Head Lice

CGCSC Head Lice Guidelines

Parents have the primary responsibility in the detection, prevention and treatment of head lice through routine checks of their child’s hair and proper treatment if live lice are found. While head lice are a nuisance, they do not spread disease and are not a public health issue. Parents are encouraged to notify the nurse/clinic assistant if their child is found to have head lice. The primary goal of identification and notification of a lice infestation in the school setting is to ensure that the child receives safe and effective treatment. Should a student present at school with a possible case of head lice, the school nurse/clinic assistant will maintain confidentiality, verify the presence of an active infestation, and bring it to the attention of the student’s parent/guardian. Presence of nits alone is not a reason to exclude a child from school.   Students with live, crawling lice and nits closer than 1cm from scalp will be considered an active infestation and would require treatment or manual removal of nits. Exclusion for an active infestation will be determined on a case by case basis. Parents will be instructed on appropriate treatment and prevention methods and asked to return to the clinic with their child after treatment for a recheck. Head lice checks are done individually and on an as-needed basis for detection and for follow up after treatment. Siblings and close contacts of students with head lice may be checked at the discretion of the nurse or clinic assistant. 

These guidelines are supported by the American Academy of Pediatrics, Centers for Disease Control and Prevention (CDC), and the National Association of School Nurses.

 What do head lice look like?

Eggs: Nits are lice eggs. The eggs are laid by the adult female and are firmly attached to the base of the hair shaft nearest the scalp. It takes a nit about 7 days to hatch. They are most often found around the nape of the neck or ears. 

Nymphs: Egg hatches to release a nymph and the nit shell remains attached to the hair shaft. Nymphs mature and become adults about 7 days after hatching. Nymphs must feed on human blood from the scalp to survive.

Adults: Adult lice are about the size of a sesame seed and are tan to grayish white in color. Females are usually larger than males and can lay up to 8 nits per day. Adult lice can live up to 30 days on a person’s head and must feed on human blood from the scalp several times per day. Off of the human scalp, a louse will die within 1 to 2 days.  

How are head lice spread?

Head lice do not have wings and cannot fly or jump. They move by crawling and are most often spread through prolonged, direct head-to-head contact. It is possible, but not common; to spread head lice by sharing clothing (hats, coats, or scarves) or personal items (combs, brushes or towels). By the time an infestation is found, the child is likely to have had it for at least a month. A child can’t catch nits. Nits are only laid by live lice.

How do you treat head lice?

Treatment is only recommended for persons with an active infestation (live lice). All household members and other close contacts should be checked; those persons with evidence of an active infestation should also be treated. There are over-the-counter (OTC) and prescription medications available. It has been reported there are now prescription medications that are quite effective, contact your child’s physician for more information. Treatment includes using a lice-killing agent, nit removal and additional measures.

Lice Killing Agent

• Apply lice medicine according to package or label directions. If child has very long hair (longer than shoulder length), it may be necessary to use a second bottle. 

• Using a fine tooth nit comb (metal ones work best), comb child’s hair from scalp to remove any dead or remaining live lice from hair.

• Live lice avoid light and move quickly. They can be combed out or removed with tweezers or by your fingers.

• Depending on product used, a retreatment may be recommended about a week after first treatment to kill any survived hatched lice before they produce eggs.

• If you are using an over-the-counter medication and live lice are found while nit combing; the product may not be effective. Contact your child’s doctor. Do not retreat sooner than 7-10 days if live lice continue to survive.

Nit removal

***Complete nit removal is the key to success in treating head lice, since most lice medications only kill the live lice and may not kill the nits.***

It only takes one unhatched nit left behind to start the whole cycle over again

• Work in a brightly lit area.

• Separate the hair into small sections and secure the hair that is not being looked at. 

• Look at each section carefully from scalp to the end. 

• Nits are attached to the hair shaft and will need to be removed with your fingers. Remove the nit by pulling the egg off the hair shaft and discard in trash. 

• Continue working on small sections of hair until the whole scalp has been checked.

• Daily head checks during first 10-14 days after treatment are very important to remove any missed nits that could later hatch. 

Additional measures

• Lice-Killing sprays are NOT recommended. They are not effective and can be toxic. A louse that is off of the human scalp is a dying louse.

• Vacuum furniture and carpets.

• Wash and dry clothing, bedding or other items that the child wore or used during the 2 days prior to treatment using hot water and a high heat drying cycle.

• Clothing that is not washable should be dry-cleaned.

• Store any items (stuffed animals) that cannot be washed or dry cleaned in a sealed plastic bag for 2 weeks. 

• Soak combs and brushes in very hot water for 5-10 minutes.