Head lice and nits: the symptoms and treatment

With one in three schoolchildren getting nits each year, knowing how to deal with them is a parenting skill you can't live without. From spotting the signs of nits to knowing how to comb them out, here's how to get rid of your child's head lice quickly and safely.

Head lice are tiny insects that live in human hair and feed on blood from the scalp. While that sounds pretty gross, having head lice doesn't hurt.

An infestation can be itchy and uncomfortable, but it's not dangerous.

However, it's best to treat lice as soon as possible to stop them spreading to others.

Here's all you need to know about nits and head lice and how to treat them effectively.

• What's the difference between nits and head lice?
• Why do head lice love kids?
• What do head lice look like?
• How to spot head lice
• Dry detection combing: how to do it?
• What do you do if you find head lice?
• Wet combing: how to do it
• How to get rid of head lice in afro hair
• Treating head lice with lotions and sprays
• What about using head lice shampoo?
• Can you treat head lice with natural products?
• Can you still send kids to school with head lice?
• Can you prevent further nits outbreaks?
• Are children with smartphones more likely to get head lice?
• My child's head's still itchy even after the head lice have gone
• Head lice myths, busted

The terms 'nits' and 'head lice' might be used interchangeably but actually, they're two different things.

• Head lice are insects
• Nits are their egg cases

Holly Barber from the British Association of Dermatologists says:

'Head lice are small grey-brown insects – about the size of a sesame seed – that live on human scalps. They can't fly or jump and can affect anyone, with long or short hair, no matter how clean the hair is.

'Female lice can live for up to 40 days, laying more than 100 eggs in that time. They attach their eggs (known as nits) to hairs close to the scalp surface. These eggs are yellow or white and about the size of a pin head.

'After seven to 10 days, the eggs hatch, and around seven days after that, the new lice are fully matured and ready to start laying their own eggs.'

That's why it's important to check your child for head lice and nits regularly and treat it as soon as you spot the signs of an outbreak.

Whether they're playing or working together at school, children tend not to respect each other's personal space.

This makes it easy for head lice to spread from one child to another.

It can take just 30 seconds for a single louse to transfer from one child’s head to another.

Because school children spend lots of time in close contact, head lice are extremely common. An outbreak can spread quickly throughout a class or even a whole school.

One study (carried out for head lice treatment NYDA) found a third of school children under 16 had experienced a head lice infestation over the previous year.

This soared to 48% for primary school children aged between four and 11.  

Are some kids more likely to get nits than others?

While anyone can get head lice, some people are more likely to get them than others and they're more common at different times:

• head lice are most common in children between the ages of four and 11
• more common in girls than boys
• most often found at the start of the school year
• head lice aren't bothered how clean or dirty hair is

Can adults get nits?

Adults are less likely to get nits, not because we're immune but simply because we don't get as close to other people. That said, if your child has an infestation and cuddles up with you, their head lice will be more than happy to take up residence on your scalp, too.

Not sure what you're looking for? These images should help ...

What nits and lice might look like in your child's hair.

A close-up look at what nits could look like in your child's hair.

A close-up of a head louse.

Two tiny head lice compared to every day objects

Because children are no longer checked for head lice at school – gone are the days of the 'nit nurse' visiting – you'll need to master the art of nit detection yourself.

Don't rely on your child having an itchy scalp to alert you to an outbreak of head lice. Not everyone gets irritated by nits and lice, and even if they do, the itching might not start for some months after they first move in.

Scratching your head yet?!

It takes more than just a quick look at your child's hair to spot nits and head lice. Often, they don't show up easily.

Signs and symptoms of head lice:

• Sometimes you'll see little brown or white specks in your child's hair as a tell-tale sign.
• Sometimes you'll notice them scratching their heads, especially behind the ears or on the neck.
• According to the NHS, the only way to be certain if your child has head lice is by detection combing. You can do this on wet or dry hair, but it's easiest on wet hair.

It should take five to 15 minutes to check your child's head, depending on hair length and thickness.

NHS Inform, Scotland’s national health information service, recommends this dry detection combing method:

• Use an ordinary, wide-toothed comb to detangle the hair.
• When the hair is tangle-free, switch to a louse detection comb.
• Make sure the teeth of the comb slot into the hair at the roots. The edge of the teeth should be lightly touching the scalp.
• Comb down from the crown to the ends of the hair.
• Look for lice on the comb after each brush. If you see a louse, trap it on the comb with your thumb and then remove.
• Comb each section of hair up to four times before moving on to the next section. Repeat until the whole head has been combed.

As soon as you become aware of head lice in your child's hair, you'll need to treat them for an outbreak.

You'll also need to check everyone else in the family and treat them, too. This will stop head lice being passed around again.

Here's how to treat lice and nits.

Treating head lice by wet combing means literally combing nits and head lice out of wet hair. It's an effective way of removing head lice, without having to use a chemical to kill them.

