KENSINGTON, Maryland (WUSA/USA Today)--Head lice are a common problem for children, says the American Academy of Pediatrics. Especially for those kids between the ages of 3 and 12.

Head lice live only in human hair. The nits (un-hatched eggs) have some sort of sticky substance that allows the nit tograb hold of a hair shaft for dear life. A nit will hatch between 7 and 10 days after an adult female louse (that's singular for lice) has laid it. The female louse can lay one nit every 3 to 4 hours. The total life span of lice is between 30 to 32 days.

As for size, think small. Very small. They can range in size from a pinhead to the size of asesame seed.

Head lice don't carry disease. They are a nuisance that can cause a lot of itching, and in some cases infection due to allergic reactions. However, it's important to note that not all people with lice itch. And for those who do, the itching usually starts several weeks after the lice have arrived.

Despite the popular belief, head lice don't fly. Instead they spread directly by head-to-head contact or by sharing things such as a hat or a hair brush.

"Think about what kids share these days," says Karen Franco. She is a lice expert who has started her own business in Kensington, Maryland called Advice on Lice. "There arehead phones, there's head gear in the gym. There are all kinds of things. Nap time in school where kids will sometimes share mat space. There's so much interaction and coming together of children these days.

It's Franco's job to help the lice-laden get rid of their little hitchhikers.

"There shouldn't be a stigma," says Franco.

Franco equates lice to the common cold. It's not about hygiene. It's not your child, she says, anyone can get them. Lice are not a sign of uncleanliness.

"It doesn't matter if you wash your hair every day or twice a week. It doesn't matter if the person you caught it from washes their hair every day or twice a week," says Franco.

Franco says the best way to prevent a lice-laden nightmare, is a tough offense.

Franco recommends a head check of children every week (minimally). Shelikesusing a fine-toothed nit comb when looking for the nits.Nits are oval and they look either milky white or tannish-brown.

"When you screen somebody for lice you are not actually looking for the bugs, but the eggs. They areglued onto a piece of hair. So you are going to look for eggs. They are not going to move.

"If a nit is laid it has the potential to become a bug, unless we get it out beforehand. So if you find them on the head, and they are empty, then whatever came out of that is likely to be in the head.

"In our experience the most often first zone of infestation is the crown of the head," says Franco.

Although behind the ears and the nape of the neck are also popular lice spots.

Bottom line, check the entire head! Go slowly and think small!


1. Use a nit comb to get out as many nits or eggs as possible. Commonly sold nit combs have more closely spaced teeth and are more reliable than louse combs, which have slightly more wide-spaced teeth. A metal comb works better than one with plastic teeth.

2. Place a towel over the person's shoulders.

3. Brush or comb the hair first with a regular brush and comb to remove tangles. Be sure to disinfect these with alcohol or boiling water after use. It's easiest to comb out slightly wet hair. For children with very curly hair, using a slightly diluted solution of water and conditioner, or a spray on detangler, can help make combing out easier.

4. For short hair, begin on one side of the head and, taking a few strands of hair at a time, carefully comb from the base of the scalp up, holding the nit comb at a sharp angle to the hair so no nits or lice can escape as you pull it through.

Some use a wooden skewer (with the tip slightly dulled by tapping it on a counter) to take up just a thin line of hair at a time. Others use tweezers. Be careful not to scratch, scrape or cut the child's head as you go.

For long hair, it can be helpful to divide the head into quadrants and twist it into ponytails or secure with hair clips, so hair that's been combed doesn't touch hair that hasn't.

5. If you see something, grab it with your fingers or tweezers and inspect closely to make sure it's actually a louse. If it is, dunk it in the bowl of alcohol or water. This ensures you've killed it.

6. Moving slowly and methodically, work your way across the head. Take only a few strands at a time and look closely to check for nits stuck to the base of the hair, usually within an inch of the scalp. You may have to reposition yourself, the child or the light so you can get a good look.


If you're going to treat using over-the-counter lice killing products, there are two main choices, pyrethrin-based shampoos (a common one is RID) or permethrin-based cream rinses (a common one is Nix).

The American Academy of Pediatrics recommends the use of these treatments and does not consider them harmful to children when used properly.

Pyrethrin-based shampoos are made from natural extracts of chrysanthemum. This formulation kills live lice but does not kill any newly laid eggs. An estimated 20% to 30% of eggs remain viable after treatment. These formulations dissipate quickly and are virtually undetectable just a day after treatment.

