Head lice and nits

Introduction

Head lice are tiny insects that live on the scalp and hair and feed on blood. They do not have wings and cannot:  

  • jump 
  • swim 
  • fly.  

Female head lice lay their eggs on strands of hair near the scalp. After 5-7 days, the eggs hatch and become nymphs. Nymphs grow into adult head lice after about a week. 

Nits are the empty eggshells that are stuck to the hair after hatching. An infestation of lice is called pediculosis. Untreated, the egg-laying process repeats approximately three weeks later.

Head lice feed by biting the skin on the top of the head, called the scalp, which causes severe itching. 

Head lice do not spread diseases, but scratching the scalp can cause irritation and infection. 

Head lice can be common in school-aged children and spread through head-to-head contact, like: 

  • hugging 
  • play 
  • sharing hair combs or brushes. 

They do not live long on surfaces other than the scalp and rarely transfer through items like: 

  • clothing 
  • hats 
  • furniture 
  • bedding. 

Headlice are not caused by dirty hair and are not a sign of poor hygiene. 

 Signs and symptoms

Not every child will have symptoms, but most children will feel intense itchiness and may also feel a “crawling” sensation on their head. 

Some children may also develop irritation or an infection from scratching their scalp. 

Diagnosis

Head lice does not need to be diagnosed by a doctor. 

If your child has head lice, you will be able to see it by looking closely at their scalp.  

Head lice:  

  • are about the size of a sesame seed 
  • have six legs 
  • have no wings 
  • are white, grey, or reddish-brown.  

Nits are:  

  • oval-shaped 
  • brown or white 
  • about the size of a pinhead.  

Treatment

There are two types of head lice treatment 

  1. mechanical removal – using a comb and conditioner  
  2. chemical removal – using treatments from the chemist and a comb. 

Mechanical removal is recommended as it is less likely to irritate your child’s scalp and skin.  

To prevent the lice from building up resistance, only use chemical treatments on children who have a confirmed case of head lice.  

Mechanical removal

Mechanical removal is also known as the “conditioner and comb” method. 

Hair conditioner does not kill the lice, but it makes them easier to remove from the hair.  

You will need: 

  1. a metal lice comb – available from your local chemist 
  2. hair conditioner 
  3. paper towel or tissue. 

Generally, the steps for mechanical removal are: 

  1. make sure your child’s hair is dry and combed with no tangles or knots 
  2. apply a good amount of conditioner to the hair 
  3. comb small sections of the hair from the root to the tip 
  4. after each section, wipe the conditioner off the comb onto the paper towel or tissue  
  5. continue to comb until you cannot find any more lice or nits 
  6. repeat every 2-3 days until all the lice and nits are gone. 

Chemical removal

Chemical removal involves using a special head lice product to kill the lice before removing them. These products contain insecticides and can be bought from your local chemist. 

Chemical head lice treatments are not recommended for use on babies or children with scalp irritation from scratching.  

You will need: 

  1. a metal lice comb – available from your local chemist 
  2. the chemical head lice product 
  3. paper towel or tissue. 

You will need to: 

  1. make sure your child’s hair is dry and combed with no tangles or knots 
  2. follow the directions on the package closely 
  3. protect your child’s eyes from the product 
  4. repeat the treatment after one week to kill any newly hatched eggs 
  5. comb through your child’s hair to check for any remaining lice. 

If you are still finding lice and nits after treatment, try the mechanical method. 

 Management

When to see your doctor

In most cases, head lice can be managed at home with the treatment options outlined.  

Scratching and itching can increase your child’s risk of infection. See your local doctor if your child develops any of the following symptoms on their scalp: 

  • scabs 
  • blisters 
  • bleeding. 

Preventing spread

If your child has head lice or nits: 

  • start treatment immediately 
  • regularly check their hair for lice 
  • avoid head-to-head contact with others 
  • let your child's school or daycare know. 

In NSW, children do not need to be sent home or excluded from school due to head lice. Children can continue attending school or childcare as long as treatment starts before the next day.  

Lowering the risk of head lice

There is no way to prevent your child from ever getting head lice. 

You can lower the risk by: 

  • tying back or braiding their hair  
  • checking their hair and head regularly with the “comb and conditioner” or mechanical method.