By Hanna Jang, PA-S
Head lice is a common condition that affects children most frequently. It can be traumatic for both children and parents.
Life Cycle of Head Lice
- Female louse lives for 1 month and can lay up to 10 eggs per day!
- Eggs (nits) take 8 days to hatch. Eggs release nymphs that mature in 8 days.
- Adult head lice are gray-white and 2-3 mm in length o Theyfeedonthescalp, face, and neck.
- They can live up to 55 hours without a host!
How do head lice get “spread”?
- Through direct contact with the head of an infested person
- Lice do not jump, fly, or use pets as vectors!
- Spread via inanimate objects is controversial
Signs & Symptoms
- Itching around scalp, neck, and ears due to an allergic reaction to lice saliva
- Visible lice and nits
How can my child be diagnosed with head lice?
- Confirmed by visualization of live lice (Nits are white and more visible than nymphs and adult lice)
- This may be done through wet or dry combing
How do I wet comb my child’s hair?
- Apply hair conditioner to hair
- Brush/comb hair to remove tangles
- Fine-toothed comb is inserted near crown so that it gently touches the scalp
- Draw comb down firmly
- Examine for lice after each stroke
- Comb entire head twice
Treatment is recommended!
Topical pediculicides may be prescribed for your child:
- Benzyl alcohol
- Topical ivermectin
Wet combing may be used in young infants and in patients who wish to avoid medications
- Session is complete when no more lice are found.
- Repeat sessions every 3-4 days for several weeks.
- Continue for 2 weeks after any session a large, adult louse is found.
Which topical medication is right for my child?
Your child’s pediatrician will make a decision based on: o Resistancetomedications
o Side effects
o Patient age
o Drug cost
How to apply topical medications:
- Hair conditioners should not be applied prior to application!
- Limit skin exposure:
- Rinse topical pediculicide off over a sink rather than a shower or bath
- Rinse with warm water instead of hot water
“My child has used 2 topical medications and still has lice!”
- Some causes of treatment failure are:
- lack of adherence to treatment
- continue contact with other infested individuals
- resistance to specific topical treatments
If 2 topical medications fail, your child may be prescribed an oral medication called Ivermectin
When can my child return to school?
According to the CDC:
- Children should not be excluded from school based upon presence of live lice/nits
- Affected children should avoid direct head contact with other individuals and should be treated promptly
- Examine household members → treat if infested
- Bedmates should be treated prophylactically
- Recommend washing clothing and linen used by infested person in hot water and drying items in
high-heat dryer cycle
- Alternative: dry-cleaning; storing in a sealed plastic bag for 2 weeks
- Vacuum furniture & carpeting (but risk of transmission is low here!)
Goldstein, A. and Goldstein, B. (2019). UpToDate. [online] Uptodate.com. Available at:
https://www.uptodate.com/contents/pediculosis-capitis/print [Accessed 10 Dec. 2019].
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