Head Lice Nits

Overview

Head lice are tiny insects that live on the scalp and feed on blood. Nits are their eggs, which stick firmly to hairs near the scalp. Head lice crawl from head to head — they do not jump or fly. They are common, annoying and treatable, and they are not a sign of poor hygiene.

Yes, head lice are very common, especially in children of primary school age. They can affect anyone and are not a sign of poor hygiene.

Anyone can get head lice, but they are most common in children aged about 4 to 11 and in people who live with or care for them.

Symptoms

Common symptoms

• Itching of the scalp, though not everyone notices it
• A tickling or crawling feeling in the hair
• Live lice seen on the scalp or hair
• Nits stuck to hairs, especially close to the scalp
• Scratch marks or mild scalp irritation
• Poor sleep because itching is worse at night

Symptoms in children

• Frequent scratching of the head or neck
• Irritability or trouble sleeping
• Nits or live lice found during school or nursery checks
• Scratch marks or small sore spots on the scalp

Symptoms in older adults

• Head lice can affect people of any age, including older adults
• Itching or scalp irritation may be the main symptom
• Mobility or eyesight problems can make self-checking harder, so ask a family member, carer or pharmacist for help
• Lice are still not a sign of poor hygiene

Causes

Main causes

• Direct head-to-head contact with someone who has live head lice
• Less commonly, sharing hats, brushes, combs, pillows or headwear with someone who has lice
• Head lice crawl; they do not jump, fly or swim
• Pets do not spread head lice

Risk factors

• Being a child of primary school age
• Attending school, nursery or childcare
• Having siblings or close household contacts with lice
• Sleepovers, camps or other close-contact activities
• Longer hair can make combing harder, but hair length does not cause lice
• Poor hygiene does not cause head lice

When to see a doctor

See a doctor urgently if:

• Signs of a skin infection on the scalp, such as spreading redness, warmth, swelling, pus or fever
• Severe itching that is not settling and is causing poor sleep or distress
• A severe allergic reaction after a lice product — call your local emergency number

Book a routine appointment if:

• You are not sure whether you have found live lice or only old nits
• Treatment does not seem to be working after a full course
• You are pregnant, breastfeeding, or need to treat a baby or young child
• Someone has asthma, eczema or broken skin and you need advice before using a pharmacy product
• You want help checking a person with limited mobility or eyesight

Diagnosis

A healthcare professional or pharmacist may check the hair, but most people can check at home. The best way is to comb wet, conditioned hair with a fine-toothed detection comb and look for live lice. Finding at least one live louse confirms active head lice.

Tests that may be done

• Wet combing with conditioner and a fine-toothed detection comb
• Dry detection combing
• Checking close household and other contacts for live lice

What to expect at your appointment

The check is simple and painless. Finding only empty nits far from the scalp may be old and does not always mean active infestation. A pharmacist, school nurse or GP can advise if you are unsure.

Treatment

Head lice are treated by checking everyone in close contact, treating only those with live lice, and using either careful wet combing or a medicated product from a pharmacy. Treatment works best when it is done properly and repeated as instructed.

Self-care at home

• Wet combing: wash the hair, apply plenty of ordinary conditioner, and comb from the roots to the tips with a fine-toothed detection comb.
• Wipe the comb on a white tissue after each stroke so you can see any lice.
• Repeat wet combing every 3 to 4 days for at least 2 weeks, and until no lice are found for 3 sessions in a row.
• Check all close contacts and treat only people who have live lice.
• Children can usually stay in school or nursery; head lice are not a reason to keep them home.
• You do not need to fumigate the house or deep clean everything. Washing recently used bedding and clothing in a normal hot wash is enough.
• Do not use fumigant sprays or insecticide bombs; they are unnecessary and can be harmful.

Medical treatments

A pharmacist can recommend a medicated lotion or spray suitable for the person's age and health. Follow the instructions exactly, including any repeat treatment. Ask for advice before using these products on infants, during pregnancy or breastfeeding, on broken skin, or if someone has asthma or eczema.

When is surgery considered?

Surgery is not used to treat head lice.

Living with this condition

Check the whole household and other close contacts, comb hair regularly during an outbreak, and keep up the treatment schedule until no lice are found. Head lice are a normal part of childhood for many families and are not a hygiene problem.

Lifestyle tips

• Avoid head-to-head contact with someone who has live lice.
• Do not share brushes, combs, hats, scarves or pillows during an outbreak.
• Tying long hair back may help reduce contact, but it is not a guarantee.
• You do not need to treat pets or wash the whole house.
• Tell the school or nursery if you are comfortable doing so, so other families can check for lice.

Diet and exercise

No special diet or exercise is needed. Eating well and staying active support general health, but they do not treat or prevent head lice.

Mental health and emotional wellbeing

Head lice can cause embarrassment, worry or stress, especially for children and parents. It may help to remember that lice are common, do not carry disease and are not a sign of poor hygiene. If the experience is causing a lot of distress, talk to a pharmacist, school nurse or GP.

Prevention

You cannot always prevent head lice, but early checking and avoiding head-to-head contact can help. There is no strong evidence that repellent sprays or special shampoos prevent lice.

Vaccines

There is no vaccine for head lice.

Screening programmes

There is no routine screening programme. Check with a fine-toothed detection comb if you have been in close contact with someone with lice or if your scalp is itchy.

Complications

If left untreated

• Ongoing itching and poor sleep
• Scratching can break the skin and lead to a skin infection
• Embarrassment, worry or missed school or work
• Head lice do not spread disease

Long-term outlook

Head lice are not dangerous and are very treatable. Most people clear them with careful combing or a pharmacy treatment. It can take patience, but it is not a sign of failure or poor hygiene.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.