Permethrin-based conditioners are made from synthetic pyrethroid and have an even lower mammalian toxicity than do pyrethrins. This treatment also leaves 20% to 30% of eggs viable, but leaves a slight residue on the hair that is designed to kill lice emerging from their eggs (called nymphs).

You'll also need:

  • Towels
  • Metal-toothed nit-and-lice comb
  • Rubbing alcohol
  • Tweezers
  • Hair clips (the kind used by hair stylists) to pull long hair out of the way.
  • A bowl
  • A good source of light. Outside daylight is excellent, but a clamp light works nicely. Some people duct-tape flashlights to floor lamps to get light at the right height.
  • A magnifying glass or cheap reading glasses from the drug store.

1. First brush and comb the hair over the bathtub or sink to dislodge as many lice as possible. Some recommend moistening the hair first with water, conditioner or detangler to slow down the live lice and decrease the chance of lice spreading to the person doing the combing. Moistening helps the lice stick to the comb and not become airborne via static electricity.

2. Then wash the hair using plain shampoo. It is very important not to use a 2-in-1 shampoo/conditioner, as the conditioner can make it difficult for the treatment to reach the lice. Note that many children's shampoos are 2-in-1 shampoo/conditioners. This is a common mistake. "When these products first came out, people were using the old Prell-type shampoos, which were like detergents," says Barbara Frankowski of the Vermont Children's Hospital.

3. Towel-dry the hair until it is almost dry. "If you put the treatment on sopping wet hair, you're diluting the shampoo or treatment so it's not going to work so well," says Frankowski.

4. Apply either pyrethrin-based shampoo or a permethrin-based rinse. The instructions for the pyrethrin-based shampoo say to apply to dry hair, but washed and towel-dried is fine.

In each case, make sure the hair is totally soaked in the solution and leave it on for 10 minutes.

5. Rinse out with cool water over the sink, not in the shower or bathtub. This minimizes possible absorption through the skin.

This counts as Day Zero. You will need to reapply your chosen treatment on Day 7 to kill any lice that may have hatched from eggs that were not killed by the first treatment. Some experts also recommend a final treatment on Day 13 or Day 15. The package instructions say to reapply on Day 7-10. Some experts suggest that the best timing for products that are not completely ovicidal (egg-killing) is Day 9 and then Day 13-15. That applies to both these over-the-counter products.

6. Now comes the tedious part. You need to use a nit comb to comb through the hair for possible nits and lice every day. This can be a quick 10-minute comb through each day or a full-head nit-removal inspection. The key is to do at least some looking every day to minimize the chance of any more eggs being laid.

7. If you find large full-grown live lice in the hair the day after treating, it's possible that you didn't correctly treat. At this point, check with your health-care provider and describe the process you went through to make sure that you treated correctly. You might be advised to treat again if the treatment was applied incorrectly. But don't treat two days in a row without checking with a health-care professional.

If you find small lice, it's very likely they just hatched and don't indicate there was a problem with treatment, so re-treatment is not necessary.

8. If the day after the second treatment you still are finding live full-grown lice (as opposed to newly hatched babies), you may be dealing with resistant lice, in which can you should:

Consult your pediatrician about possibly using a malathion-based lotion, sold as Ovide and only available by prescription. This is excellent at killing lice and nits, but it must be used very carefully, as it contains alcohol and is highly flammable.

Do careful, rigorous combing and nit-picking.

Consider hiring a professional lice-removal service. These services often provide a guarantee of total lice removal, but only if the entire family is treated. Their services are not cheap, costing between $50 and $100 an hour or treatment (except for a few non-profit services, which offer a sliding scale.)

Karen Franco's company, Advice on Lice, charges $85 the first hour; $65 per hour after that (or any part of an hour thereafter). Franco says an average visit is 1 to 3 hours, "depending on the number of people needing treatment, the severity of the infestation, and the length and thickness of hair."

Also, if one person in a family or school environment has lice/nits then everyone who had any contact with that child should also get checked out says Franco.

This means not being ashamed and spreading theword (remember lice has nothing to do with personal hygiene). Be open with family, friends and schools.

"Because if you find the lice infestation in its earliest stages and in the first head then you're going to have so much less work to do."


There are some things you can do that might help with a re-infestation of lice:

  • Wash all clothing, bed linens, towels and stuffed animals in hot water

  • Dry clean whatcan't be washed

  • Buy new pillows

  • Do a daily vacuuming of floors and furniture

  • Soak combs and brushes in rubbing alcohol

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