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Worried About Head Lice? Learn How to Prevent and Treat Infestations This Winter

Child holding head lice sign
Image via Getty Images


Lice. Just reading the word can send shivers down a parent’s spine.

However, lice infestations in children are relatively common. According to estimates from the Centers for Disease Control and Prevention, between 6 million and 12 million American children between the ages of 3 and 11 get head lice each year.

We called on the expertise of Dr. Edith Dietz, pediatrician at Johns Hopkins Bayview Medical Center, and Dr. Emily Wisniewski, pediatrician with Mercy Family Care Physicians, to address common concerns related to head lice.


What exactly is a head lice infestation in children?


“Head lice are tiny, but visible insects about the size of a sesame seed that take up a home on a human scalp,” explains Dietz. Head lice depend on human body temperature and “meals from our scalp” to survive, she notes. This combination fuels the lice and the infamous itching. Human skin gets irritated by the saliva from lice as they eat.

Infestations occur when an adult female louse lands on a human head. Once on the head, it will “lay eggs that are tightly bound to the hair shaft, close to the scalp,” says Dietz.

The most common symptom of head lice is itching, alongside excoriations (scratches) on the scalp, neck and behind the ears, says Wisniewski.

“You may even occasionally see some enlarged lymph nodes in the neck,” she adds. “Sometimes you can also feel a ‘crawling or tickling’ sensation.”

Notably, lice are most active at night. As a result, children may have a harder time sleeping, Wisniewski says.


How do head lice get passed to children?


Adult lice cannot fly or hop. They travel only by crawling. This action, Dietz notes, is why most lice transmission occurs when two individuals have direct contact with one another.

“Less often, lice can transmit from one person to another by a brush or hat, but they will die within about one day without food or warmth from a human,” explains Dietz.


Why is winter a notable time for infestations?


In terms of winter infestations, lice don’t necessarily have a season. Since people are in tighter quarters, sharing winter wear (like hats) or are in contact with more people, the season can promote infestations.

According to Wisniewski, “All of these (scenarios) ‘increase the risk of transmission’ because you have more contact with more people.”


Wait … how do I know it’s not just dandruff?


Another common cause of itchy scalp during cold months is dandruff, but you can distinguish this skin condition from lice. Wisniewski reports, “Lice lay eggs or nits (that) look like little grains of sand or rice which are on the hair shaft … as opposed to dandruff, which is more of a flakiness of the scalp itself, not the hair.”

Nits, she notes, will show up as a white or yellow color in the shape of a teardrop. Adult lice are “tan, brown or black in color.” Picking nits off the hair shaft is difficult, while dandruff should be easy to remove from a child’s scalp, she adds.


My child has head lice. Now what?


Mother using a comb to look for head lice.
Image via Getty Images

Treating lice is best done at home with a “combination of topical treatment and manual removal of nits … with a fine-toothed comb,” notes Dietz. This treatment process should kill all living lice within 12 hours, she explains.

Wisniewski adds that one application of treatment is usually enough, but a second may occasionally be necessary seven days later. She advises, “To make the cream most successful, we recommend not using conditioner before, using warm water (hot water actually makes it less effective) and putting the product in over the sink (we want to reduce contact with the skin if possible).” She notes that a doctor’s visit may be necessary to get a prescription for the topical cream. If a cream is unsuccessful, oral medication may be the next step.

“Lice do not spread other diseases,” Dietz emphasizes. “While an infestation can be very bothersome, it will never require hospitalization or threaten a child’s life.”

How can I protect my child against having winter head lice infestations?


Dietz acknowledges that direct contact among kids in certain indoors settings can be unavoidable. “Parents should teach kids not to share brushes, combs, barrettes and hats,” she says, but she stresses that these guidelines are never more important than the use of protective headgear.

“Regular surveillance can help to identify infestation before it spreads to others,” she adds.

Wisniewski emphasizes that the biggest risk factor for lice is direct contact with an infected person. “There is some controversy about whether you can transmit through products (like hats), but there is no harm in making sure we keep those shared products washed!” she explains. “If you decrease any sort of contact with infected people (including the sharing of items), you will likely decrease the risk of spreading lice around.”


Symptoms of lice include:


• Intense itching on the scalp.
• Tickling feeling in the hair.
• Sores on the scalp, neck and shoulders (scratching can lead to small red bumps that may become infected).
• Egg sacs on the hair shaft.


What’s the difference between dandruff and lice?


“Lice lay eggs or nits (that) look like little grains of sand or rice which are on the hair shaft … as opposed to dandruff, which is more of a flakiness of the scalp itself, not the hair,” says Dr. Emily Wisniewski of Mercy Family Care Physicians.