Head lice (Pediculosis)

What is Pediculosis (head lice infestation)?

Head lice are tiny insects about the size of a sesame seed that live on the skin of the scalp and  the hair. They feed on blood and lay eggs that they attach to the hair shaft. Eggs hatch in about a week, and the young lice feed and molt three times before molting again to an adult. Adult lice will live for about a month. Lice are common among children in all socioeconomic groups and are not a health hazard or a sign of uncleanliness. 

Signs and symptoms

• Presence of lice or attached eggs on the scalp or on the hair 
• Itching behind the ears and at the back of the neck (scratching may lead to secondary infections)

Incubation period

There is no incubation period. An infestation begins with the transfer of a louse or several lice to a new human host. Rarely, a shed hair with an attached nit can hatch and start an infestation. Shed hairs may be present on clothing or bedding.

Contagious period and spread

Head lice are spread by direct contact with the head of a person with infestation, or by contact with items used by a person with infestation such as combs, brushes, and hats. Lice walk. They cannot hop or fly.

A person can transfer lice to others as long as they are infested with live lice. Even when no live lice are present, there may be nits close to the scalp that have not hatched. Once these eggs hatch, live lice are once again present and can be transferred.

Public health reporting requirements

Individual cases are not reportable. The school nurse/facility director should be consulted for specific concerns. Consultation with the state or local public health agency is also available. 

Control of spread

• Teach children not to share personal items like hats, combs, brushes, scarves, or coats. 
• Hang coats separately. Do not hang or pile them on top of each other.
• Clothing and personal items should be stored separately (different hooks, cubby holes, etc.).
• Students/children likely to have had direct head-to-head contact with someone who is infested should be checked for lice and treated if live lice are found.
• Parents/guardians/caregivers of infested students/children should be instructed about in-home control measures and should check other household members for lice.
• Checking entire classrooms or schools has not been shown to be effective at controlling the spread.
• No-nit policies are not recommended because they have not been shown to be effective at controlling head lice infestations, and such policies may keep children out of the program needlessly. 
• Environmental control measures
  • Carpet and furniture can be vacuumed or gently ironed (not sprayed with insecticide).
  • Combs and brushes should be soaked in a disinfectant or lice-killing solution for at least 10 minutes.
  • Launder clothing and bedding in hot water (130℉) and dry them on high-heat setting for at least 40 minutes, OR dry clean them.
  • This should be done for items in the facility and at home.
  • Items that cannot be cleaned should be placed in a plastic bag for two weeks.

Treatment

• Over-the-counter and prescription treatments are available. Parents/guardians should consult with their health care provider if they have any questions about which treatment to use. 
• Follow treatment instructions closely. Nits can survive treatment, so a second treatment is needed seven to 10 days after the first treatment to kill lice that have hatched from those eggs.
• Flammable or toxic substances such as gasoline or kerosene should never be used.
• Use a nit comb to remove nits from the hair.
• Herbal and “natural” remedies, like ylang-ylang and tea tree and lavender oils, have not been scientifically studied and are not regulated by the FDA. Therefore, the content, safety, and effectiveness cannot be assumed, and use of these remedies does not represent treatment.

Exclusion

• Exclude a child or children with an active infestation from the end of the program or school day until after a pediculicide treatment has been applied. 
• Until the end of the program or school day, avoid any activity involving head-to-head contact or sharing of head gear.

Role of teachers, caregivers, and family

• Report infestation to the staff member designated for decision-making and action related to care of affected children in the facility.
• That person, in turn, will alert potentially exposed close contacts and staff members to watch for symptoms.
• Check children observed scratching their heads for lice — if lice are found, check all contacts.
• Teach staff and parents/guardians/caregivers how to recognize lice and nits.

Resources

Lice - Fact sheets and letter templates (CDPHE Google folder)