Buzz
If you find out that your child (or one of their friends) has head lice, your first instinct might be to feel disgusted, anxious, and want to sanitize everything in your home. However, the CDC advises against this: They don’t recommend sending children with lice home from school. While head lice may be unpleasant, they pose no immediate health risk and are not easily transmitted.
Head lice are not harmful
Head lice are tiny creatures that live in hair and feed on blood from the scalp. Though unpleasant, they’re expertly suited for life on our heads. Their tiny legs cling to hair strands, and when they lay eggs, they attach them to individual hairs, very close to the scalp.
That's all they do. They don't spread diseases or cause serious health issues. Their relatives, body lice, can cause problems, but those bugs live on clothes and only become a concern if you go without changing clothes for weeks. A case of head lice doesn't indicate poor hygiene. These pests can survive washing, so they can end up on anyone’s head, regardless of cleanliness.
Head lice must bite your scalp for every meal (gross, I know). After a few weeks of this, you might become sensitive to their saliva and start itching. Kids are often diagnosed only when a parent or teacher notices them scratching. I spoke with pediatrician Dr. Cynthia D. Devore, who authored the American Academy of Pediatrics’ 2015 guidelines on head lice (which were updated in 2022), about the worst case scenario for a child with severe lice. She explained that intense scratching might break the skin, potentially leading to infection. However, this risk applies to any kind of scratch or wound. Dr. Devore emphasized, 'Lice are a nuisance, not a life-threatening condition.'
A few years ago, 'super lice' resistant to treatment made headlines. A study in the Journal of Medical Entomology revealed that a gene allowing these bugs to resist certain insecticides was more widespread than previously known. But this wasn't a new issue—entomologists and doctors were already aware that some bugs are immune to specific insecticides.
Head lice aren’t easily transmitted
You don’t need to worry about your pets, stuffed animals, or furniture. Head lice only live on human heads. They die within one or two days without a human blood meal, so there's little cause for concern about a hat worn a week ago or a louse that happened to fall onto your carpet.
You're unlikely to get lice from a hat or pillowcase, as transmission through these objects is rare. Lice are typically spread when heads make direct contact. For example, if two children are absorbed in the same book or iPad game, with their heads touching, that's when lice can spread.
Surprisingly, many back-to-school lice cases likely don’t originate from schools, since kids aren’t usually in close head-to-head contact during class. Devore points out that if a child doesn’t show signs of lice until they begin scratching their head, it’s probably a case that’s been around for a few weeks. Therefore, if itching begins in September, the lice were probably contracted at summer camp.
To spot lice when they first arrive, you'll need to inspect your child’s scalp regularly. Since lice can be difficult to detect, this can be a challenging task. Devore recommends routine checks, but personally, I can’t see myself dedicating time for frequent head inspections of my children’s hair.
While it's wise to avoid sharing hats and other hair-contact items, there's no need to become overly anxious about it. For instance, if a sports team shares helmets, it's better to wear the helmet than risk head injuries due to fear of lice. Devore suggests that simply wiping a hat or helmet with a damp paper towel should be enough to eliminate stray lice. Alternatively, letting the item sit in a plastic bag for 72 hours is another option. She advises against insecticide sprays, as the dangers of exposing children to the chemicals outweigh any potential benefits.
Although dealing with lice is frustrating, it’s certainly not impossible to get rid of them.
Every year, millions of children, between six and twelve million to be exact, get head lice. While adults can also be affected, you're likely to hear of incidents at school (with some schools even informing parents) or rumors about the emergence of 'super lice' in your state. If you or your child end up with head lice, don't despair.
If a teacher or school nurse identifies lice, it’s important that they don’t send your child home for the day. School policies differ, but the American Academy of Pediatrics strongly believes that children should not be excluded from school due to lice, since they pose little risk of spreading in classrooms. The National Association of School Nurses concurs. Devore advises that a child with lice should remain in class, with the parents treating them that evening. The nurse will then monitor the child's condition daily for two weeks. However, some schools may require children to stay home until treatment is complete and the eggs are gone. If you feel this disrupts your child's education, you may want to consider reaching out to the U.S. Department of Education's Office of Civil Rights.
The most effective way to treat lice is by using an insecticidal shampoo, but there are a few important considerations. Before applying pesticides, it's wise to confirm that your child has lice. Dandruff and dirt are often confused with louse eggs, and even if eggs are present, they might be from a previous infestation that resolved on its own. What you should be looking for are live lice, which are small, roughly the size of a sesame seed, and their eggs will be located close to the scalp. A louse comb can be helpful, as a typical infestation contains around ten live lice, making them difficult to spot. The comb will catch both lice and nits, removing them from the hair.
Although insecticidal shampoos are not foolproof, they remain the most dependable treatment available.
There is a wide range of shampoos designed to kill lice, but some of them may be ineffective against certain resistant strains, including the so-called 'super lice'.
It’s a good idea to check in with your pediatrician, Devore recommends, as they can guide you on which shampoos work best for the lice in your area. They may also provide access to stronger prescription shampoos. (Here’s a handy chart outlining various available treatments.) Prescription options tend to cost more, reaching up to $250, while over-the-counter treatments usually range around $25. However, if the drugstore options fail and you need to use them multiple times, the overall cost could add up to more than the prescriptions in the long run.
Aside from resistance, there are other reasons why a treatment might not work. The CDC outlines these potential issues: you may not have followed the instructions to the letter, there may have been conditioner in the hair beforehand, or you may have used a two-treatment product but applied the second dose too soon or too late. It’s worth reviewing the directions carefully to avoid the need for repeated treatments.
If the idea of insecticidal shampoos seems too difficult or risky, you might be tempted to simply smother your child’s hair in mayonnaise and call it a day. While the concept behind mayonnaise or olive oil treatments is to suffocate the lice, there isn’t enough evidence to confirm whether these remedies actually work. Feel free to try them, but just be aware of the uncertainty surrounding their effectiveness.
By the way, if your child insists on shaving their head, that truly is an effective method for getting rid of lice. However, it’s by no means required. If that’s not the hairstyle they prefer, stick with the shampoos and other treatments.
Another option is to hire a professional head lice removal service. They use many of the same treatments you could try at home, but some may also employ a device called AirAllé, which dehydrates lice with air. Think of it as a low-temperature, high-speed hair dryer. The maker of AirAllé lists removal services that use their product here. Additionally, many independent local businesses offer these services, which you can find by searching in your area or asking for recommendations. One big advantage of hiring a professional is that you won’t have to get up close and personal with your child’s lice-infested hair.
If there are a few lice on shared items like pillowcases or hats, simply wash or dry them. Temperatures over 130°F will kill lice. You can also place items in a plastic bag for a few days, which will eliminate any live lice. If you're concerned that lice eggs might hatch on that hat or hairbrush (though it's unlikely, since eggs need body heat to survive), you can keep the bag sealed for up to two weeks.
