Head lice and nits

Head lice

Children in nurseries and primary schools are particularly exposed to head lice due to play with a lot of close contact. The most common cause of head lice is head-to-head transmission. Regular checks for head lice are the best measure to prevent the spread and larger outbreaks, therefore examine the children for head lice at least once a month.

How to detect head lice?

Head lice thrive best on the neck, behind the ears and up towards the back of the head. Lice can live on the scalp for several weeks without being detected. Signs of lice can be:

• Itching (the saliva of the lice triggers itching in many people when bitten), but not everyone who has lice experiences itching!

• Ulcers or infections in the scalp (can come from torn lice bites).

• Louse droppings (looks like black powder) can be detected on the head pillow or collar.

The easiest way to detect lice is to comb wet hair with a lice comb. Wet hair prevents the lice from moving as quickly, making them easier to spot. Put a white towel over your shoulders when combing and check both the towel and the comb for lice and eggs.

What do lice look like?

Adult lice are 2-3 millimeters long and can have different colours: grey, transparent, black, brown or red (just after they have sucked blood). Young lice (the nymphs) resemble adult lice, but are smaller and often more transparent in colour.

Lice eggs with contents are firmly attached to the hair strands closest to the scalp and have a yellowish-white, transparent colour. Hatched eggs are whiter in color and have no lids. Eggs that sit longer than 1 cm from the scalp are often already hatched or dead.

Both lice and lice eggs can be seen with the naked eye, but a magnifying glass is useful for seeing details.

Prevention of lice

• The best measure is to examine the children regularly, at least once a month, preferably every week.

• Do not borrow hats, scarves, hair ties or combs from each other.

• When lice are discovered, it is important that everyone in the family, class or nursery is informed and checked for lice.

How are lice transmitted?

Lice are transmitted by lice crawling from one head to another through direct contact or through the shared use of hats, scarves, hair ties and combs. Lice move quickly, but cannot fly or jump. They die within 2 days if they get away from the scalp.

Treatment of lice

If lice are detected, it is important to start treatment as soon as possible. It is not necessary to treat anyone other than the person(s) who have been diagnosed with lice. If several members of the family have been attacked, these should be treated at the same time to prevent re-infection.

Lice comb

Thorough and systematic combing with a lice comb in wet hair can fight head lice. Treatment with lice medicine will also be better if it is combined with combing.

Place a white towel over your shoulders to catch lice and eggs that come loose from your hair. Comb systematically through the hair from the scalp down to the ends. Use good light and preferably a magnifying glass. Rinse the comb or wipe after each comb to remove dead lice. Feel free to use conditioner to make combing easier. Combing must be carried out every day or every other day for 12-14 days.

How to comb and use the lice comb correctly?

• Part the hair in several sections

• Divide each lot into small strands

• Then carefully comb each lock of hair; start from the roots and comb the entire lock out towards the tip of the hair

• When a lock of hair is finished combing, you put it back

• Clean the comb after each lock of hair

• The towel and lice comb must be washed at 60 °C or placed in the freezer for at least 4 hours to kill lice and eggs. Check the hair, preferably daily, for 3 weeks after the last day of treatment.

Shaving

Shaving the scalp to a hair length of less than 0.5 cm may be a relevant form of treatment for some. Then the lice will have nothing to cling to.

What do I do if new lice are discovered after treatment?

If live lice are detected after completing the course, you should try another lice remedy.

If you discover live lice after the first of the two recommended treatments, then these are newly hatched lice. You should not change the lice remedy, but complete the course as normal.

It is not unusual to see dead or hatched eggs in the hair after having lice. New eggs are usually closer than 1 cm from the scalp, and if you discover this after completing treatment, you should be extra careful when checking for live lice.

Be aware that re-infection from others with lice can occur, and that this is a common reason why many people do not get rid of lice on the first try. It is therefore very important that everyone in the social circle, in the nursery and at school, checks and treats with lice medicine if lice are detected, to prevent re-infection.

How to remove lice from the home?

It is unlikely that head lice are transmitted via furniture and clothing, but headgear, bedding and towels should be cleaned in one of the following ways:

Wash at a minimum of 60 ºC

Freeze overnight (-20 ºC for at least 4 hours)

Store the items in a room that maintains at least 25 ºC for 2 days

Can the child go to nursery/school after head lice?

The child can continue to attend nursery school and school as normal. If head lice are discovered when the child is at nursery or school, it is not necessary to send the child home either. However, it is important that treatment with lice medicine starts as soon as possible after the child comes home. Also inform the nursery school/school, so that other children can check themselves.

Sources:

Institute of Public Health, Norwegian electronic medical handbook, Norwegian drug handbook for healthcare personnel, Joint catalogue, Manufacturer information and Relis