Prevention and Control of Communicable Diseases

Head lice infestations are a common problem for children in child care settings and schools. Anyone can get head lice. There are two other kinds of lice that infest people, but they do not live on the head. Parents should check their child(ren) for head lice regularly. If they find lice or eggs, use the information provided below.

Cause

Pediculus humanus capitis, a louse.

Head lice are very small (less than 1/8" long, about this size [--]), brownish-colored insects that live on human heads and lay their eggs (nits) close to the scalp. The eggs are tiny (about the size of the eye of a small needle) and gray or white in color. Adult lice move fast and do not like light.

Symptoms

Itching of the head and neck. Look for: 1) crawling lice in the hair, usually few in number; 2) eggs (nits) glued to the hair, often found behind the ears and at the back of the neck; and 3) scratch marks on the head or back of the neck at the hairline.

Spread

Lice are spread by head-to-head contact and by sharing personal items such as combs (especially on picture day), sports head gear, brushes, barrettes, hats, scarves, jackets, blankets, sheets, pillowcases, stuffed animals, play activity clothes, and hats. Head lice may be spread during sleepovers.

Lice do not jump or fly; they crawl and can fall off the head. Head lice do not live longer than 48 hours off the head. They only lay their eggs while on the head. Nits which are more than ½" from the scalp are dead or empty and will not hatch. The eggs do not hatch if they fall off the head. Lice do not spread to or from pets.

Incubation

It takes 7 to 10 days from when the eggs are laid until they hatch.

Contagious Period

Until treated with a lice treatment product.

Exclusion

Child Care and School: Until treatment has started and no live lice are seen. Nits are NOT considered live lice. Children do not need to be sent home immediately if lice are detected; however they should not return until effective treatment is given.

Treatment

• Call a healthcare provider or pharmacist for advice. Recommended treatment includes using either an over-the-counter (OTC) or prescription medicated (lice killing) product. Use products that contain permethrin or a pyrethrin-based shampoo. Refer to the Centers for Disease Control and Prevention for the most current head lice treatment guidelines.

• Follow the product directions carefully (especially the amount of product to use, length of time on the hair, and whether to use on dry or damp hair). Directions will vary, depending on the product used.
• With certain products a second treatment is recommended 7 to 10 days later to kill any lice that may have hatched after the first treatment. Until the treatment course is completed, avoid any activity that involves the child in head-to-head contact with other children. Do not resume these activities until no new lice are seen and there are no nits within ¼" of the scalp for anyone in the group.
• It may take 24 hours for products to kill lice.
• Lice treatment products are not 100% effective in killing lice, especially nits. Removing the nits (nitpicking) is an essential part of the treatment for controlling the spread of head lice. The nits are glued onto the hair shaft as they are laid and require effort to remove. To remove the nits, use a metal nit comb, cat flea comb, or your fingernails to slide eggs off the hair shafts, or use scissors to cut the hair shafts that have nits glued to them. Continue checking the head and combing hair daily for 2 weeks. If all nits within ½" of the scalp are not removed, some may hatch and the child will be infested again. Remember: it takes at least 2 weeks to get rid of lice.
• Check all household members for head lice. Treat only household members with head lice, and treat all at the same time.
• Many alternatives to OTC or prescription head lice control products have been suggested. CDC does not have clear scientific evidence to determine if suffocation of head lice with mayonnaise, olive oil, margarine, butter, or similar substances is an effective form of treatment.

Prevention/Control

• DO NOT share combs, brushes, other hair grooming items and other hair accessories (barrettes, etc.), towels, bedding, clothing, hats, and headgear, such as personal headphones and sports helmets.
• Hang coats, jackets, and caps in individual lockers or on assigned coat hooks. If this is not possible, put the clothing in separate plastic bags. Bedding, when not in use for naptime, can be stored in individual plastic bags or storage boxes.
• Parents should check their child's head frequently throughout the year. If one person in a household, child care, school, etc., has head lice, others should be checked too. Sleepovers are a common setting in which head lice are spread. When a child returns from a sleepover, check the child’s head and launder any bedding that they brought home.
• Clean all combs, brushes, other hair grooming items and accessories (barrettes, etc.) by doing one of the following:
  • soaking in the lice treatment product for 10 minutes.
  • cleaning with hot soapy water.
  • boiling for 5 minutes.
• Vacuum carpets, upholstered furniture, mattresses, and seats in the car(s) thoroughly. Insecticide sprays are NOT recommended because this will expose household members to unnecessary pesticides and most viable lice are found on the head, not in the environment.
• Wash clothing worn in the last 3 days (e.g., jackets, hats, scarves, pajamas), bedding, and towels in hot (1300 F or higher) water and dry in a hot dryer for at least 20 minutes before using again. Clothing or backpacks that cannot be washed or dried, linens, and stuffed toys can be dry cleaned or sealed in plastic bags for 2 weeks.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7), or call your local health department.

