Head Lice And Nits

Overview

Head lice are tiny insects, about the size of a sesame seed, that live close to the scalp and feed on a small amount of blood. They cannot jump or fly — they crawl from one head to another. Nits are the empty egg shells that stay glued to hair after the baby lice have hatched. Head lice are a common, annoying problem, not a sign of being dirty, and they do not spread disease.

Yes. Head lice are very common worldwide, especially among primary-school-age children. Most families will deal with them at some point.

Anyone can get head lice, but they are most common in children aged about 4 to 11 and in the people they live with. They affect all hair types, backgrounds and income levels equally.

Symptoms

Common symptoms

• Itching of the scalp, especially behind the ears and at the back of the neck — this is an allergy to lice saliva and can take a few weeks to appear
• A tickling or crawling feeling in the hair
• Live lice seen moving in the hair, often near the scalp and behind the ears
• Small white or brownish egg cases (nits) stuck firmly to hairs — they do not flick away like dandruff
• Small red bumps or scratch marks on the scalp or neck
• Some people have no symptoms at all, particularly with a light infestation

Symptoms in children

• Frequent scratching, which may cause sore or broken skin on the scalp
• Irritability or poor sleep because lice are more active in the dark
• Nits found during a school or nursery check
• Sometimes a rash-like irritation at the nape of the neck

Symptoms in older adults

• Head lice are less common in older adults but can still happen, usually caught from grandchildren or other close contacts
• Itching may be less obvious, so lice can go unnoticed for longer
• It is worth checking all household members if one person has lice

Causes

Main causes

• Direct head-to-head contact with someone who has lice — this is by far the most common way they spread
• Crawling from one head to another during close contact such as hugging, sleeping close together, or taking group photos with heads touching

Risk factors

• Being a child of primary school age, or living with one
• Close contact at school, nursery, sleepovers, camps or clubs
• Having siblings or household members with lice
• Long hair can be harder to comb thoroughly, but any hair type can host lice

When to see a doctor

See a doctor urgently if:

• Signs of a skin infection: spreading redness, swelling, warmth, pain, pus or crusting on the scalp or neck
• Fever together with a painful or swollen scalp
• A reaction to a treatment such as a rash, swelling or breathing difficulty (call emergency services if breathing is affected)

Book a routine appointment if:

• You are not sure whether it is head lice or something else, like dandruff or seborrhoeic dermatitis
• Treatment has not worked after two full courses done correctly
• Lice are found in eyelashes or eyebrows
• The person with lice is pregnant or breastfeeding, or is a baby under 6 months old
• The person has asthma, eczema or a sensitive skin condition and you want advice before using a medicated treatment
• The itching is disturbing sleep and affecting daily life

Diagnosis

You can usually check for head lice yourself at home. The reliable method is 'detection combing': wash the hair, apply plenty of ordinary conditioner, then comb through with a fine-toothed detection comb, wiping the comb on a white tissue after each stroke and looking for moving lice. Pay special attention to behind the ears and the back of the neck.

Tests that may be done

• Wet combing with conditioner and a fine-toothed detection comb (the main way to confirm lice)
• Checking whether 'nits' are firmly glued to the hair shaft (lice eggs) rather than loose flakes of dandruff
• No blood tests, swabs or scans are needed

What to expect at your appointment

A check takes about 10 to 15 minutes. Finding even one live louse means treatment is needed. Finding only empty egg cases far from the scalp may mean an old, treated infestation. Your pharmacist or practice nurse can show you the combing technique if you are unsure.

Treatment

There are two main approaches, and both work if done properly: regular wet combing with conditioner, or a medicated treatment bought from a pharmacy. Many families try wet combing first, especially for young babies, during pregnancy, or when someone has asthma or eczema.

Self-care at home

• Wet combing ('bug busting'): apply lots of conditioner to wet hair, comb through with a fine-toothed detection comb from root to tip, wipe the comb on a white tissue, and repeat over the whole head. Do this every 3 to 4 days for at least 2 weeks, until no lice are found for three sessions in a row.
• Check every household member with the same combing method, and treat anyone who has live lice on the same day.
• Tell the school, nursery or club so other families can check — this helps stop lice going round and round.
• There is no need to deep-clean the house. Lice die quickly off the head; washing bedding and towels on a hot cycle and soaking hairbrushes in hot water is enough.
• There is no need to keep a child off school, and no need for special shampoos or sprays as a 'preventer'.
• Avoid scratching: keep nails short and consider a plain moisturiser for irritated skin.

Medical treatments

Pharmacists sell medicated lotions and sprays designed to kill head lice. Some kill lice only and need a second application about a week later to catch newly hatched lice; others may affect eggs too. Which one suits you depends on age, pregnancy or breastfeeding, asthma, eczema and skin sensitivity, so always ask your pharmacist to help you choose and read the instructions carefully. Apply enough to cover the scalp and hair, leave it on for the time stated, and repeat as directed. Never use pet flea products, kerosene, or other home remedies on hair — they can be dangerous. If two properly done courses fail, see your doctor or pharmacist for advice.

When is surgery considered?

Surgery is never needed for head lice.

Living with this condition

Life carries on as normal. Children go to school, adults go to work, and sports and sleepovers can continue — just let close contacts know so they can check. Set a reminder for combing days so the routine does not slip, and keep a fine-toothed comb in the bathroom.

Lifestyle tips

• Make combing part of a weekly routine for children during term time, so lice are caught early
• Tie long hair back for school and activities to reduce head-to-head contact
• Avoid sharing brushes, combs, hats and hair accessories while lice are being treated
• Wash recently used bedding and towels on a hot cycle

Diet and exercise

No special diet or exercise is needed. Eating well and sleeping well help anyone feel better, and there is no food or vitamin that prevents or treats head lice.

Mental health and emotional wellbeing

It is very common to feel embarrassed, anxious or frustrated, especially if lice keep coming back. Remember that lice are a normal part of childhood and say nothing about you or your family. If the worry is affecting your sleep or mood, or your child feels upset or teased, talk to your doctor, school nurse or pharmacist — they hear this all the time and can reassure you.

Prevention

You cannot fully prevent head lice, because they spread through ordinary close contact that is part of normal life. What helps most is regular detection combing so lice are found and treated early, before they spread to the whole household. There is no good evidence that repellent sprays or 'preventive' shampoos work.

Screening programmes

Weekly wet combing with conditioner is the best 'screening' for children of primary school age, and after any letter from school about lice, or after sleepovers and camps.

Complications

If left untreated

• Continued itching and disturbed sleep
• Broken skin from scratching, which can occasionally become infected and need antibiotics
• Spread to other household members and classmates
• Ongoing worry, embarrassment or teasing

Long-term outlook

Very good. Head lice are common, harmless and treatable, and almost every case clears with consistent combing or a pharmacy treatment. It can take a few weeks and a couple of rounds, so try not to be discouraged if you find a louse after the first attempt — that is normal. If things are not settling, your pharmacist or GP can help you work out what is going wrong.

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