/2004

Revised 7/2004

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