How to Check for Head Lice

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This survival-medicine website provides general information, not individual advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

How to Check for Head Lice. Step 1: Brace Yourself.

Head-lice nit.

A nit (egg). Those red spots are eyes. When you check for head lice, the nits look like white dandruff, but they don’t brush off easily.

by James Hubbard, M.D., M.P.H.

It’s back-to-school time. And soon afterwards, a young child’s rite of passage—the note from the teacher stating your little darling has head lice.

I can hear the collective “but we’re not a nasty family” now. For the umpteenth time, no one—not the teacher nor the principle nor the doctor—thinks you are. It’s not a question of cleanliness.

Truth be told it doesn’t have to be related to school. It can happen anytime one person’s hair comes in contact with another person’s hair that has the lice. You can also get it if you use a contaminated brush, comb, hat, barrette, or scrunchy and a louse (singular for lice) catches a ride for fresh blood. School just makes the odds more likely because there are more people close together.

In that way, school is like a survival shelter. Many people from multiple places are packed into a small room. Any time there’s a crowd in close contact, the risk goes up.

How to Check for Head Lice
  1. Make sure both the lice checker and the checkee are comfortable. You don’t want to rush this. Find some good lighting and stand or sit above the person, looking down on the scalp.
  2. Be psychologically ready. Back when I first started practice, I remember examining a prim and proper elderly lady who was in for something else but said, “Oh, by the way, my scalp’s been inching a lot lately.” Confident I would find a red scalp from some sort of allergic reaction or maybe a bad case of dandruff, I was somewhat taken aback when I parted the perfectly-perm gray hair and spotted a couple of bugs crawling around.
  3. Be ready to squash those critters. In the case above, I admit I wasn’t. Wear gloves if it makes you feel better. Think of the little critters as ants or gnats are something. They aren’t going to attack you. They like where they are. If you just can’t bring yourself to kill them, that’s okay. I list some treatments below that’ll do the job.
  4. Check for the nits (eggs). They’re attached, really cemented, to hair strands. Sometimes they’re all you’ll see. You’ll usually find them within a fourth of an inch from the scalp. They’re pretty tiny but definitely noticeable. Good lighting and a magnifying glass can help. Dirt and dandruff can be confused for nits, but they brush off easily. The nits don’t.

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How to Treat Head Lice

If you use a product, follow all of its directions exactly. Don’t use a conditioner prior since it can coat the hair, making it hard for the lice treatment to work. If conditioner’s been used, I’d wash the hair with plain shampoo or soap and water before treating.

1. Pick a lice killer:

Mayonnaise and plastic for head lice

To kill head lice, you can coat the scalp with mayonnaise and cover it with plastic for thirty-six hours. Obviously, use caution and your best judgement if you decide to put plastic on children’s heads, and don’t do it with young kids.

    • Your fingers, to squish the lice.
    • Mayonnaise. Slather it over the scalp and seal it with a shower cap or some sort of plastic for thirty-six hours. This will kill the lice but not necessarily all the nits.
    • Shampoos that contain pyrethrin, such as Nix, which kill the lice and the eggs.
    • Neem oil or shampoos containing it, which work okay, but you’ll need to shampoo for twenty minutes and leave them on for an additional ten.

2. Pick out the nits after you’ve finished the topical treatment. You could sit in a tub or do it outside, or seal the nits in a plastic bag. A fine-tooth comb is good for this. You can buy one in any pharmacy. Wet and comb the hair. Pick out every egg that’s within a half-inch or so from the scalp. The lice lay their eggs close to the scalp and, of course, the hair grows. So nits found further than half an inch from the scalp have probably already hatched and are empty casings.

3. If you haven’t used a treatment that kills the nits, you’re going to want to repeat this nit-picking daily for about nine days.

4. Repeat the treatment about seven to nine days later to get rid of any lice hatched from nits that survived the first treatment.

You can save yourself a lot of trouble by just shaving the head. Okay, this is probably not the first option for most. Even cutting the hair short is going to make it easier to find those nits.

But, even in a disaster setting, keep the psychological impact in mind. And it’s really not that much harder to check long hair for nits since it’s the first one-fourth to one-half inch from the scalp you’re concerned about.

How to Prevent Head Lice

Treat everyone who’s been in close contact with the person who has lice. Also treat people who used the person’s hair accessories or slept in the same bed within 48 hours prior to the diagnosis.

Wash all potentially contaminated materials in water that’s 130 degrees F or hotter. If you can’t do this, either throw the materials away or seal them in a plastic bag for two weeks. The lice and nits can’t live away from the comfort and food (blood) of a good scalp for more than a few days.

What’s been your experience?

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Nit photo courtesy CDC/ Dr. Dennis D. Juranek.

  • hehter

    did you know that if you take listerine mouthwash and let it soak over night and rinse it out,in the morning it kills the bugs and after that put vinger for 2 hours then comb it with the lice comb it will come out super easy and

  • Kelly

    I have been treating my daughter for lice for several months now. We’ve tried lots of chemicals and natural stuff too. I have not seen anything close to an adult now for several weeks. But, she has lots of the eggs down in her hair follicles that you can only get out by rough combing and sometimes the spot where they came out bleeds. We are starting to wonder if she still has lice/nits or if we are seeing pseudo nits. We can’t really tell even with a magnifying glass. Anyone have any input on what the eggs look like at the follicle – are these eggs that have been laid? And, how do the eggs get there if we are not seeing any adults to lay them? How long can they live under the skin at the follicle? Help!

