Lice Q&A

Frequently Asked Questions About Head Lice

From the Montclair Public School Nurses


Head Lice: the tiny (about the size of a sesame seed, 1-2mm) greyish/brown parasites that live on the scalp of their human hosts. They do not hop or fly, they only crawl. Head lice are very fragile and can only live about 24 hours off the human scalp.

Nits: the eggs deposited by head lice, very close to the scalp; nits are firmly attached to the hair shaft by a "glue-like" substance secreted when the nits are laid. Nits cannot be flicked or blown away easily (like dandruff, flakes, sand, etc.). Nits found more than about ½" away from the scalp are considered "hatched", or not viable. Nits cannot be passed from one head to another; only a hatched, live louse is capable of moving on a human scalp.

Why are parents advised to check for head lice? Why can't children be periodically examined in school for head lice?For practical reasons, the primary responsibility for the identification, treatment and prevention of head lice must lie with the parents. Effective inspections are best done on a regular basis on damp scalps. Inspections done on an entire class of students on any given day, will not detect a child who may acquire the condition the next day or another day thereafter. Also, school inspections can never be done on a sufficiently regular basis to make any real impact. Mass school screenings are not recommended, cause students to lose valuable class time, and have never been effective in screening for head lice. 

Why is it more effective to look for head lice on a damp scalp, rather than on a dry one? Unless numerous head lice are visible, 'dry', head checks are often unreliable, due to the speed at which head lice can move.

How do I look for head lice? Generally, a parent should part a child's damp hair after bathing or shampooing, and examine the scalp closely for the presence of bugs. Only when a head louse is actually seen, can a diagnosis of head lice be confirmed. Also, look for signs of irritation (redness and scratch marks) on the scalp. Head lice can be detected anywhere on the scalp, but very often they will be most evident at the nape of the neck and over the ears. Parents who regularly inspect (at least once a week) for head lice are usually more likely to detect any changes in a child's scalp that might suggest the presence of head lice.

I've heard that head lice are difficult to eliminate, is this true? Not necessarily. If parents check scalps regularly, an early case of head lice is not difficult to eliminate. Established cases of head lice can be more challenging for parents, which is the reason that regularly checking damp scalps is highly recommended. The key to controlling all scalp conditions, including head lice, is for parents to take the lead.

Head lice conditions are not a serious health hazard, so why should parents check for it regularly? While it is true that head lice do not cause serious illness, they can be a time consuming nuisance for parents to deal with in the home. Early cases of head lice can be much more easily and quickly treated than cases where head lice have multiplied on a child's scalp.

What if I am not sure about what I am seeing; or if my child is scratching his/her head a lot (and I don't see anything); or if I hear that one of my child's friends has head lice? In these instances, parents should "step it up a notch" when checking for head lice. When this happens, it's a good idea for parents to check more frequently, even on a daily basis. A good way to do these more vigilant inspections is by using inexpensive white hair conditioner and carefully combing through the hair in multiple sections. Here's how to check using this method

To check hair for head lice: carefully comb plenty of hair conditioner through the dry hair, then comb again in sections with a metal fine-tooth 'nit' comb. The hair conditioner slows the head lice down so they can be trapped


in the comb. Wipe the combings on a white paper towel and examine them with a magnifying glass in strong light, e.g. sunlight, to look for head lice and eggs.

To check more effectively for eggs: it is helpful to use a magnifying glass in strong light, e.g. sunlight, to examine the hair close to the scalp, especially behind the ears and at the nape of the neck.

What other things can be mistaken for head lice? Other objects in the hair can be and are often mistaken for head lice or eggs. These include sand, dandruff, flakes of hair spray, ants, aphids, or other small insects. It is important to remember that nits cannot be blown or flicked off the hair shaft easily; nits can only be removed with a very fine-toothed nit comb, or by using one's thumb nail to drag the nit off with some effort.

What if I continue to find nits on my child's head after treatment? Nits cannot be passed from one head to another; only a hatched live louse is capable of moving on a human scalp. Nits are sometimes discovered after treatment for head lice. This most likely represents nits that were missed after the initial treatment for head lice. For this reason, parents should continue checking for head lice and removing viable nits(the ones deposited less about than ½" from the scalp)daily, for 4 weeks after treatment. Their removal is best done by daily combings with the hair conditioner technique described above.

Should I treat my child for head lice with an over the counter insecticide "just in case" I hear that other children have head lice or nits, and if I don't see live bugs on my child's scalp? No. Never use these chemical products "just in case". Only when a diagnosis of head lice is made by the actual presence of a head louse or multiple bugs (lice), should a chemical insecticide be used as directed by the instructions contained in the package.

If I hear that the school nurse checked my child or other children in his/her and class, I don't have to bother looking myself, right? Not all cases of head lice are reported to the school nurse, and a parent should never assume that inspections done by a school nurse on dry scalps are 100% effective in identifying early cases of head lice. While dry scalp inspection screenings will certainly identify significant cases of head lice, early cases can be missed. Scalp inspections on one day will not always detect a child who may present with head lice the next or any other day thereafter. This is why regular checking of children's heads at home is an important parental responsibility.

What products should a parent have in the home to eliminate head lice when found? It is a good idea for parents to be prepared for the possibility of the discovery of head lice early in the cycle. Parents should familiarize themselves with the treatment options beforehand, and choose to have on hand for treatment either an inexpensive white hair conditioner, olive oil or an over-the-counter insecticide product, and a fine-toothed comb (nit combs are available in most drug stores) to comb out the hair to remove head lice and nits after the treatment products are applied.

If I am unsure of what to look for, can I call the school nurse to check my child? Absolutely! It's a good idea for the parent to accompany his/her child to the nurse so the inspection process can be demonstrated. The school nurses are always ready to assist parents in the head lice inspection and to advise them about treatment options.

Why are parents not always informed when head lice are in the schools? Thebest practice is for parents and caregivers to be proactive by inspecting his or her own child's damp scalp regularly. Parents and caregivers can identify and treat early cases before the head lice multiply and make treatment more difficult and time consuming. Parents should not need to rely on "professional" paid lice pickers if routine inspections are done in the home.

Because most schools are likely to have at least a few students with head lice at any time, an "alert letter" could  potentially be sent every day of the school year. These letters often cause parents to believe there is an "outbreak" of head lice, when, in fact, only one child may have one nit. In many situations, these letters cause parents to treat their own child "just in case" with a powerful pediculicide; this is never recommended or necessary. It is important to remember that just because a child in the school or in the neighborhood has head lice, one's own child will not automatically have them as well.

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