More information about head lice can be found on the Centers for Disease Control and Prevention website.

A flowchart has been developed for your use in determining appropriate actions to take in a school setting.

Your child may have been exposed to:

Head Lice

Anyone can get head lice. Head lice are very small brownish-colored insects that live on the head. They are less than 1/8" long, about this size [--]. They lay eggs (nits) close to the scalp. The eggs are tiny (size of the eye of a small needle) and gray or white in color.

If you think your child has Head Lice:

• Tell your child care provider or call the school.
• Treat your child for head lice and check child’s head and remove nits daily. It takes at least 2 weeks to get rid of lice.

• If all nits within ½" of the scalp are not removed, some may hatch and your child will be infested again.

• Check everyone in the house for head lice. Treat only household members with head lice, and treat them all at once.
• Need to stay home?
  • Child Care and School:
    Yes, until treatment has started and no live lice are seen. Nits are NOT considered live lice.

Symptoms

Itching of the head and neck. Look for: 1) crawling lice in the hair, usually there aren’t very many; 2) eggs (nits) glued to the hair, often found behind the ears and at the back of the neck; and 3) scratch marks on the head or back of the neck at the hairline.

If your child is infested with lice it will take 7 to 10 days from when the eggs are laid until they hatch.

Spread

• By head-to-head contact. Check your child for lice often.
  
  Lice do not jump or fly; they crawl and can fall off the head. Head lice do not live longer than 48 hours off the head.
  They only lay their eggs while on the head. The eggs do not hatch if they fall off the head. Lice do not spread to or from pets.

Contagious Period

Until treated with a lice killing product.

Call your Healthcare Provider

• Call your healthcare provider or pharmacy for advice. Recommended treatment includes using either a prescription or store-bought lice killing product.
• Follow the product directions carefully. With certain products a second treatment is recommended 7 to 10 days later. Lice treatment products are not 100% effective in killing lice, especially nits.
• Removing the nits (nitpicking) is a very important part of the treatment for controlling head lice. The nits are glued onto the hair shaft as they are laid, and require effort to remove. To remove the nits, use a metal nit comb, cat flea comb, or your fingernails to slide eggs off the hair shafts, or use scissors to cut the hair shafts that have nits glued to them. Continue checking the head and combing hair daily for 2 weeks. If all nits within ½” of the scalp are not removed, some may hatch and your child will get head lice again.

Prevention

• Never share hair grooming items and hair accessories (barrettes, combs, brushes, etc.). Clean all hair items by soaking in the lice treatment product for 10 minutes or cleaning with hot, soapy or boiling water for 5 minutes.
• Never share towels, bedding, clothing, hats, and headgear.
• Check your child's head every month. If one person in the home has head lice, others should be checked too. Sleepovers are a common place for head lice to spread. Check your child’s head after a sleepover and wash all bedding brought home from the sleepover.
• Vacuum carpets, upholstered furniture, mattresses, and seats in the car(s) thoroughly. Insecticide sprays are NOT recommended because this will expose household members to unnecessary pesticides.
• Wash clothing worn in the last 3 days (e.g., jackets, hats, scarves, pajamas) bedding, and towels in hot water and dry in a hot dryer for at least 20 minutes before using again. Clothing, stuffed toys, linens or backpacks that cannot be washed or dried can be dry cleaned or sealed in plastic for 2 weeks.

How to Remove Nits

Work in a well lit room or under a bright lamp (using a magnifying glass may help you see the nits)

• Divide the hair into 4 parts and divide each part into 1-inch sections.

• Stating at the scalp, use a metal nit comb, cat flea comb, or your fingernails to comb each hair section individually.

• Use the comb or your fingernail to slide eggs off the hair shaft or use scissors to cut hair shafts that have nits glued to them.

• Remove all nits each time you comb the hair.

Remember: it can take at least 2 weeks to get rid of lice.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7), or call your local health department.

More information about head lice can be found at the CDC website.