• Head Lice

    In this Chapter

    • HEAD LICE - Pediculosis Capitis
      • Head Lice Symptoms, Transmission, Treatment
      • School Action 
      • Controlling a Classroom Outbreak
      • Chronic Lice Procedure
      • Head Lice/Nit Plan of Action 
      • Head Lice Notification & Treatment Letter
      • Head Lice Treatment & Nit Removal Plan
      • Cleaning the Environment
      • Additional Head Lice Information for Parents/Guardians
      • Nit Notification and Treatment Letter
      • Parent Notification of Nit Check Results 
      • Lice/Nit Follow-up Check Tickler  Display/Print Tickler
      • Head Lice/Nit Tracking Log  (see reverse side of Lice/Nit Follow-up Check Tickler)
      • Head Lice/Nit Tracking Log Instructions (Back of Tracking Log)

     

    HEAD LICE (Pediculosis Capitis)

    Signs and Symptoms:

    • Tickling feeling or something moving in the hair
    • Itching, caused by an allergic reaction to the bites
    • Visible lice crawling on scalp and hair
    • Irritability
    • Sores on the head caused by scratching that may become infected

    Cause: 
    Pediculus humanus capitis, the head louse.  Adult lice or eggs (nits) are found in the hair, often behind the ears or near the nape of the neck.   

    There are three forms of lice: the nit, the nymph, and the adult.

    • Nit: Nits are head lice eggs.  They are hard to see and are often mistaken for dandruff or hair spray droplets.  Nits are found firmly attached to the hair shaft.  They are oval and usually yellow to white in color.  Nits take about 1 week to hatch.
    • Nymph: The nit hatches into a baby louse called a nymph.  It looks like an adult head louse but is smaller.  Nymphs mature into adults about 7 days after hatching.  To live, the nymph must feed on blood.   
    • Adult: The adult louse is about the size of a sesame seed, has six legs, and is tan to grayish-white.  In persons with dark hair, the adult louse will look darker.  Adult lice can live up to 30 days on a person’s head.  To live, adult lice need to feed on blood.  A louse can only survive 1-2 days away from the scalp.   

    Click here for picture of nit and louse

    Incubation Period:  

    • From laying of eggs to the hatching of the nymph is 6-10 days.  These nymphs reach maturity capable of reproducing in 2 weeks. 

    Transmission:

    • Contact with an infested person.  Contact is common during play (slumber parties, sports activities, at camp, on a playground).
    • Sharing infested clothing, such as hats, scarves, coats, sports uniforms or hair ribbons.
    • Using infested combs, brushes or towels.
    • Lying on a bed, couch, pillow, carpet or stuffed animal that has recently been in contact with an infested person.
    • Head lice can survive only 1 to 2 days away from the scalp. 

    Treatment:

    • Use an effective pediculicide treatment to kill the lice and nits.  Treatment is only effective if the product (pediculicide) label instructions are followed carefully.  Failure to do so can cause re-infestation and increase resistance to the product. 
    • Use a fine-toothed comb to remove all nits from hair and scalp. Continue to comb for nits until no longer detected.
    • Wash clothing and linens in hot water; dry-clean non-washable items or place in sealed plastic bags for two weeks.  Soak combs, brushes, etc. in hot water (130° F) for 10 minutes.  Vacuum all carpets, pillows, mattresses and upholstered furniture including car seats.

    Immunization:

    • Does not apply.          

    School Action

    Head lice create the most common form of ill will in the schools.  They are the nuisances, not the students, not the family.  Remember to keep the best interest of the child in mind.  Provide as much privacy and confidentiality as possible.  Handle the situation kindly, gently and with sensitivity.  Strive to ensure that the children do not feel badly about themselves because they have head lice.  Keep in mind that anyone can get them. 

