The best way to banish head lice

The note comes home from childcare or school, and your scalp starts itching out of pure sympathy. Take heart: head lice are one of the most common parts of childhood, with around one in four primary-school-aged children in Australia have them at any given time. They're a nuisance, sure, but they're not a danger. 

Here's what to do when your child brings home unwanted guests.

What's the difference between head lice and nits?

Head lice are tiny wingless insects that live on the scalp and feed on blood, while nits are their eggs, which cling firmly to the hair shaft close to the scalp. A female louse lays several eggs a day, and because some lice are hatching while others are laying, the cycle keeps going. That's why one treatment is never enough, you have to keep going to catch newly hatched lice.

How do you know if your child has head lice?

The most common sign is an itchy scalp, especially at the nape of the neck, behind the ears, and on the crown, though plenty of children have no symptoms at all. The surest way to check is to comb conditioner through wet hair with a fine-toothed lice comb and wipe it on a tissue after each stroke, looking for live lice and eggs. Eggs stick firmly to the hair near the scalp, while dandruff flakes off when you shake the hair.

How do you get rid of head lice?

Australian health authorities recommend two main approaches: the conditioner and comb method, and chemical (insecticide) treatments. According to the Victorian Government's Better Health Channel, both are accepted first options, and the conditioner and comb method is the safest for a mild case. Whichever you choose, you'll need to treat more than once, because no single treatment kills every egg.

If you use a chemical product, healthdirect advises applying it once and again 7 to 10 days later to kill newly hatched lice, checking the packaging for your child's age, and looking for an AUST R or AUST L number that shows it's registered with the Therapeutic Goods Administration. Insecticide resistance is common, so check that the lice you comb out afterwards are actually dead.

How do you do the conditioner and comb method?

The conditioner and comb method (sometimes called wet combing) stuns the lice so you can physically remove them, with no chemicals. Conditioner doesn't kill lice, but it immobilises them for around 20 minutes, long enough to comb them out. 

• Untangle first. Brush your child's hair with an ordinary comb to remove knots.
• Load up on conditioner. Cover the whole scalp and hair from roots to tips. White conditioner makes the dark lice easier to spot.
• Comb in sections. Using a fine-toothed metal lice comb, work from the scalp to the ends, section by section, starting at the nape.
• Wipe and check. Wipe the comb on a white tissue or paper towel after every stroke and check for lice and nits. Clear a clogged comb with an old toothbrush.
• Repeat the round. Keep combing each section until no more appear, then wash the comb in hot, soapy water.

Do this every second or third day until you find no live lice for 10 days straight.

What if the head lice treatment isn't working?

If you're still finding live lice after treatment, the most likely culprits are not using enough product, not repeating the treatment after 7 to 10 days, or insecticide resistance. Avoid re-applying the same chemical over and over. Instead, switch to a product with a different active compound, or use the conditioner and comb method. If treatments keep failing and live lice persist, see your pharmacist or doctor, who can advise on prescription options.

Can my child go to childcare or school with head lice?

Yes, in most cases. Children don't need to be kept home for long, and exclusion isn't an effective way to break the cycle anyway. A child may return to school or a children's service once treatment has started, even if some eggs remain, and there's no need for a clearance certificate from a doctor or council. The sensible step is to tell your childcare service or school so other children can be checked, which helps stop an outbreak spreading.

How do you prevent head lice coming back?

There's no product that stops your child catching head lice, since they spread through ordinary head-to-head contact and can't be repelled. What does help is staying alert. Tie long hair back, run a conditioner-and-comb check through your child's hair once a week to catch new arrivals early, and discourage sharing of brushes, combs, and hats. You don't need to fumigate the house: lice don't survive long off a human head, so beyond washing the pillowcase in hot water, there's no evidence that cleaning furniture or bedding makes a difference.

Head lice and parenting tend to go hand in hand, and a bout of combing is tiresome, but it passes. Take some comfort in the company (a quarter of Aussie classrooms are in the same boat) and in the fact that your child's hair will be beautifully conditioned by the end of it. If you're choosing a childcare service, it's fair to ask how they handle outbreaks and notify families, and you can search and compare childcare near you on Care for Kids.

FAQs

Do head lice spread disease?

No. Head lice are a nuisance, but they don't carry or transmit any infectious disease, which is one reason health authorities don't recommend excluding children from school or childcare over them.

Do head lice prefer dirty hair?

No. Lice feed on blood, not dirt, and are just as happy in freshly washed hair as in unwashed hair. Catching them says nothing about hygiene.

Can head lice jump or fly?

No. Head lice have no wings and can't jump. They spread only by crawling from one head to another during direct head-to-head contact, which is why they move so easily between children at play.

Do I need to wash all the bedding and clean the house?

No. Lice don't survive long away from the scalp, and research shows bed linen, hats, clothing, and furniture don't harbour or spread them. Washing your child's pillowcase in hot water is enough.