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Finding and Treating Head Lice

Expert Q&A

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Updated December 31, 2005

Q. My daughter has little white things on her hair and I'm not sure what they are. I was thinking that they are head lice nits, but my friends told me that she should have live bugs if she had lice and I am not seeing anything crawling around. Could it just be dandruff or ringworm or something? She has long thick hair, the white things are attached to the hairs and are hard to get off, and her scalp is itchy.

A. They sound like nits or lice eggs, which are often confused with dandruff. Unlike dandruff however, nits are hard to remove, as they are firmly attached to your child's hair by a type of glue. A visit to your Pediatrician or the school nurse might be helpful to see if she really has head lice.

If she had a ringworm infection on her scalp, you would also expect her scalp to be red and that she might have some patches of hair loss (alopecia).

Head Lice Treatments

Now if she does have lice, the question is what do you do since you don't see any live lice. Many experts actually don't recommend treating a child with a head lice shampoo if they just have nits, unless you see live lice.

But if there aren't any live lice, then where did the nits come from? Since the nits are the eggs of adult lice, they did come from a live louse, but it could have died already or been inadvertently removed. So you could remove the remaining nits and see what happens. If you continue to see new nits, then there are definitely live lice remaining and you should treat your child.

The location of the nits can also give you some hint as to whether your child has live lice on her head. Are they all very far from her scalp? New eggs can usually be found within about 1/4 of your child's scalp, so if all of the nits are much further away, then they may have already hatched and may be old. If you are finding many nits close to your child's scalp, then she likely does still have live lice on her head.

The fact that she has an itchy scalp also points to an active head lice infestation.

Finding Head Lice

One thing to keep in mind is that the fact that you aren't seeing live lice doesn't mean that they aren't there. Since lice are only about the size of a sesame seed and are very fast moving, they can be hard to find.

And if your child has long, thick hair, especially if it is brown, it can be even harder to spot lice (adult lice are usually tan colored, so can blend in with brown hair).

Plus, each adult female louse can lay up to 8 nits a day and can live for up to 30 days, so you might see a lot of nits on your child's head, but only have a handful of live lice crawling around.

See our Head Lice Pictures for more help on identifying head lice and our Head Lice Treatment Guide for more information on what to do when you find them.



References:

  • Centers for Disease Control and Prevention Division of Parasitic Diseases Head Lice Infestation Fact Sheet
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