    Follow the procedure below for the prevention and treatment of Pediculosis:

    • Students who are displaying signs of head lice, such as excessive scratching of the head, may be sent to the health room to be checked as needed.  A thorough examination of the hair and scalp should be done for the presence of live lice.
    • Siblings should be checked for lice infestation as well.
    • If nits are present, contact parent/guardian and send Nit Notification and Treatment Letter home with student.  Student can return to class with a pass from the health room aide or RN.  Student must report to the health room on a daily basis to monitor process of nit removal until no nits are found*.  Student must report to the health room in 10 days for a final recheck.  If nits are still present, the RN should be notified for follow up. 
    • If lice are present, call parent to pick up the student.   
    • Give parent/guardian the following forms and review information:  
      -  Head Lice Notification and Treatment Letter - See Forms Section
      -  Head Lice Treatment & Nit Removal Plan (side two of above letter) 
      -  Additional Head Lice Information for Parents/Guardians 
      Note: If the parent does not pick the student up, he/she can be given the information and ride the bus home at the discretion of the principal. 
    • After lice treatment, the student must report to the health room with parent/guardian to be examined for lice/nits before they can return to class.    
      -  If no lice or nits are present, student can return to class with a pass from the health room aide or RN.  Student must report to the health room in 10 days for a final lice/nit recheck.
      -  If lice are present, the student is sent home with parent/guardian.  Note: Presence of lice 24 hours after treatment suggests a very heavy infestation, re-infestation, resistance  to therapy, or incorrect use of treatment product.  Discuss with parent/guardian what treatment was used and re-instruct on treatment options.  The parent/guardian may contact their licensed healthcare provider regarding re-treatment with a pediculicide. 
      -  If nits are present, notify parent/guardian using the Parent Notification Form and encourage continuing daily efforts to remove all nits.  Student can return to class with a pass from the health room aide or RN.  Student must report to the health room on a daily basis to monitor process of nit removal until no nits are found*.  Student must report to the health room in 10 days for a final lice/nit recheck.
    • Classroom head checks are not recommended.  A Head Lice Information letter is available and can be used at the principal’s discretion. 

    * Use the head lice/nit-tracking log to monitor progress.

    Controlling a Classroom Outbreak 

    There are measures you can take to reduce the number of outbreaks in your classroom:    

    • Encourage children not to share clothing and hair accessories.  
    • If possible provide individual lockers or separate hooks for clothing.
    • Wipe headphones after each use if shared.
    • Encourage children with long hair to keep it tied or braided.
    • Carpeted areas should be vacuumed as frequently as possible. Head lice are seeking new hosts, not hiding places. Use of insecticide sprays is not recommended.  (Head lice can only survive 1-2 days away from the scalp.)
    • Reinforce these messages before vacations and holidays. 
    • Watch for telltale scratching that might indicate head lice.  If you suspect that a child has head lice, contact the school health aide.
    • Invite the school nurse for a head lice prevention lesson in your class.

    Chronic Lice Procedure

    If head lice continue to be a recurring problem, the following procedures should be followed: 

    • Chronic lice is defined as a child having live lice three times in a school year; and the child has been absent for 10 or more days in a school year due to lice.* 
    • When a case of chronic lice occurs a written referral is sent to the school social worker.
    • The school social worker will contact the school school nurse and together they will schedule a home visit and/or parent/guardian contact.
    • The home visit/contact will include instructions, demonstrations and counseling regarding the lice situation.  
    • Check all other students in the class for lice.
    • Prior to returning to class, the student must be checked for lice and rechecked again in 10-days.
    • If chronic lice continue a second written referral is sent to the school social worker.  The school social worker and school nurse will make a second visit/contact. 
    • If the situation persists, prosecuting the family under the compulsory attendance law may be considered    

    Following proper procedure and documentation is essential in cases of chronic lice.* 

    *Use the head lice/nit tracking log to monitor the process.

    HEAD LICE TREATMENT & NIT REMOVAL PLAN 

    When one family member has head lice it is important to check all members of the household and close contacts.  Treat only the infested family members.  Follow the plan below:

