Text_Files/Pediculosis_Head_Lice.txt

PEDICULOSIS CAPITIS (Head Lice) CONT. 
Division of Public Health Services  Disease Handbook for Childcare Providers 
Bureau of Infectious Disease Control   REVISED –January 2018 
PEDICULOSIS CAPITIS (Head Lice) 
 
Head lice are tiny insects that live only on 
people’s scalps and hair.  The adults hatch from 
small eggs, called nits, which are attached to the 
individual hairs near the scalp.  Nits may be found 
throughout the hair, but  are most often located at 
the back of the scalp, behind the ears and the top 
of the head.  The eggs hatch in 10- 14 days, with 
new lice reaching adulthood in about 10 days.  
The female louse can live for 21-30 days, and lays 
about six to eight eggs a day.  The lice live by 
biting and sucking blood from the scalp. 
 
The major symptom of head lice is itching caused 
by the bite of the louse.  Persistent scratching of 
the head and back of the neck should be viewed 
with suspicion.  Often red bite marks and scratc h 
marks can be seen on the scalp and neck and a 
secondary bacterial infection causes discharge and 
crusting.  Swollen neck glands can also occur  
related to an infection from scratching. 
 
Who gets this disease? 
Contrary to popular belief, head lice are not a sign 
of unclean people or homes.  They can occur at 
any age and to either sex.  Anyone who has close 
contact with an infected person or shares personal 
items can become infested. 
 
How is it spread? 
Lice do not jump or fly.  They cannot be caught 
from gra ss, trees, or animals.  They are spread 
only by crawling from person- to-person directly 
or onto shared personal items, such as combs, 
brushes, head coverings, clothing, bedding and 
towels.  Frequent bathing or shampooing will not 
prevent lice or eliminate them once they are 
established. 
 
How is it diagnosed and treated? 
Lice are less than 1/8 -inch long and are usually 
light brown in color.  They avoid light, which 
makes it difficult to see them.  The diagnosis is 
most often made by finding nits within a ¼ -inch 
of the scalp.  Nits are tiny, plump, pearl gray 
colored; oval -shaped specks attached to the hair 
and cannot be easily moved up or down the hair 
(as could specks of dandruff).  It helps to use a 
magnifying glass and natural light when searching 
for them.  The best places to look are the hair on 
the back of the neck, behind the ears and the top 
of the head.  Hatched eggs can be found further 
out on the hair shaft and are snow -white and 
conspicuous. 
 
Treatment is directed at getting rid of the lice 
from bo th the infested person and his/her 
surrounding and personal items.  All household 
members and persons with close physical contact 
with the infested person should be examined for 
lice and treated if infested (live lice are seen).  
Some healthcare providers may simultaneously 
treat all members of a household. 
 
Treating the infested person. 
Consult a physician before treating:  (1) infants, 
(2) pregnant or nursing women, or (3) anyone 
with extensive cuts or scratches on the head or 
neck.  For others, there are  several medicines 
available to kill head lice.  They are used like 
shampoo.  Many head lice medications are 
available at your local drug store without 
prescription and some products are available by 
prescription.  All of these products must be used 
carefully and according to direction. 
 
There are several over -the-counter (OTC) name 
brand products which include A -2000 Pronto, 
R&C, Rid and Triple X that all contain the active 
ingredient Pyrethrins.  Pyrethrins are natural 
extracts from the chrysanthemum flower.  Though 
safe and effective, pyrethrins only kill  crawling 
lice, not unhatched nits.  A second treatment is 
recommended in 7- 10 days to kill any newly 
hatched lice.  Treatment failures are common. 
 


PEDICULOSIS CAPITIS (Head Lice) cont. 
Division of Public Health Services  Disease Handbook for Childcare Providers 
Bureau of Infectious Disease Control   REVISED –January 2018 
Nix is another commonly available OTC 
medication that c ontains the active ingredient 
Permethrin.  Permethrin is safe and effective and 
may continue to kill newly hatched lice for 
several days after treatment.  A second treatment 
may be necessary in 7 -10 days to kill any newly 
hatched lice that may have hatched  after residual 
medication from the first treatment was no longer 
active.  Treatment failures are common. 
 