The wet combing method is actually exactly the same one used for detecting head lice (see the dry detection combing method above) where wet hair is combed through carefully with a special comb designed to remove the lice.

The only difference is that you'll need to comb through your child's hair regularly until you've got rid of not just the live lice, but also any unhatched eggs.

Follow the NHS guide for wet combing:

• Wash hair with ordinary shampoo
• Apply lots of conditioner
• Comb the whole head from the roots to the ends of the hair.
• Repeat the wet combing method on days one, five, nine and 13 to catch any newly hatched head lice.
• On day 17, check again to make sure your child is lice-free.

What are the benefits of wet combing?

Stuart Gale, chief pharmacist for Oxfordonlinepharmacy.co.uk, believes wet combing is 'by far and away the most effective and safe method for removing head lice.'

It's reliable and doesn't involve using harsh (and expensive) chemicals that may not be suitable for young children or pregnant women.

What are the downsides of wet combing?

The downside to wet combing is it’s time consuming. It takes around 10 minutes to comb short hair and 20 to 30 minutes for long, frizzy or curly hair. 

There are special nit combs on the market which can be helpful for detecting and also eradicating nits.

The Nitty Gritty comb has teeth that have been specially designed to capture eggs and live lice.

You can buy it here at Amazon for under £10.

It can be tricky to do the dry detection method on afro and multi-textured hair. Instead, if your child has natural hair try the wet combing method, above. 

More drastic steps may be needed if your child has dreadlocks.

Netmums' official GP, Dr Kenny Livingstone says:

'If your child has dreadlocks and the products aren't helping then the only option is to remove the dreadlocks and then treat the head lice and nits.'

You can also use a chemical treatment for head lice such as Hedrin, Lyclear and Full Marks, which can be bought over the counter in pharmacies.

You should only use these if you've found head lice on your child.

Your pharmacist can advise you on the best treatment. Some are unsuitable for children under two, and shouldn't be used if you're pregnant, breastfeeding or have asthma or allergies.

Make sure you follow the instructions to the letter, to give the treatment the best chance of working. Some only need to be left on your child's hair for 10 minutes or so, while others have to stay on for as long as eight hours.

Not all chemical treatments kill unhatched eggs, so you usually have to repeat the treatment after a week to kill any lice that have hatched since you first used the product.

Find out why you need to be careful using some head lice products here.

The NHS advises against using shampoos or rinses, as these aren't as effective as lotions and sprays.

Google ‘natural remedies for head lice’ and you’ll see lots of suggestions, including using mayonnaise or oil to suffocate them. There’s no scientific evidence that these methods work, but they could be worth a try.

Find some tips for homemade nit remedies, here.

If you find head lice or nits in your child's hair, there's no need to keep them off school, according to the NHS.

They may have had head lice for a time before you spot the signs, so keeping them home now won't stop them spreading.

You should start treatment straightaway, and it's a good idea to tell the parents of their close friends so they can check for lice, too.

Many schools also appreciate being give the heads up if you find head lice in your child's hair. This allows them to inform the parents of your child's class and stops kids constantly reinfecting each other.

Although it may be tempting to use head lice treatments regularly to pre-empt getting nits, don't – not only are these chemicals harsh for your child's skin but the British Association of Dermatologists says overusing them 'simply encourages the emergence of resistant strains of lice'.

In other words, it can make head lice become resistant to treatment.

Holly recommends 'regular examinations with a nit comb in order to detect an infestation early, as starting treatment sooner rather than later will help prevent further spread.

'Parents should also keep in mind that head lice can spread to anybody, no matter how clean their hair or home is. It is unnecessary to keep children home from school if they have head lice, however, treatment should be started immediately.'

The NHS also says that there’s no need to wash laundry on a hot wash.

Yes!

A 2017 study by Oxford University Hospitals NHS Foundation Trust found 62.5% of children with smartphones or tablets had head lice compared to 29.5% who didn’t own or use a device.

Researchers think this is partly due to children crowding round smartphones, allowing the lice to transfer from one head to another.

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Itching after head lice have gone is quite common.

Just as it can take weeks or months for itching to begin after becoming infested, it can also last for days or weeks even after you've successfully got rid of the lice.

An itchy scalp can also be down to eczema so if it does continue once you've treated head lice, ask your pharmacist or GP to have a look.

1. Head lice can't fly, jump or swim – they can only be spread by head-to-head contact.

2. Head lice don't prefer clean hair, although you might want to tell your child this if they're embarrassed about having them. Anyone can get them, regardless of their hair type and washing habits.

3. They don't always make you itch. The itching is caused by an allergy to the lice, rather than the lice biting, so don't assume that no itching = no nits.

4. Head lice don’t live on pillows. They they can only survive on humans, so there's no need to wash bedding or soft toys if your child has an infestation. 

5. There's no evidence that tying long hair back securely, or braiding hair will help to prevent head lice.

6. Head lice can’t be caught from pets. Nor can they live on your pet. Lice need human blood to survive.

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