Back to school special: 10 tips to avoid head lice

While the back-to-school news may cover lots of articles about how to treat head lice, there just aren’t very many about how to prevent it. Other than, of course, the tired and true obligatory phrase: “don’t share combs or brushes.” I’m not sure about you, but I don’t see that many kindergartners fluffing and tossing a shampoo-commercial head of hair at school. The underground market for “pre-owned” brushes during recess just doesn’t seem that large. So what reasonable steps can you take to reduce your chances of bringing home head lice? Without being all paranoid and nit-picky, that is?

First, before we dive into this infested topic, brace yourself. The more you know about the wonders of head lice, the more likely you are to spend the next two weeks scratching your head from time to time and shuddering. Thinking about lice too much provokes that kind of reaction. It’s what we highly-skilled professionals in the world of homeless healthcare term, with diagnostic precision, a case of “the heebie-jeebies.”


Second, try to channel a bit of helpful fatalism. People don’t die from head lice. Sure, if you find a louse crawling on your teeny child’s scalp, you might end up flapping your hands and running around in circles while emitting an airless eeh-eeh-eeh scream. But unless you trip, fall and impale yourself on one of Urban Outfitters’ invisible toy sticks, no one’s going to get hurt. Or sick. Maybe nauseated. But not sick.

Even when it comes to changing your life to avoid head lice, it’s important to maintain perspective. As a doctor who works in a homeless clinic, I can tell you that we staff see it all – things that crawl and creep and slither across human skin. What you realize is that reasonable precautions are important. But staying happy, and productive and (frankly) sane means that you’ve just got to shrug and, after taking reasonable precautions, think that hey, what will be will be. Every living creature on this earth has its own version of lice (aphids are plant lice). But I’ve seen friendships and social events and classrooms literally destroyed by the emotional fallout of a head lice outbreak. Which makes you wonder if, really, should we let the little suckers have that much power over us? Instead, we can focus that energy into anti-louse action.

The first way to prevent head lice is to arm yourself with some knowledge. Here are a few important head lice facts to keep in mind:

1) People are infested, on average, four to six WEEKS before they discover they’ve got lice. That means it can be essentially impossible to know who got what, when, from whom. The blame game, in a world of lice, is meaningless. Take it out on the lice – those little creepers are sneaky beyond belief. How sneaky?

2) Lice, except in florid cases, can be harder to diagnose than you might think. Hey, theoretically, all you need for a self-sustaining infestation is one fertilized female louse. They’re tiny. And sometimes speedy (6-32 cm/min). On-going cases exist with as few as 10-15 live lice on a person’s entire head (average = 12).

Same-color nit casing cemented to hair shaft. Sneaky...

Same-color nit casing cemented to hair shaft. Sneaky…

3) Nit cases are how most diagnoses are made. The louse glues an egg to the base of a hair shaft and the heat of a person’s body incubates the egg. Lice (being nobody’s fool) lay eggs that are, generally, the color of the person’s hair. Only when the egg has hatched, and the hair has grown out, and the “husk” that’s still glued to the hair-shaft pales, can you reliably see the empty cases. But even that is sometimes difficult to be sure about. Telling the difference between normal scalp fluff or skin, and an old nit case, is a job for someone with experience.

4) Shampoo and conditioner won’t help. Keep in mind, getting head lice has nothing to do with hygiene. Trust me, lice don’t actually care how often you wash your hair. They like a nice invigorating shower as much as the next person. You get lice when lice from one head move to another head. That’s it. There’s nothing more to it. Lice has nothing to do with poverty either – they don’t know how much is in your bank account. Lice can be more common when people are living in crowded settings, though, purely because the lice can more easily spread to more heads. Our only saving grace is that they can’t live very long on another surface (max = hours, but not more than 2 days). Lice have to feed (urk – your blood) frequently. Five times a day. And lice can’t jump. They’re not fleas. High heat works to kill them, but we’re talking clothes dryers here. If you try to treat lice by blow-drying high heat on someone’s head, you can burn and/or kill the child (true – there are reported cases where treatment solutions on a head ignite), but the lice are fine – they just move to the other side of the head.

5) Are they dead yet? When it comes to lice treatment the question is (as people in the Oval Office have been known to ask), exactly how do you know when the war is won? From the situation room, here’s the scene, based on what we now know: So we’ve got a very few stealth lice, nearly invisible, dodging and zipping around hair shafts like a SWAT team. But from our command central post, our most reliable visual clue that lice-invaders are still in forbidden territory is a dead husk (or three) from 6 weeks ago (which may, *cough*, be lint). AND you’ve got, among the civilians, a school-wide epidemic of the willies (aka lice PTSD). Every single person is scratching and shuddering constantly. How are you ever going to be able to tell if increasingly toxic and desperate measures have cured…anything?

