Head lice

What are head lice?

Head lice are small, wingless insects that live in the hair on your head and can be challenging to eradicate. They can only survive in human hair, need to feed from the scalp several times a day and can only survive up to two days off the person’s head. Though not dangerous, head lice are a common problem for children between the ages of 3 and 11 and have nothing to do with personal hygiene or cleanliness and do not carry disease.

Head lice can crawl onto your scalp when your head touches the head of someone with head lice and, although rare, they can be transferred through a hair brush or hat.

Lice eggs are called nits and are about the size of a small flake of dandruff, but cannot be easily shaken off or brushed out. Lice lay their nits on hair shafts close to the scalp and rely on the warmth of the head to hatch. Nits hatch within one to two weeks of being laid and once hatched, the shell looks white or clear and stays firmly attached to the hair shaft. If lice are not treated, this process repeats itself about every 3 weeks.

What are the signs?

The first signs that your child may have head lice is a tickling feeling in the hair, frequent scalp itchiness or sores/scabs on the scalp from scratching. It is important to be aware that the itching may not be immediate and in some cases, it can take weeks before your child starts to complain.

Although very small, a single adult louse can be seen and is about the size of a sesame seed. They usually look like tan or brown dots.

Unless the infestation is heavy, it is more likely that you will see nits in your child’s hair, rather than lice crawling around. A good method of checking your child’s head is by parting the hair in small sections and checking for lice and nits with a fine-tooth comb close to the scalp, behind the ears, and around the nape of the neck. Good lighting and a magnifying glass may help this process. If you are still unsure, and your child is constantly itching and complaining, speak to your health care provider or pharmacist.

What is the treatment?

Treatment should only be applied when live lice are found on the head. If more than one person in your family has been infested, treatment should be applied at the same time to break the cycle.

There are two methods of treatment:

1. Conditioner and combing technique (non-insecticidal treatment)

Conditioner stuns lice and blocks their breathing pores. This, together with the slippery effect of the conditioner, makes it easier to mechanically remove the lice. This treatment method is equally as effective as insecticidal or other chemical treatments but generally requires longer treatment times. However, it may be preferred as a cheaper alternative to insecticidal or other chemical treatments.

Step 1: Generously apply conditioner to dry hair to cover the scalp and the full length of the hair.

Step 2: Untangle the hair with a wide-toothed comb.

Step 3: Place a fine-toothed headlice comb flat against the scalp and draw the comb through each section of hair from the roots to the ends.

Step 4: Wipe the comb after each stroke onto a tissue or paper towel, checking each time for head lice and nits.

Step 5: Comb each section of hair at least five times.

Step 6: Wash the hair as normal.

Step 7: Scrub both combs with an old toothbrush to remove any eggs or lice that may be present.

Repeat the conditioner and combing method every second day to remove young lice as they hatch. Continue for ten or so consecutive days until no lice are found.

2. Treatment with synthetic or natural insecticides or other chemicals

There are different forms of treatment which you can get from the chemist without prescription. All preparations must be applied strictly according to the manufacturer’s instructions and none of them should be used on children under two years of age, except on medical advice. If a product doesn’t seem to work, speak with your chemist about a product with a different active ingredient.

• No chemical treatment kills all the eggs.
• A second treatment should be applied 7-10 days after the initial treatment to kill the young lice that have hatched from the eggs remaining from the first treatment.
• Do not apply the treatment more than once per week as more frequent applications could lead to scalp problems and have little or no effect.

Nits are the most difficult to kill. The most effective way to remove eggs is to actually pull them off the hair using your fingernails.

Prevent reinfestation

There is no need to use pesticides around your home, as lice cannot survive more than a day or two away from the scalp. The following recommendations will help to prevent reinfestation:

• Regularly check your child’s scalp for signs of lice.
• Teach your child to avoid head-to-head contact during play and other activities.

Developed by General Paediatrics Division, Children’s Health Queensland. We acknowledge the input of consumers and carers.

Resource ID: FS332. Reviewed: February 2019.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.