• Lice are tiny insects that live on the scalp and crawl through the hair. They are gray, brown or black and can be difficult to see.
• Lice need human blood to live, and die within 24 hours if they cannot feed.
• Lice lay eggs (nits) on the hair close to the scalp. Nits are oval shaped and most often can be seen in the hair behind the ears or near the neck. They cling to the hair and do not shake off.
• Lice hatch from nits after about 6 days, and 10 days after they hatch they can lay more eggs. They have to be on the hair near the scalp to hatch.
• Head lice are not a health hazard or a sign of uncleanliness, and they don’t spread disease.

Itching of the scalp is the most common symptom, but is not necessarily a sign of active infestation. Scratching can cause skin sores and skin infections.

• Head lice are usually spread by head-to-head contact with a person with lice.
• Less often, lice can be spread by sharing clothing, combs, brushes, bedding, or sharing storage compartments (like lockers) with someone who has lice.
• Human head lice don’t feed on pets, and pets do not need to be treated.

• Avoid head-to-head contact common during play at school and at home.
• Do not share infested combs, brushes, towels, clothing or headgear.
• Do not share sleeping mats or bedding.
• Use separate storage areas for clothing and other personal items.
• Do not lie on beds, couches, pillows, or carpets that have recently been in contact with an infested person.

• The most important step is to use medicine that kills the lice. If you aren’t sure which treatment to use, ask your pharmacist or health care provider.
• Talk to your health care provider before treating anyone who is under 2 years old, pregnant, has a history of seizures, is allergic to the medicine, has asthma, or has scalp sores.
• Apply lice medicine by carefully following label instructions.
• WARNING:
  • Do not use a cream rinse or combination shampoo/conditioner before using lice medicine.
  • Do not re-wash hair for 1 to 2 days after treatment.
  • Do not use extra amounts of lice medication unless instructed to do so, and do not mix lice drugs.
  • Do not use the same medication more times than written on the label instructions.
• Combing the hair to manually remove nits and lice (see next page) has been shown to help get rid of lice. After treatment, use a nit comb to remove nits and lice every 2 to 3 days. Continue to check for 2 to 3 weeks until you are sure all lice and nits are gone.
  
• Talk with your health care provider if the treatment does not seem to work.

• Permethrin (Nix^®) is the safest over-the-counter insecticide shampoo, and is the treatment recommended by the American Academy of Pediatrics.
• Nix^® may continue killing newly hatched lice a few days after treatment, but you may need to use it again after 7-10 days.

Talk with your healthcare provider about prescription medications for head lice.

• Most chemical-free treatments can be used as often as needed and most are generally safe for all ages. They do not kill lice or nits. They may make it easier to comb lice out. There is little scientific information on how well they work.
• Some of these treatments include coating the hair with water-based products or oil-based treatments such as olive oil or full-fat mayonnaise.
• Do not use these treatments at the same time chemical treatment is used.

• Use an effective nit-removal comb and work in good light.
• Comb the hair in sections. Start at the scalp and pull the comb all the way through to the end of the strands of hair to remove the lice and nits.
• After each comb-through, dip the comb in hot water and wipe it with a paper towel. Comb until all sections are done.
• Wash the clothes the person wore during the combing (see below).
• Soak the comb in extra-hot (128.3ºF or hotter), soapy water or rubbing alcohol for at least 10 minutes.

• If head lice medication does not kill any crawling lice within 24 hours, then the treatment may not be working. Talk with your healthcare provider.
• Medication may kill crawling lice, but may not treat the nits. You may need to use some treatments more than once.
• You can get lice more than once. Treating all persons in a household who have lice at the same time may prevent getting it again.

• Check close contacts for lice. Treat only those that have live lice or nits in their hair.
• Tell your childcare program or school if your child has lice. Washington State health regulations require that children in child care be free of lice and nits. School districts have separate policies.
• Wash items such as clothing and bedding used in the two days before treatment by doing ONE of the following:
  • Wash in extra hot water (128.3°F) or heat dry for at least 5 minutes, or
  • Dry clean the item, or
  • Pack non-washable items in a sealed plastic bag for 14 days.
• The risk of getting lice from a carpet or sofa is small. You may vacuum upholstered items used by the person with lice in the 2 days before treatment, but don’t spend a lot of time doing so.
• Do not use lice and insect sprays; they are not effective and may cause toxic or allergic reactions.

• Ask your child care program if you have questions about their head lice policy.
• Visit the following websites:
  • American Academy of Pediatrics
  • Centers for Disease Control
  • National Pediculosis Association