Head lice are every parent’s nightmare. Not only do those words conjure images of dirtiness, they also inspire dread about the process of treatment and disinfestation.

What are head lice?

Lice are parasitic insects that get into people’s hair, feed on their blood, multiply and spread quickly. They’re quite a common problem among school children and children in day care, wreaking havoc in the form of itchy scalps and red bumps on the neck and ears.

There are an estimated 6 to 12 million cases of head lice infestations each year in the United States in children 3 to 11 years of age, according to the Centers for Disease Control and Prevention.

The U. S. Food Drug Administration says head lice are a year-round problem, but the number of cases seems to peak when children return to school in the fall and again in January.

Dr. Trent John , a pediatrician at Novant Health Medical Plaza Pediatrics , said lice are a common problem among children. “People have been dealing with lice for thousands of years and the reason we see more cases at the beginning of the school year and when it begins to get colder is because children come in closer proximity with each other,” John added.

Head lice are spread through head-to-head contact with an infested person and can be transmitted through shared clothing such as hats, scarves, coats, sports uniforms, hair brushes or pillows.  The insects are not spread through poor hygiene. Because children play so closely together, lice can easily crawl from one child to another.

To check your child for lice, part his or her hair in several different places using a comb. Small flecks resembling dandruff near the scalp may be an indication of nits, the eggs that lice lay. Unlike dandruff, however, nits will be difficult to remove from a strand of hair using a fingernail.

John said that lice infestations are rarer among African-Americans due to their hair structure and some of the products they use for grooming their hair. “It’s harder for the lice to attach to African-American hair than to people who have finer hair,” he said.   

Treatment of lice

There are many safe shampoos, creams and lotions for the treatment of head lice. Some can be purchased over-the-counter at a drug store and others are available by prescription from your provider.

John said parents should start the treatment for lice with over-the-counter products such as RID. “Anybody can use these products, but you must follow the directions,” he said. “If you do not see improvement after two to three treatments, you should see your doctor. You may not be using the product properly or it may be a case of reinfestation.”

The Food and Drug Administration provides these suggestions for treatment:

  • Before treating young children, talk with your child’s doctor for recommended products based on a child’s age and weight.
  • After rinsing the product from the hair and scalp, use a fine-toothed comb or special “nit comb” to remove dead lice and nits. Drugstores sell “nit combs.”
  • Follow directions for use on the label closely and do not use more product than advised. John said you need to leave the treatment on for 10 to 15 minutes before rinsing it out.
  • Apply the product only to the scalp and the hair near to the scalp.

After the first treatment, parents will need to apply a second treatment a week later, John said. “Head lice die quickly, but nits hatch a week later so that’s why there needs to be a second treatment,” he added.

Eliminating the infestation

  • Combs and brushes used by a child with head lice need to be soaked for five to 10 minutes in hot water measuring at least 130 degrees.
  • Wash all bedding, clothing and towels that have been in contact with an affected person up to 48 hours beforehand. Wash the items in hot water and dry them in the dryer’s high temperature setting. Items that aren’t washable should be dry cleaned.
  • Thoroughly vacuum all rugs and upholstery that came in contact with the affected person.
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  • Do not use insecticide or foggers. Because head lice cannot survive once they fall off someone’s scalp for more than a day or two, it is not necessary to use pesticides.
  • All members of the family will need to have a treatment.

A week after treatment, check all members of the family to see whether the infestation was completely removed from the scalp.  John said it’s important that children who have head lice to stay out school until the first treatment is completed.

“If over-the-counter treatments don’t work, your pediatrician can provide you with a prescription medication. Permetherin, the active ingredient in products like RID, is effective, but in some rare cases lice are becoming resistant to it,” he said.

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