Prescription medications used to treat head lice 
include Lindane (Kwell) and Malathion (Ovide).  
Consult with your healthcare provider on the 
proper use of these prescription medications.  For 
these medications, retreats in 7 -10 days ONLY if 
crawling bugs are found. 
 
Although these products will kill lice, none will 
kill 100% of the nits.  Nit removal after 
shampooing may be time -consuming and difficult 
due to their firm attachment to the hair.  A 
solution of vinegar and water may help make 
removal easier.  Special, fine- tooth combs can be 
used to aid in nit removal.  Most treatment 
requires retreatment in 7 -10 days.  A daily nit 
check for the next ten days is advisable.  If there 
is evidence of new nits (less than ¼ -inch from the 
scalp) or newly hatched lice, it may be necessary 
to repeat treatment.  (NOTE:  Unless reinfection 
occurs, more than two treatments are unnecessary 
and can be dangerous). 
 
Treating the surroundings/personal 
items in the childcare center. 
Head lice can only survive 24-48 hours if they fall 
off a person and cannot feed.  You don’t need to 
spend a lot of time or money on cleaning 
activities.  Follow these steps to help avoid re -
infestation by lice that have recently fallen off the 
hair or crawled onto clothing or furniture. 
1. Machine-wash in HOT water all washable 
items belonging to the daycare facility that 
may contain lice. 
2. Non-washable (e.g., furry toys, pillows) 
can be put in a HO T dryer for 20 -minutes 
or dry-cleaned. 
3. Things that cannot be washed, dried, or 
dry-cleaned can be sealed in a plastic bag 
for two weeks, the duration of the life 
cycle of the louse. 
4. Soak combs and brushes for 1 hour in 
rubbing alcohol, Lysol™, or wash with 
soap and hot (130  F) water. 
5. Vacuum the floor and furniture.  The risk 
of getting re-infested from a louse that has 
fallen onto the carpet or sofa is very small. 
6. Insecticide sprays are not recommended 
and can be harmful to people and animals. 
 
How can the  spread of this disease be 
prevented? 
1. General cleanliness at the center, as 
previously outlined, should be practiced. 
2. Children should not share personal items 
such as clothing, brushes, combs, hats, etc. 
3. Each child should have his/her own crib 
mat and should not switch. 
4. Children’s personal belongings should be 
stored separately. 
5. Caregivers should learn to recognize nits 
and should help regularly check children’s 
hair when there is a known case of head 
lice in the center. 
6. If a case is identified, the center should 
follow cleaning procedures outlined 
above. 
 
Who should be excluded? 
Routine exclusion of school -aged children with 
head lice is not recommended.   The child’s 
parents or guardian should be notified when head 
lice is identified by a care provider or t eacher.  
The child’s parent or guardian should be 
telephoned/emailed or a note sent home with the 
child at the end of the school day
 stating that 
prompt, proper treatment of this condition is in 
the best interest of the child and his/her 

PEDICULOSIS CAPITIS (Head Lice) cont. 
Division of Public Health Services  Disease Handbook for Childcare Providers 
Bureau of Infectious Disease Control   REVISED –January 2018 
classmates.  A chi ld should be allowed to return 
to school after proper treatment even if nits are 
still present.  “No Nits Policies” are not effective 
and should be discouraged.  Mass screenings are 
also not recommended but close contact s should 
be checked ideally.   
 
Children in preschool or daycare settings who 
have visible live lice may need to be excluded 
only if direct head to head contact cannot be 
avoided. 
 
Reportable? 
No.  Pediculosis is not reportable by New 
Hampshire law.  However, the Bureau of 
Infectious Disease Control professionals are 
available for consultation at (603) 271-4496.