Getting a head lice notice from daycare, or spotting lice while your child scratches, can be upsetting. Head lice have nothing to do with cleanliness, tend to spread when children play with heads close together, and are not known to spread disease. The question most parents ask is when their child can return.
Why It Happens
Head lice are tiny insects that live on the scalp and feed on blood. They spread mostly through direct head-to-head contact because they crawl rather than fly or jump. Sharing hats, combs, or pillows may occasionally pass them along, but head contact is the main route. Eggs, called nits, are glued firmly to the hair close to the scalp and do not flick off easily, which sets them apart from dandruff.
How It Looks at Different Ages and Stages
Lice are common in children of preschool and elementary age, roughly 3 to 11 years, and tend to spread when kids play close together. Scratching behind the ears and along the neckline is the most common clue, but some children have little itching early on, so lack of itching does not rule lice out. Eggs are generally reported to hatch in about a week, which is why new lice can appear after a first treatment if some eggs survive.
Home Care
The AAP and CDC describe over-the-counter 1% permethrin or pyrethrin products as a reasonable first choice. Follow the label, and because these medicines do not kill every egg, a second application about 9 days later is commonly advised. After treatment, combing wet hair with a fine-toothed nit comb from scalp to tip can help remove nits. Clothing, pillowcases, and towels can be washed in hot water and dried on high heat, and items that cannot be washed can be sealed in a plastic bag for about 2 weeks. Fumigating the house or spraying strong insecticides is generally not considered necessary.
Common Parent Misconceptions
“No-nit” rules, which keep a child home until every nit is gone, are not supported by the AAP or the CDC. The CDC’s guidance is that a child can finish the school day, go home for treatment, and return once treatment has begun. Individual schools or daycares may still have their own rules, so it is sensible to check with your child’s teacher or program. Another common belief is that lice come from infrequent washing, yet clean hair is just as easy to infest. Cutting or shaving the hair is not required.
Signs That Need Medical Care
Talk with your pediatrician if live, moving lice are still present after two treatments, as another medicine may be needed. If heavy scratching leaves sores that become red, swollen, crusted, or filled with pus, a bacterial skin infection is possible. If these signs come with fever, a child who seems unwell, or redness that spreads quickly, go to urgent care or the emergency room right away. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.