Head Lice

Dear Lisa,

My daughter caught head lice from camp and now I’m worrying that my son is going to get it too. How can I tell if he has lice too? What am I supposed to be looking for? Is there anything that I can do to prevent him from getting it?

“Grossed Out by Lice”

Dear “Grossed Out by Lice”,

Head lice is caused by the organism Pediculus Humanus capitis. The most common symptom of head lice includes intense itching, especially at the nape of the neck. (1) Although, if a child has a mild infestation consisting of only a handful of lice, there may not be any itching at all. I have had some children present with a red rash on their neck, and it turned out the rash was from their scratching due to a head lice infestation.

If you inspect a child’s head you may be able to find adult lice. They are the size of a piece of rice. They do move very quickly and are often very hard to find. Head lice can typically be found around the ears and at the nape of the neck. The eggs or nits are tiny white pearly circular beads that can be found attached to the hair shaft. They are usually the size of a pin head and if you pick one off the hair shaft it feels very hard. People sometimes confuse the presence of dandruff on the scalp for nits. The difference is dandruff flakes off with little effort and the nits stick to the hair shaft and can only be pulled off with a lot of effort. Sometimes the first sign of an infestation is a sore, open excoriation, crusting or skin infection. This secondary infection that develops is the result of a child's repetitive scratching. (1) You may also notice enlarged lymph nodes in the neck area if a secondary skin infection is present. (2)

Lice are transmitted from one child to the next when head to head contact occurs. The problem is that children tend to have a lot of close contact when playing and therefore there’s a greater chance they will spread it from one child to the next. Lice can also be spread from a child’s personal belongings such as a pillowcase, hat, scarf, brush, comb or hair ornaments. (1) Head lice can only survive for one to two days away from the scalp and the eggs can only hatch when they live in warmer temperatures such as that found on the scalp.

In regards to your son, the recommendation is to inspect his scalp, paying particular attention to the area around the ears and at the nape of the neck. If you find signs of lice or nits you should treat him at the same time as his sister. (1) There is no reason to prophylactically treat your son, unless he sleeps in the same bed as his sister who has the lice infestation. (2) In order to prevent the spread of head lice, avoid sharing combs, brushes, hats, scarfs or pillows. Your daughter’s bed linens should be laundered in hot water and her bedroom and play area should be vacuumed. (1) Washing combs and brushes in hot water with a temperature exceeding 128.3 degrees Fahrenheit for five minutes is lethal to head lice and their eggs. (2)

The treatment for head lice includes the application of over the counter products containing Permethrin 1% crème. The product should be applied to dry hair for maximal effectiveness. (1) The treatment should kill the lice shortly after application. Therefore, if you find living lice on the scalp twenty-four hours after treatment your child may have had a heavy infestation, been reinfested or the lice were resistance to therapy. If this occurs the child should be treated with a different product and retreated 7 to 10 days later. Some practitioners recommend automatically retreating a child 7 to 10 days after application of the first treatment. (2) If over- the–counter products do not work contact your child’s Doctor or Nurse Practitioner for a prescription.

It is important to remember that the presence of eggs or nits after treatment do not reflect a reinfestation. Once the eggs die, they leave an egg case behind which cannot spread the condition. It is a good idea to remove the egg case so that they will not be confused with a future reinfestation. (2) If you cannot remove the egg case with the use of a fine tooth nit comb, put white vinegar on your child’s hair and wrap the hair in a towel soaked in white vinegar for 30 to 60 minutes. This helps loosen the glue that attaches the nits to the hair shaft. (2) You should be able to remove the nits with the fine tooth comb more easily after this application.

(1)Treadwill P. Spot the rash. Infectious Diseases in Children. 2006. July:72.
(2) American Academy of Pediatrics. Pediculosis. In: Peter G, ed. 1997. Red Book: Report of the Committee on Infectious Disease. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:387-390.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Keeping Kids Free from Infections