By Dr Megan Yap - PaediatricianGeneral05 Mar 2018

So was contemplating what health topic I might blog about today and was scrolling back through past posts.

My thought process was, “Ooooh!! I should totes do a Kids-Infection-Trifecta and add HEAD LICE to the recent topics of school sores and threadworms?”

Lovely!  Might even make it a quadfecta (is that even a word? I might have made that up) by doing scabies another week!!  Gorgeous (seriously? And people think that doctor’s jobs are glamorous?! My blog should really disprove that misconception… at least about paediatricians!  Ba ha ha ha!).  Do you feel itchy yet??  Ha ha ha!!!


So head lice.  Almost (but not quite) as gross as threadworms (prolly ‘not quite’ because threadworms crawling out your anus and making you scratch your bum, and anything to do with your butt and poop really has to be the worst).

So very, very common and such a pain to treat.  I remember my mum combing head lice shampoo, spray, mousse (you name it) through my always-very-long-hair on many an occasion through my school days.  They were (and still are) so hard to get rid of, and any parent who has had to treat their child will relate to the sheer frustration of painstakingly combing through their child’s hair, only to have them start scratching and then finding more of the little blighters a week later.

Anyone who knows me, knows that I HATE INSECTS.  Almost universally.  With the exception of butterflies and ladybugs.  I will scream, run away, smash them with a shoe, use a full can of insect spray on them, or indeed a full can of insect repellent on myself any time I go outside… oh and I Don’t. Do. Camping.

Head lice are small, biting, wingless insects that live in human hair.  Ewwwww…. **SHUDDER**

They feed by sucking human blood through the scalp. Thankfully, even though these parasites bite and suck blood, they don’t transmit diseases.  Because they can’t fly, they spread by head-to-head (or hair-to-hair) contact (crawling).  This is why they are so common in children – who spend a lot of time with their heads together playing, hugging and interacting at school, kindy or day-care.

They CAN also be spread by sharing hats, hair ties, hair brushes, clothing, pillows and the like, but this is less common (because the lice don’t survive well off the head – they cling to the hairs (very effectively) and rely on the heat and humidity that comes off the scalp; when they are off, they tend to dry out and die within about 2 days).

When I was at school, I remember hearing people say that “lice like clean hair, not dirty hair.”  This is actually not true.  Lice do not discriminate!!  They will suck the blood out of anyone’s scalp and live in anyone’s hair given half a chance – dirty/clean, long/short, thick/thin, blonde/brunette, coarse/fine.  Your child is not immune!!

So to reduce the chances of your child catching lice – TIE THEIR HAIR BACK and pin back wisps (the less free-flowing the hair, the better)!!


Signs and symptoms

Well, the obvious symptom is itching – kids will scratch their scalps, especially behind the ears and around the nape of the neck (but anywhere really).  I have even seen kids who have a rash down the skin of their neck from lice bites.

When you look closely at your child’s hair, you might see small teardrop/oval-shaped eggs, also called nits, attached to the root of the hair, no more than about 1-2 cm from the scalp. These are attached firmly and cannot be brushed off.  Nits can be white (already hatched), or brown-black (these eggs that will hatch into live lice in about a week) in colour.

You also need to look for live head lice as well as nits. The live lice range in colour from whitish, to reddish-brown. If your child still has live lice, they’re still laying nits and the life cycle is still going.  Live head lice move fast, to spot them, you have to part the hair very quickly or use the conditioner/wet-combing method.

If you find your child has head lice, you need to check every member of your household, and tell anyone who might have had head-top-head contact with your child (eg school/kindergarten).

2 methods to get rid of head lice:

The easiest and most effective way to find head lice is to use the conditioner and comb treatment(also called “wet-combing”).  This includes:

  1. Comb hair conditioner onto dry, brushed (detangled) hair. This stuns the lice for about 20 minutes and makes the hair shaft slippery and difficult to grip onto.
  2. Thoroughly comb sections of the hair with a fine tooth head lice comb.
  3. Wipe the conditioner from the comb onto a paper towel or tissue.
  4. Look on the tissue and on the comb for lice and eggs.
  5. Repeat the combing for every part of the head at least four or five times
  6. Repeat this method every 2-3 days for 2 weeks until no more lice or nits are found in the combings over the whole head.

Here is a cool link to a parent’s info sheet I found online about wet combing:


It can be hard to get kids to sit still for the lengthy process of combing – a good DVD or an iPad can help you to entertain them whilst you comb.

The second method of treatment is to use a chemical treatment (essentially a pesticide for topical use) that you can buy over the counter from the chemist. After you have completed the treatment according to the packet instructions, comb through with a fine-toothed nit comb to remove any living eggs still present and dead lice.  This is the time to check if any of the lice are still alive – and if they are, they are probably resistant to the insecticide.

Chemical treatments are variably effective, sometimes the lice are resistant to the pesticide in the shampoo/mousse/spray and the treatment will be ineffective.  In these cases, the wet-combing method will still work, else might have to try a different preparation with a different active ingredient.  Even when the lice are killed by the preparation, retreatment in 7-10 days is still recommended as the unhatched eggs not be killed by the treatment and will hatch and re-infest the host.


  • TIE YOUR CHILD’S HAIR BACK!  Plait long ponytails or wind them into a bun.  Use hairspray or pins on fly-aways.  The less possible contact with other kids hair, the better!
  • Treat your child as soon as you have found a lice infestation. Children may return to school the day after appropriate treatment has been given.
  • Family and close contacts should be inspected for signs of infestation and treated if lice are found (a contact is any person who has been close enough to an infected person to be at risk of having acquired the infection from that person).
  • Concentrate on the head. It is not necessary to treat the house or classroom.
  • Combs and brushes should be washed with detergent and hot water.
  • Bed linen, hats, pillows, hair ties/scrunchies should be washed in hot water (60ºC or more), or dried in a clothes dryer on the hot setting for at least 20 minutes.


Now, I don’t know about you but my HEAD IS ITCHING!!!!!!!  AARGH!

I’m going to go wash my hair!!  ha ha ha

Till next week peeps!!

Oh, and happy scratching!!   Baaa ha haha hahaha!!


xxDr Megs


For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/




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