Back to school can be an exciting time for both kids and parents. Preparing for a new school term starts with so many new things: new stationary, new shoes, new clothes, new hair style, and may be even new classmates. One thing parents and kids don’t prepare for when going back to school is bringing home head lice and nits. Head lice are regular visitors for many school children and their parents - they’re more than happy to turn up uninvited! So, let’s explore what you need to know about head lice just in case they decide to come home with your child.
Head lice are tiny little wingless parasites that feed on blood from the human scalp.1 Nits is the term used for the empty louse eggs that are left glued to the hair shafts.1
Head lice have six legs ending in hook-like claws, which are designed to help them grip onto human hair.1 When fully grown, head lice are around the size of a sesame seed and similar in colour (tan/grey).1 When newly hatched, head lice are called ‘Nymphs’ are they are around the size of a pin head, so they are a lot more difficult to spot on the scalp.1
Nits, or louse eggs, are oval shaped and can sometimes be confused with dandruff because you will find them close to the scalp and they are similar in colour (whiteish-yellow).1
Head lice and nits are exclusively found on the scalp of the human head. With head lice and nits being so small it can feel like a needle in a haystack when you have to try and find them. However, head lice have favourite places to hide on the scalp where they like to lay their eggs, such as2,3:
Nape of the neck
Behind the ears
Temples of the head
Behind braids and ponytails
Anyone of any age, gender or colour is at risk of catching head lice. However, they do tend to affect children more commonly, in particular the following groups1:
Children of school age (4 to 11 years)1
Children with long hair1
Children with more siblings1
Girls are more commonly affected than boys1
Families of lower socio-economic status1
Direct head-to-head contact with an infested person is the most common way to get head lice, as head lice cannot jump, fly, or swim from person-to-person.1,2 Head-to-head contact is common during play at home2, on the playground2, slumber parties2, when taking selfies with another person5, hugging4 and some close contact sports2.
Although it is uncommon, head lice can be spread by sharing clothing or belongings like towels, pillows, hairbrushes, hats, scarves, and coats.2
When you think of head lice, do you feel like scratching your head? Although itching is the most common symptom associated with head lice, it is not always the most reliable as itching can also be a sign of dandruff, dermatitis, allergies, etc. Here are some other signs and symptoms that can indicate you have head lice:
The presence of head lice or nits in the hair or scalp1
A tickly feeling or moving sensation on the scalp6
Red bumps or sores on the scalp, neck, or shoulders1
Oozing or crusting sores on the scalp, neck, or shoulder – usually caused by infected bites or excessive scratching1
Difficulty sleeping due to excessive night-time scratching1
Irritability due to lack of sleep1
Anxiety due to the stigma and shame associated with having head lice1
Itching may be the most common symptom associated with head lice, but an itching scalp is not enough to diagnose an active head lice infestation.1 The only way to diagnose head lice is to find a living, moving louse on the scalp as the presence of louse eggs alone, whether hatched (nits) or unhatched, is not reliable for indicating an active infestation.1 You can check for head lice using a method called detection combing - the systematic combing of the hair with a fine-toothed comb.1
Detection combing is considered the most reliable way to check for head lice. Detection combing is more reliable than visual inspection.1 There are two detection combing methods1:
Wet Detection Combing
Dry Detection Combing
Less preparation is needed for dry detection combing, but wet combing is more accurate because lice struggle to move around the scalp when the hair is saturated with conditioner.1
It is recommended that children of school and nursery age are checked once a week for head lice. This is because they are the most vulnerable group at risk of catching head lice, and with female lice laying up to 150 eggs in their 30-40 day lifespan, you can image how an infestation can quickly get out of control.1
Live head louse eggs are laid close to the scalp surface and are strongly attached to the hair shaft with a glue-like substance.1 Viable, live eggs are usually found less than 1cm from the scalp as they need heat to hatch.7 If the egg if further than 1cm from the scalp it is likely to be an empty eggshell also known as a ‘nit’.7
Finding head lice on your child can feel like a nightmare. So many questions on what to do and who to tell. It is important to conduct some form of head lice contact tracing to help reduce the spread of these pesky parasites.8
The aim of contact tracing is to inform everyone who may have caught head lice from the infected person, and to detect the source of the infestation.8 This may include your child’s closest friends, their teacher, any family, or friends your child has been in close contact.8 Please be mindful that contact tracing is the responsibility of the family affected and not the school.8
In short, no!6 There's no need to keep your child off school if they have head lice.6 Historically, there may have been ‘no-nit policies’ that dictated that children with head lice should not attend school, but that is no longer necessary. There are steps parents can take to reduce the spread such as detection combing and treating anyone in your own household with head lice on the same day.
Treatments to get rid of head lice are available to buy from pharmacies, supermarkets and online.9 The treatments come in different formats like shampoo, lotion, spray, mousse.9 Not all treatments kill both head lice and eggs in one application, so make sure you check the box or ask your local pharmacy team for advice on which treatment to choose for your child. Make sure you follow the instructions thoroughly as each treatment is left on for a different amount of time.
If you do not want to use a medicated treatment, you can use wet detection combing on days 1, 5, 9 and 13 to catch any newly hatched head lice and do a final check on day 17 to make sure that everyone's hair is free of lice.6 This process can be significantly more time consuming, but it is also considered an effective method for eliminating head lice and their eggs.
Modern head lice treatments eliminate head lice and their eggs by physical means such as suffocation or dehydration. Unfortunately, they do not dissolve the glue-like substance that attaches the nit to the hair. This means it is possible than nits will be left in the hair and will become more visible as the hair grows. Check if your head lice treatment comes with a free fine-toothed ‘nit-comb’ which allows you to easily remove the nits from the hair.
If head lice do not respond to treatment, check that you are using a non-pesticide treatment that is less likely to encounter resistance, ask your pharmacists about non-pesticide treatments that work have physical mode of action. It is also important to check that you have followed the instructions correctly and sometimes the product was not applied liberally enough, not achieved full coverage or not left on for long enough.7
It is also possible that the person treated picked up a new infestation immediately after the treatment finished because other close contacts and family members were not checked and treated.7
If someone in your home has head lice, it is important to check and treat everyone else in the household who has live lice present.6 However, it is not necessary to treat the furniture, carpets, and bedding in your home. It can help to reduce the spread in the household by avoid the sharing of personal items such as pillows, towels, hairbrushes, hats, and clothes.2
Realistically, there's nothing you can do to prevent head lice.6 There are some head lice repellent products available to buy over-the-counter that may help. The best thing you can do is to be vigilant and check your child’s head once a week. Remember, head lice are nothing to be embarrassed about – they are a part of childhood and a part of parenting - it can happen to any head at any time! So, when they do stop by, don’t feel ashamed, tackle them straight away.
Invest in a fine-toothed detection comb
Make sure you check your child at least once per week for head lice – remember their favourite hiding spots
Discourage your child from sharing personal belongings like brushes, hats, headphones, clothes, etc
Tie back or braid long hair
If someone in your house has head lice, remember to check everyone else in the house
Treat all members of the household on the same day to avoid re-infestation
Reassure anyone affected by head lice that it is perfectly normal to catch them, they don’t hurt you, they are not a sign of poor hygiene, and they are not something they should be embarrassed about
Make sure you inform all relevant parties who have had close contact with an infected person to check for head lice to reduce the spread of these annoying critters.