    • James Hubbard, MD, MPH

      The eggs can take as long as 12 days to hatch. They don’t actually live under the skin. The eggs are stuck to the hair close to the skin and the adults crawl around on top of the scalp and in the hair.

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  • Andrea A

    My daughter is friends with a family of children continually infected with headlice so we have had our share of mild infestations. I suppose any front-line, pharmacist approved treatment is generally effective at removing the lice themselves, but the best thing I ever did was obtain a true metal fine-tooth lice comb rather than the cheap plastic variety. (Mine came included in a non-pesticidal treatment called Zap). A good comb will quickly strip both lice and nits right out of the hair, even with long thick hair. A few days of combing, especially around the 7-10 day mark following treatment, takes care of any remaining nits very quickly and with a lot less fuss.

    • James Hubbard, M.D., M.P.H.

      Thanks, Andrea.

    • Andrea A

      And I forgot to mention tea tree oil did absolutely nothing for us except give my daughter an inflamed, irritated scalp. I doubt there is enough active ingredient in most shampoos to be effective at killing lice. The kids that keep passing along headlice to us are only “treated” with tea tree oil!

      • Beedoo

        Sorry to hear about your trouble with the tea tree oil. *winces*
        Undiluted, it will cause inflammation and irritation in anyone, but only some people are truly allergic to small amounts. Your daughter might be one of those people. (Unless the tea tree oil you used was full-strength or not diluted enough… that is never recommended.) When it’s sold at full-strength, the manufacturer expects that the customer will dilute it. Just a few drops will do you – preferably mixed with a few cups to a gallon of water, depending on the use.

        It sounds like the other family might not be taking care of the source, just the infested scalps. When I was growing up, I knew a family living in a structurally beaten-up home. Plenty of stuff was able to get into the lowest part of the split-level, and I remember discovering fleas living not on the kids but in the thirty gallon Lego bucket. My friend Matt, one of those kids, got the occasional bite on his legs when he played in the ‘basement’ level, but the pests seemed happier occupying the seldom-cleaned toys and furniture.

        Even if the tea tree oil has been working for the family you mentioned, (as I assume it has, or they probably would have ditched it for another remedy,) they’re just going to keep catching fresh lice if they’re not sterilising the bedsheets, clothes, etcetera. If the infestation has been continuous for long enough, the things might even be established in and/or under the carpeting.

  • Kim

    I have used tea tree oil in shampoo with a lot of success and it works well as a deterrent for keeping them out of the hair. To treat, mix about 5 drops of tea tree oil with a handful of shampoo and let set for 10 to 20 minutes, rinse and comb with nit comb. Add a drop or 2 to your shampoo as a deterrent.

    • Kim

      I should add to shampoo the hair with the shampoo/tea tree mixture, not just let it sit, lol.

      • James Hubbard, M.D., M.P.H.

        Thanks, Kim.

  • nannyb

    Tilt the child BACKWARDS and pour straight rubbing alcohol thru the hair until wet. Then wrap in a towel or a shower cap for about 15 minutes. Lice die, eggs come loose, scalp stops itching, and hair feels amazingly soft and conditioned…(unless hair is damaged from hair treatments..then you might wanna use conditioner after alcohol)…cheapest and best treatment..DONT tilt head forward to apply alcohol because of smell/fumes. You whirl be amazed at dead lice on towel!

    • mindi

      is this going to damage my hair ???

    • James Hubbard, M.D., M.P.H.

      Thanks, nannyb

  • Becki

    Our daughter was four when she got it from daycare. I was pregnant at the time, so chemicals were definitely out as an option. We found a lot of info about listerine (BLUE) and white vinegar. We soaked her waist length hair for two hours in listerine (kills the lice), washed her hair, soaked for two hours in the vinegar (loosens the nit bonds), washed again, and then picked. It took about two hours to go through her hair every day for several days. This was easiest when her hair was wet as her hair is thin and fine. It was exhausting and her blonde hair was slightly tinted blue for a few weeks, but very worth it!! We also read that coconut based/scented shampoos repel lice, so she uses a coconut shampoo all the time, and have had no subsequent lice problem for the past three years. The listerine also dyed the nits and made them easier to see. Our two year old son got a buzz cut as the eggs are attached at 1/4 inch from the scalp. As for the blow dryer, I have read that the heat needed is higher than you can get with a normal blow dryer.

    • James Hubbard, M.D., M.P.H.

      Thanks, Becki

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  • http://Facebook Monica Prentiss

    I have 2 daughters that came home from a summer camp this year and noticed lice witin the first 2 days. UGH! I use the mayo in the hair for as long as they can stand it. Usually 24 hours. Then shampoo with RID or NIX. Blow drying and picking but as I see no one had mentioned I use a flat iron after blow drying. The temp that is the highest set for mine is 400′ so I run that through their hair over and over and try to get down close to the scalp. They basically fall off with the heat and are fried.Works like a charm. I have them continue the shampoo blowdry and flat iron for at least 2 weeks. They are 12 and 14 year olds and are usually doing that anyway. Thanks for the tips.

    • James Hubbard, M.D., M.P.H.

      Thank you, Monica.

  • Susan

    Wyntyr – We went through this when our kids were in school. Unfortunately, a call to anyone won’t yield any results. I guess it’s not really child abuse to let lice eat your children? All you can really do it what you’re doing.
    Keep one of those combs handy and what we did was every time our kids took showers, we had them comb their hair with those combs right after they washed their hair (while still in the shower). It seemed to do the trick!
    Good luck!