Physical Health

Head Lice

The discovery of head lice can be alarming for families, teachers, and caregivers, but lice can be addressed with very little disruption to a child’s routine. Head lice infestations occur in people of all socioeconomic groups and are not the result of poor hygiene.

Lice spread discomfort, not disease.

Head lice are small, gray insects about 2 to 3 mm long that hold very tightly to hair shafts. They do not hop or jump but can crawl very quickly. Lice do not easily spread without direct head-to-head contact. They can live only a day or two on items such as beds or helmets. Lice reproduce by laying eggs, called nits. The nit hatches on a warm scalp, and the newly hatched louse (a single insect) needs to be near the scalp to feed on blood. Nits on hairs that have fallen from the body may hatch, but these lice die quickly if they are not able to feed.

Signs of Lice

Here are the common signs of lice:

  • Itchiness on the scalp or neck. It may take up to six weeks for itching to begin, and it can continue for several weeks after the lice are gone.
  • Nits, which look like small white or yellow-white bumps firmly attached to hair. They are commonly found behind ears and on the neck.
  • Redness, from scratching behind ears and on the neck.
  • Open sores and crusting from a secondary bacterial infection that may also cause swollen lymph nodes (glands).

How Your Program Can Handle Head Lice

Consider these recommendations when dealing with head lice.


Head lice spread from direct head-to-head contact. They are not usually passed to others by sharing hats, helmets, towels, or bedding. That said, it’s best to avoid sharing these items. If a program does not have enough helmets for each child to use when riding tricycles or other riding toys, they may share them. Helmets can be cleaned by simply wiping with a damp cloth. Avoid vigorous washing, detergents, sanitizers, and chemicals because they cause the helmet and its straps to deteriorate. Preventing a brain injury heavily outweighs the risk of head lice.


Head Start and other early childhood programs should inform a child’s family when they see symptoms of head lice. The program should not send the child home early or exclude the child because of head lice. After detecting lice on a child, programs should avoid activities for the rest of the day that involve children sharing headgear or clothing (like dress-up) or making head-to-head contact with one another. The child can return the next day after a single treatment with over-the-counter medication. Because of close contact with children in their care, staff may also have lice. Staff may finish the day and then return the next day after a single treatment. Close contacts should be checked for lice for three weeks after treatment. Policies should not require staff or children to be nit-free before returning because these policies do not prevent the spread of lice. Instead, they needlessly exclude children from care and cause unwarranted and excessive burdens on families.


Machine wash and dry clothing, bed linens, and other items that the child wore or used during the two days before they were treated. Use the hot water (130 F) laundry cycle and the high heat drying cycle. Clothing and items that are not washable can be dry cleaned or sealed in a plastic bag for two weeks. Soak combs and brushes in hot water (at least 130 F) for five to 10 minutes. Although the risk of getting infested by a louse that fell onto a rug, carpet, or furniture is very low, it’s a good idea to vacuum the floor and furniture, particularly where the child with lice sat.


Treatments for head lice are available at many grocery stores and pharmacies. Generally, they are safe and effective when used as directed. Some treatments may cause an itching or a burning sensation of the scalp. Most products for head lice are pesticides that are somewhat toxic and can be absorbed through the skin.

Tell caregivers to rinse all topical lice medication from a child’s hair over a sink using warm water, rather than while the child is in the shower or bath. This reduces the amount of medicine that the child’s skin absorbs. All medicines for treatment of lice should be used with care and only as directed.

The “comb out” method may not work well to treat lice, but it is low cost and can be useful after other treatment to finish removing lingering nits.

Listen to this podcast for more information about head lice.

Tips for Working with Families

Offering fact-based education about lice goes a long way in helping families and their children stay calm about head lice infestations. Most families feel a sense of shame about lice. Children pick up on this and can feel they have done something wrong. Assure families that head lice are common, and insects do not care whether a scalp is clean or dirty, nor whether the parents of a child are rich or poor.

Refer to a health provider. Tell families to consult with their health care provider for diagnosis and treatment choices. Parents should only treat a child who is known to have lice. The diagnosis should be confirmed, along with treatment advice for the age and weight of the child.

Educate families with these facts:

  • Remedies using common household products (e.g., salad oils, mayonnaise, petroleum jelly) do not work, and some (e.g., kerosene, flea shampoo) are dangerous. Essential oils can irritate the scalp.
  • The child should not use shampoo for a few days after applying the lice treatment This is  to give the treatment time to work on any lice that might be left after the first treatment.
  • Families should not shave their child’s head. Shaving a child’s head can be traumatizing.
  • Cats and dogs do not carry lice and should not be treated.

Inform other families. Staff should use their best judgment when deciding whether to tell families about cases of lice in the classroom. It is not always the best course of action and can depend on factors like the number of cases and likelihood of transmission. If it is necessary to do so, it is crucial to keep confidentiality. Tell families when a child has been diagnosed with lice without saying which child or adult it is. For example, “A case of head lice has been detected in the program. Please check your child’s scalp and let us know right away if you think your child may have lice so we can work together to limit its spread.”

For Your Family Newsletter

Tailor the messages below to include them in your family newsletter.

What are lice? Head lice are little insects that cause itching but do not carry diseases. Head lice are common in young children because they make close contact with one another during play.

How do I know if my child has lice? You should inspect the hair and scalp of your child, particularly if they seem to be scratching a lot. Look for nits (little white specks in the hair). Nits are not loose like dandruff but are firmly attached to the hair.

What else might I see? Sometimes scratching the scalp can cause redness, especially behind the ear or on the neck. If the skin breaks because of lots of scratching, sometimes the bacteria that is normally on the scalp can cause bumps. Lice themselves do not cause skin infections.

What do I do? Talk to your child’s health care provider about lice medication. Do not apply lice treatment to the hair or scalp of children younger than 2 without speaking to a health professional. The medication includes chemicals, so discuss how to use it properly with a health care provider before treating very young children. Check everyone who lives in the home for lice every few days for two weeks and treat anyone who has lice.

What about staying home? Your child will not be sent home early and can return the next day once they have received a single treatment. Some treatments may need to be repeated (see the medication instructions), but your child can return after the first treatment.

Do I need to disinfect my house? Washing bed linens may be helpful, but lice do not survive off the body for more than a day or two, so rigorous cleaning is not necessary. Anything you can’t launder or do not wish to launder can be sealed in a bag for two weeks. Do not fumigate or spray the air with a lice treatment spray. Sprays can be toxic if inhaled or absorbed through the skin. The likelihood of infestation from a louse that has crawled or fallen off a child is small.

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