Kim Malsam-Rysdon, Secretary of Health


Lice Guide

SH A.4
DATE: 9-1-2000

Lice infestations are not a major health threat but they are highly communicable and create embarrassment and sometimes panic in parents, families and communities.

Information on the prevention, identification and treatment of head lice can be found on the department’s website. This web site is a valuable tool in helping to educate and lessen the stigma associated with head lice infestations.


  1. History of exposure to others with infestation.
  2. Persistent complaints of itching.
  3. Measures used to treat.


  1. Scratching of the scalp especially at nape of neck and in front of ears.
  2. Rash on scalp.
  3. Presence of nits.
  4. Presence of live lice.


  1. Use high intensity light.
  2. Place clean wooden applicator (or round toothpick) at hair roots and separate sections of hair.
  3. Observe for lie nymphs and adult lice.
  4. Observe for hatched or unhatched nits affixed to hair shafts.


  1. Nits are firmly attached to hair shafts. Hair spray globules or dandruff are readily removed.
  2. Nits are elongated with a cap on one end. A magnifying glass and/or microscope may be necessary to aid in identification.


  1. Refer to handouts: "Treating Head Lice" and "Instructions for the Treatment of Head Lice.".
  2. Pediculicides (refer to Office of Community Health Services policy SP-A-6)
    a. Over-the-counter products including RID, A-200 Pyrinate, Triple X, R and C Shampoo, Nix, etc.
    b. Lindane, the major prescriptive product.
    c. Effectively kill all lice, but do not destroy all nits.
  3. Manual removal of lice and nits. See handout "Instructions for the Treatment of Head Lice."


  1. Avoid direct contact with infested persons.
  2.  Avoid indirect contact through inanimate objects such as each others’ brushes, combs, hats, coats, earphones, etc.


  1. Refer to "Scheme for Managing Presumed Head Louse Infestations in Schools", Harvard School of Public Health. (attached)
  2. Encourage schools to adopt policies that do not exclude infested students from school. Neither the American Academy of Pediatrics, American Public Health Association nor the National Association of School Nurses recommends excluding children from school when they have head lice ("No Nit Policy").


  1. To kill lice and eggs on clothing and linens. See handout "Cleaning Household Items to Get Rid of Lice".

Kansas Department of Health and Environment, Children, Youth, and Families Health Services Manual, July 1995.

Massachusetts Department of Public Health, The Comprehensive School Health Manual, January 1995.

Whaley & Wong, Nursing Care of Infants and Children, 1999.

South Dakota Department of Health, Pediculosis Fact Sheet

Lice Aren’t Nice Community Coalition, Snohonush Health District, Everett, Washington.

Instructions for the Treatment of Head Lice
Pesticide Treatment Products (Rid®, Clear®, R&C®, Nix® and Lindane)

Step 1
Gather supplies: shampoo, lice shampoo (lice shampoo), three towels, nit comb (usually provided with lice shampoo), and timer. You will need one entire bottle of lice shampoo for each person being treated for head lice.

Step 2
Read all instructions included with the lice shampoo. Shake the bottle well.

Step 3
Remove individual’s clothing and place directly in the washing machine or a sealed bag until the clothing can be washed. Wash items using very hot water or dry items in the dryer using high heat for 30 minutes. The heat will help kill the lice and nits.

Step 4
Wash the child’s hair with shampoo that is water-based clarifying shampoo. Examples are:

Johnson® Baby Shampoo
Neutrogena® Anti-Residue Shampoo
Salon Selectives®, Level 7® Shampoo
Ivory© Shampoo
Prell© for Normal or Oily Hair Shampoo

This prepares the hair for the lice shampoo. Use of your regular shampoo and/or conditioner may coat the hair and interfere with the treatment. Note: If you will be using Nix, do not use hair conditioner or any other substance that might block the residual action of the pesticide after treatment. If you want to use vinegar or products such as Clear and Step 2 to help with nit removal, apply and comb out the nits before you shampoo your child’s hair.

Step 5
Towel dry hair. The hair should be as dry as possible from towel drying, without being completely dry. If the hair is too wet, it will dilute the lice shampoo.

Step 6
Cover your child’s eyes with a towel. Ask the child to tightly close their eyes.