All of which is to re-enforce the need, when it comes to lice, for calm. And some perspective. Especially when the urge becomes almost overwhelming to either a) grab a pitchfork, some torches and mob up, in order to go after that family you know is to blame, or b) cancel all human activity and eliminate all possible human contact – just to protect your loved ones from this scourge.

Instead, here are some practical, sensible approaches to help you and yours avoid head lice.

6) Use the star pattern for sleeping arrangements at sleepovers. First, make it a habit, if it’s not already, to have sleeping bags and sleeping-on-the-floor an expected part of sleepovers. No sharing pillows or beds. Second, when night-time comes, instead of putting kids side by side, or lying in a circle with their heads in the middle, try to get kids to lie in a circle with their feet in the middle. A good PR move for encouraging this arrangement is to tell kids that this way everyone gets enough room, and no one is left sleeping on the ends.

7) Beware performance culture! Adults who wouldn’t dream of letting their kids share a comb or a hat seem to forget all precautions when it’s time for a performance. Schools with strict lice policies will hang posters for a production of “Annie!” where 37 kids in two casts swap 6 wigs between 5 scenes. Make-up and hair volunteers will style all kids with the same implements, hair-bands, and hair-ties. And the hats! Don’t get me started on the hats! Make sure your kid’s joy of performing isn’t marred by a 4-6 week delayed mega-infestation. It’s important to have performance programs develop sensible anti-lice precautions. Cosmetic grade disinfectant should be mandatory for hair styling. If that’s not possible, at a minimum, each kid should have their own brush/comb with strict non-sharing supervision. Keep in mind that lice tend to be dead if left on a surface for more than a couple of days, so those elaborate hats for “Dolly” can probably still be used between separate casts, as long as they perform on different days.

8) Safety (equipment) first! Let’s take a moment here and play the Worst Case Scenario Game-show! Which of the following would you choose? What’s behind Door #1 – Skull fracture and death; or Door #2 – Head trauma with a lifelong seizure disorder; OR Door #3 – Itching. Not really much of a comparison, is it? That’s why, when it come to your kid’s long-term health, helmets trump head lice fears any day of the week. Sure, in terms of avoiding head lice, it’s best if everyone has their own, individual head-protection. But if your nine year old son is at a friend’s house and they’ve decided to take on Dead Man’s Cliff with a borrowed skateboard, you want to make sure he knows it’s better to borrow the helmet too – rather than avoid head protection because of lice fears. It gets a bit trickier when expensive protective head gear is shared constantly on a team, and passed among players during the same event/day/tournament. While the practice may not be optimal for lice avoidance, it’s definitely better than having someone forced to take what’s behind Door #1.

10) What’s the deal with movie seats and airline headrests? Once you’re aware of head lice transmission patterns and risks, you’ll probably start to wonder about those cushy movie theater seats. You know, the kind where hundreds of people lean their head back against them, over and over again all day. Can you get head lice from leaning your head back against them? The same question applies to airplane seats. Planes are emptied and refilled rapidly, with only cursory trash removal. Many airlines no longer use (or change!) those flimsy paper headrest covers – and who knows if those even “worked” in the first place? And, since most people can’t know they’ve got a case of head lice until 4-6 weeks after exposure, how would you know one of those seats is where you got it? Unfortunately, I don’t have a definitive answer for you there. What’s reassuring is that most clusters of head lice occur in the same predictable ways – among elementary to middle school kids and their siblings/family members. But if you’re worried, you can do like a nurse friend of mine does – carry a scarf to toss over the seat back, then shove it in a plastic bag afterward to launder and dry on high heat. Does that work? Reasonably, it could, but sorry, again, I don’t have a definitive answer for you there.

Bottom line: We humans are uniquely prone to infestations. Hey, it may be the real reason we’re, as a species, essentially hairless. Which leads me to wonder if the only difference between us and chimps, over time, is that we ARE hairless. After all, if you have to spend all day, every day, picking nits, it’s hard to find time to paint the Mona Lisa. When it comes to recognizing, treating, and containing the spread of lice, we’re all in this together. Be sure to email, tweet or share this information with others, including school officials. But if lice happens in your community, try to avoid the blame game. After all, anyone can have a lousy day.

What do you think? Is it possible to avoid head lice without making yourself crazy? Do you have any lice stories you’d be willing to own up to? Are we only an “advanced” species because we’re less lousy than our ape-relatives? Share in the comments section below. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is a practicing board-certified internist. You can get more health posts at, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.

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