Head lice infestation: Transmission, treatment & prevention

Head lice


Head lice are small wingless biting insects which live and breed in human hair and feed by sucking blood from the scalp. Head lice are a very common problem, especially for children. Outbreaks are common in children in schools and institutions everywhere.

Head lice infestation



They lay eggs which stick to strands of hair very close to the scalp. Once the egg hatches the empty case left behind is called a nit. Head lice are hard to see because they are tiny. Their eggs are very small, about one-third (1/3) the size of a sesame seed. They take 6 to 12 days to hatch the eggs. The nits are easier to see below the hair shaft. Both eggs and nits may look like dandruff, but are hard to get off because they are sticky.

They’re contagious, annoying, and sometimes tough to get rid of. But while they’re frustrating to deal with, lice aren’t dangerous. They don’t spread disease, although their bites can cause scalp irritation, itching and scratching which can lead to infection. It’s best to treat head lice quickly because they can spread easily from person to person.

How are head lice spread?

Anyone can get head lice. Having lice does not mean a person has poor personal hygiene or lives in an unclean environment. Anyone who has hair can get lice. They are most commonly spread through head-to-head contact by crawling from one hair to another. Head lice are commonly spread among people who have close head-to-head contact. Head lice cannot jump or fly from 1 person to another.

Rarely, it can also be spread by contact with items which have been recently used by someone with head lice, such as:

  • combs
  • brushes
  • hats
  • scarves
  • pillowcases.

What are the symptoms?

Often people who have head lice have no symptoms. However, less than half can experience symptoms such as;

  • crawling or tickling sensation on the scalp
  • itchy scalp due to an allergic reaction caused by the bites
  • scratch marks or small red bumps like a rash
  • sores from scratching your scalp
  • tiny white specks (eggs or nits) on the bottom of each hair which are hard to get off

How can I check for head lice?

The most accurate way to check for head lice is the wet combing method:

Head lice



  • Wash and rinse the hair. Apply enough hair conditioner to cover the whole scalp (usually 2 handfuls). The conditioner stops the lice from moving, making them easy to find.
  • Use a wide tooth comb to get the tangles out. At any time if the comb tugs, add more conditioner.
  • Begin combing the entire head with a lice comb. Pull the comb through the hair in one stroke from the front to the back of the head. Keep the teeth in contact with the scalp for the entire stroke.
  • After each stroke, wipe the comb on a paper towel and check for lice.
  • If you find head lice or eggs, continue combing the whole head until there’s no conditioner and no more head lice appear in the comb.
  • Repeat the conditioner and combing at least every two or three days until you find no head lice for 10 days. This may take three to four weeks.

If you find no lice, repeat the above process weekly as part of your family’s hygiene routine.

Treatment of head lice

Treatment is only when live lice are present. However, head lice will not go away without treatment. If one person in the household has lice, there is a good chance other household members do as well. All members of the household should undergo an examination on the same day. Treatment should start for those with lice. The two most common treatment methods are wet combing and chemical treatment.

Wet combing

This method removes live lice. Wet combing is less expensive and non-chemical. It’s the same steps to check for lice above. Any young lice, that hatch from eggs after the first session gets off at the second, third and fourth sessions. This is why it is important to do the full series of sessions.

Furthermore, it is safe for infants, young children, as well as pregnant and nursing mothers.

Chemical treatments

OTC treatments such as shampoos, creams, rinses and sprays that contain an ingredient that kills lice. They are available at most pharmacies without a prescription. Some examples are permethrin, pyrethrins and dimethicone.

These products may not be appropriate for children or adults of all ages. Therefore, it is important to talk to your health care provider or pharmacist to find out which is best for you or your child. Always carefully follow the directions for use on the label.

Most treatments are repeated in 7 to 10 days. This is to make sure that any head lice that have hatched after the first treatment are killed before laying any eggs. It is also important to check the head for any eggs and remove them after the second treatment. Itching may however last for 7 to 10 days, even after successful treatment.

Preventive measures

Even though it’s not possible to completely prevent head lice, the following tips can help.

  • Brush your hair every day. This can help to kill or injure lice and stop them from laying eggs.
  • Don’t share brushes, combs, headbands, ribbons, hair clips, helmets or hats. Basically anything that has direct contact with someone’s head.
  • It’s best for children to keep their clothes separate from other children’s at public changing or locker rooms.
  • If you do get head lice in your family, treat everyone who has them at the same time. This can help reduce the chance of re-infestation.
  • Keep long hair tied up to reduce the chance of lice being transmission from one person’s hair to another.
  • Regularly check your children for head lice such as every 7 days.
  • Clean combs and brushes with detergent and hot water.
  • Wash bed linen in hot water (60ºC or more), or dry in a clothes dryer on the hot setting for at least 20 minutes.
  • Vacuum carpets and any upholstered furniture (in your home or car), then throw away the vacuum cleaner bag.
  • Dry clean anything that can’t be washed (like stuffed animals). Or put them in airtight bags for at least 3 days.


About felclinic 593 Articles
Felix Ntifo is a Registered General Nurse who has so much passion to improve health care delivery. He founded FelClinic with the hope of making health information accessible to everyone who may not come in contact with him personally. "At felclinic.com we are very passionate about health and well-being of everyone. Our team is made up of professional doctors, nurses, midwives and lab technicians."

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