Step 7
Shampoo hair in the sink. Do not treat your child during or right after taking a bath or a shower. The heat opens the pores of the skin and may allow the pesticide to penetrate and enter the bloodstream more easily.

Step 8
Apply the lice treatment undiluted to the hair. Do not pour all at once into your hand or onto the hair. The method for applying lice shampoo is the same method you would use if you were checking for head lice. Section the hair, pin back, and make a part. Pour the lice shampoo down the part like a stream of toothpaste on a toothbrush. Rub the lice shampoo gently across the scalp, along the length of the part so it completely coats the scalp, roots, and lower inch or two of each strand of hair. Then make another part about ¼ inch away, directly across from the first part, and again apply the lice shampoo. Continue across the scalp making rows and applying the lice shampoo until the entire head has been covered. Go over the head again to treat all of the remaining hair. If you have any left, finish the bottle on the same child. If you run out, use another bottle. Use as much as needed to saturate the child’s hair.

Step 9
Set your timer or alarm clock for the amount of time stated in the instructions for that particular pesticide, such as Rid®, Clear®, R&C® or Nix® for example. While you are waiting you can do some of the following important tasks:

  1. Inspect fingernails, both yours and your child's for nits and lice.
  2. Examine all family members living in your house. Ask an adult to examine your head for nits or lice.
  3. Call the parents of children who might have been exposed to your child and ask them to check their child/children for lice and nits.
  4. Try to remember all the places your child may have shed lice or nits.
  5. Clean suspected household items to get rid of lice and nits.

Step 10
Rinse out the lice shampoo when the time is up. Note: If using Nix, do not shampoo the head for at least 24 hours after treatment.

Step 11
Towel-dry the hair with a clean, dry towel. Do not use the one that was used to dry the hair before the treatment. Comb hair to de-tangle before using the fine-tooth nit comb. If you are using Nix, do not us a de-tangling lotion or spray.

Step 12
Comb hair with a nit comb to remove dead lice and nits. Because no lice treatment kills all of the nits, it is important to remove each and every nit to prevent them from hatching and re-infesting the child or family again. Be patient, this step could take an hour to do a complete job.

Combing hints:

  • Work with small sections of hair, one inch or smaller
  • Move the comb teeth deep in the hair from the scalp to the hair’s end.
  • Clean the comb often with tissue after each stroke through the hair.
  • Pin combed sections of hair away from the uncombed sections.
  • Dampen hair with a spray bottle to maintain moisture

After picking all the lice and nits you can see, rinse the hair with water to wash out any loose nits.

Step 13
Check hair again for nits or lice. Do the best you can to manually remove all lice and nits. Continue to check and pick nits two times per day for the next two weeks. This is the most effective way to prevent re-infestation. Use only baby shampoo or a regular shampoo without conditioner for 2 weeks after the lice treatment. Do not use hair coloring, mousse, gel or hair spray for at least 2 weeks after the lice treatment.

Cleaning Household Items to Get Rid of Lice

  • Off the head, adult lice usually con not survive for more than a day or two. Nits off the hair will die within hours of hatching if they can’t find a meal. So, there is no point in cleaning every nook and cranny.
  • Pets do not carry human head lice. They do not need any special cleaning.
  • Evidence shows that lice sprays are not effective in killing lice or nits.

Things to wash in a washing machine:

  • Bath towels
  • Coats
  • Washable rugs, hats, scarves
  • Sheets, blankets, and pillow cases
  • Stuffed animals in contact with head and neck

Wash items using very hot water or dry items in the dryer using high heat for 30 minutes. The heat will help kill the lice and nits.
Things to sanitize:

  • Brushes, combs, and special nit loosening combs.
  • Barrettes, and other hair holders
  • Detachable foam pads inside bike, headphones and sports helmets

To sanitize these items, soak the item in ¼ cup bleach to 1-quart cold water for one hour.
Things to vacuum:

  • Rugs and carpets
  • Car seats
  • Chairs and couches
  • Pillows from a couch or bed (wash pillowcases)
  • Bed mattress
  • Stuffed animals in contact with head and neck

Another cleaning option: Items exposed to lice, such as stuffed animals, should be placed in a plastic bag and closed tightly for two weeks. During these two weeks the lice and nits will have no food (blood) and will die.

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