    • The recommended first-line treatment is a FDA approved, over-the-counter, lice killing product (pediculicide) for humans.  The American Academy of Pediatrics recommends the use of a product that contains permethrin.
    • Before applying the treatment, cover the child’s eyes with a towel or washcloth.  Do not treat in the shower or bathtub. Instruct the child to lean over the sink and only apply the product to the head area.  This prevents absorption through other skin areas.
    • Apply lice product according to the label instructions.  If your child has extra long or thick hair, you may need to use a second bottle to assure complete coverage.
    • Wash the hair according to label instructions. Once applied, allow the lice killing product to continue working by using only regular shampoo for two weeks after treatment because cream rinses and conditioning shampoos coat the hair and protect lice from the lice killing the product.  
    • Following treatment, use a fine-toothed metal comb to remove lice and nits from the hair shaft.     Metal lice combs (i.e. Licemiester, etc.) are preferred because they have finer teeth for nit removal, are less likely to break or bend when combing through the hair, and can be boiled or sterilized.  Any remaining nits need to be removed by sliding the nit down the hair shaft with your fingernails.
    • Recheck the hair daily for lice or new nits laid close to the scalp.  Continue to comb out nits with the fine-toothed metal comb.  Removing all nits will help to prevent a new infestation.
    • Retreat according to the instructions on the lice-killing product (pediculicide).
    • Continue to check all treated and untreated persons in the same household for 2-3 weeks even after they appear to be nit and lice free.

    Alternative Treatments

    The effectiveness of non-pesticide treatments such as Hair Clean 123, Not Nice to Lice, olive oil, mayonnaise, and petroleum jelly has not been proven through research

    ALERT:  The use of kerosene, gasoline, paint thinners, turpentine, flea products, or industrial/garden pesticides is dangerous to your child.

    Cleaning the Environment:

    1. To live, adult lice need to feed on blood.  Lice die within 1-2 days when away from the blood source.  Therefore, excessive cleaning measures are not necessary, however, routine cleaning is recommended as follows: the same day as the head treatment, clothing and bed linen should be washed in hot water and dried in a dryer; carpets and upholstered furniture need to be vacuumed thoroughly; pillows and stuffed animals should go into a hot dryer for at least 10 minutes or be placed in a sealed plastic bag for 2 weeks and combs, brushes and hair accessories should be soaked in hot water (at least 130 degrees) for at least 10 minutes.

    2. Spraying of furniture, rugs, carpets, car seats, and pets with a pesticide is not recommended.

    Additional Head Lice Information for Parents/Guardians

    What are head lice?
    Also called Pediculosis humanus Capitis, head lice are parasitic insects found on the human head and scalp.  Having head lice is very common, however, there is no reliable data on how many people get head lice in the United States each year.

    Who is at risk for getting head lice?
    Anyone who comes in close contact with someone who has head lice, or contact with their clothing or other personal items (such as brushes or towels).  Preschool and elementary-age children, 3-10, and their families are infested most often.  Head lice are more common in females than in males.  

    What do head lice look like?
    There are three forms of lice: the nit, the nymph, and the adult.

    Illustration of a nit.

    Nit:   Nits are head lice eggs.  They are hard to see and are often mistaken for dandruff or hair spray droplets.  Nits are found firmly attached to the hair shaft.  They are oval and usually yellow to white in color.  Nits take about 1 week to hatch.

    Nymph:  The nit hatches into a baby louse called a nymph.  It looks like an adult head louse, but is smaller.  Nymphs mature into adults about 7 days after hatching.  To live, the nymph must feed on blood.

    Adult:  The adult louse is about the size of a sesame seed, has six legs, and is tan to grayish-white.  In persons with dark hair, the adult louse will look darker.  Adult lice can live up to 30 days on a person’s head.  To live, adult lice need to feed on blood.  A louse can only survive 1-2 days away from the scalp.

    Where are head lice most commonly found?
    They are most commonly found on the scalp, behind the ears and near the neckline.  Head lice hold on to hair with hook-like claws found at the end of each of their six legs.  Head lice are rarely found on the body, eyelashes, or eyebrows.

    What are the signs and symptoms of head lice infestation?

    • Tickling feeling or something moving in the hair
    • Itching, caused by an allergic reaction to the bites
    • Visible lice crawling on scalp and hair
    • Irritability
    • Sores on the head caused by scratching.  These sores can sometimes become infected.

    How did my child get head lice?

    • Contact with an infected person.  Contact is common during play (slumber parties, sports activities, at camp, on a playground).
    • Sharing infested clothing, such as hats, scarves, coats, sports uniforms, or hair ribbons.
    • Using infested combs, brushes, or towels.
    • Lying on a bed, couch, pillow, carpet, or stuffed animal that has recently been in contact with an infected person.

    Note: This Information was obtained from the Centers for Disease Control.  For more information about head lice, access this website:  http://www.cdc.gov under “search” type in head lice.