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Your children are not the only ones headed back to school. Some families will get a rude shock when they discover that their child has picked up an infection of head lice. According to the American Association of Pediatrics (AAP) Clinical Report on head lice:

A 1997 report estimated that approximately 6 to 12 million infestations occur each year in the United States,4 but this number was based on sales of pediculicides and is most likely an overestimation. Anecdotal reports from the 1990s estimated annual direct and indirect costs totaling $367 million, including remedies and other consumer costs, lost wages, and school system expenses. More recently, treatment costs have been estimated at $1 billion.5 Head lice are not a health hazard or a sign of poor hygiene and, in contrast to body lice, are not responsible for the spread of any disease. http://pediatrics.aappublications.org/content/early/2010/07/26/peds.2010-1308

In 2010, the AAP updated its guidance regarding head lice:

AAP Offers Updated Guidance on Treating Head Lice
6/26/2010

Head lice are often a fact of life for school aged children. While inconvenient, head lice cause no medical harm and can be effectively treated. A revised clinical report from the American Academy of Pediatrics (AAP), “Head Lice,” published in the August print issue of Pediatrics (published online July 26), clarifies and updates protocols for diagnosis and treatment, and provides guidance for the management of children with head lice in the school setting. Head lice are not a health hazard or a sign of poor hygiene and, in contrast to body lice, are not responsible for the spread of any disease. No healthy child should be excluded from or miss school because of head lice, and no-nit policies for return to school should be abandoned. Informed school nurses can help with diagnosis and suggestions about treatment. Because head lice are usually transmitted by head to head contact, parents should carefully check a child’s head before and after attending a sleepover or camp where children share sleeping quarters. There are many ways to treat active infestations, but not all products and techniques have been evaluated for safety and effectiveness. One percent permethrin lotion is recommended as initial treatment for most head lice infestations with a second application 7 10 days after the first. Parents and caregivers should make sure that any treatment chosen is safe; preferred treatments would be those which are easy to use, reasonably priced, and proven to be non toxic. All products must be used exactly according to manufacturer’s instructions. Your pediatrician can help with diagnosis, treatment choices and management of difficult cases.
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The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.
http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Offers-Updated-Guidance-on-Treating-Head-Lice.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

The Centers for Disease Control (CDC) have a wealth of information about head lice. In Frequently Asked Questions (FAQs), the CDC advises:

What are head lice?
The head louse, or Pediculus humanus capitis, is a parasitic insect that can be found on the head, eyebrows, and eyelashes of people. Head lice feed on human blood several time a day and live close to the human scalp. Head lice are not known to spread disease.
Who is at risk for getting head lice?
Head lice are found worldwide. In the United States, infestation with head lice is most common among pre-school children attending child care, elementary schoolchildren, and the household members of infested children. Although reliable data on how many people in the United States get head lice each year are not available, an estimated 6 million to 12 million infestations occur each year in the United States among children 3 to 11 years of age. In the United States, infestation with head lice is much less common among African-Americans than among persons of other races, possibly because the claws of the of the head louse found most frequently in the United States are better adapted for grasping the shape and width of the hair shaft of other races.
Head lice move by crawling; they cannot hop or fly. Head lice are spread by direct contact with the hair of an infested person. Anyone who comes in head-to-head contact with someone who already has head lice is at greatest risk. Spread by contact with clothing (such as hats, scarves, coats) or other personal items (such as combs, brushes, or towels) used by an infested person is uncommon. Personal hygiene or cleanliness in the home or school has nothing to do with getting head lice.
What do head lice look like?
Head lice have three forms: the egg (also called a nit), the nymph, and the adult.
Egg/Nit: Nits are lice eggs laid by the adult female head louse at the base of the hair shaft nearest the scalp. Nits are firmly attached to the hair shaft and are oval-shaped and very small (about the size of a knot in thread) and hard to see. Nits often appear yellow or white although live nits sometimes appear to be the same color as the hair of the infested person. Nits are often confused with dandruff, scabs, or hair spray droplets. Head lice nits usually take about 8-9 days to hatch. Eggs that are likely to hatch are usually located no more than ¼ inch from the base of the hair shaft. Nits located further than ¼ inch from the base of hair shaft may very well be already hatched, non-viable nits, or empty nits or casings. This is difficult to distinguish with the naked eye.
Nymph: A nymph is an immature louse that hatches from the nit. A nymph looks like an adult head louse, but is smaller. To live, a nymph must feed on blood. Nymphs mature into adults about 9-12 days after hatching from the nit.
Adult: The fully grown and developed adult louse is about the size of a sesame seed, has six legs, and is tan to grayish-white in color. Adult head lice may look darker in persons with dark hair than in persons with light hair. To survive, adult head lice must feed on blood. An adult head louse can live about 30 days on a person’s head but will die within one or two days if it falls off a person. Adult female head lice are usually larger than males and can lay about six eggs each day.
Where are head lice most commonly found?
Head lice and head lice nits are found almost exclusively on the scalp, particularly around and behind the ears and near the neckline at the back of the head. Head lice or head lice nits sometimes are found on the eyelashes or eyebrows but this is uncommon. Head lice hold tightly to hair with hook-like claws at the end of each of their six legs. Head lice nits are cemented firmly to the hair shaft and can be difficult to remove even after the nymphs hatch and empty casings remain.
What are the signs and symptoms of head lice infestation?
• Tickling feeling of something moving in the hair.
• Itching, caused by an allergic reaction to the bites of the head louse.
• Irritability and difficulty sleeping; head lice are most active in the dark.
• Sores on the head caused by scratching. These sores can sometimes become infected with bacteria found on the person’s skin.
How did my child get head lice?
Head-to-head contact with an already infested person is the most common way to get head lice. Head-to-head contact is common during play at school, at home, and elsewhere (sports activities, playground, slumber parties, camp).
Although uncommon, head lice can be spread by sharing clothing or belongings. This happens when lice crawl, or nits attached to shed hair hatch, and get on the shared clothing or belongings. Examples include:
• sharing clothing (hats, scarves, coats, sports uniforms) or articles (hair ribbons, barrettes, combs, brushes, towels, stuffed animals) recently worn or used by an infested person;
• or lying on a bed, couch, pillow, or carpet that has recently been in contact with an infested person.
Dogs, cats, and other pets do not play a role in the spread of head lice.
How is head lice infestation diagnosed?
The diagnosis of a head lice infestation is best made by finding a live nymph or adult louse on the scalp or hair of a person. Because nymphs and adult lice are very small, move quickly, and avoid light, they can be difficult to find. Use of a magnifying lens and a fine-toothed comb may be helpful to find live lice. If crawling lice are not seen, finding nits firmly attached within a ¼ inch of base of the hair shafts strongly suggests, but does not confirm, that a person is infested and should be treated. Nits that are attached more than ¼ inch from the base of the hair shaft are almost always dead or already hatched. Nits are often confused with other things found in the hair such as dandruff, hair spray droplets, and dirt particles. If no live nymphs or adult lice are seen, and the only nits found are more than ¼-inch from the scalp, the infestation is probably old and no longer active and does not need to be treated.
If you are not sure if a person has head lice, the diagnosis should be made by their health care provider, local health department, or other person trained to identify live head lice.
How is head lice infestation treated?
More on: Treatment
Is infestation with head lice reportable to health departments?
Most health departments do not require reporting of head lice infestation. However, it may be beneficial for the sake of others to share information with school nurses, parents of classmates, and others about contact with head lice.
I don’t like my school’s “no-nit” policy; can CDC do something?
No. CDC is not a regulatory agency. School head lice policies often are determined by local school boards. Local health departments may have guidelines that address school head lice policies; check with your local and state health departments to see if they have such recommendations.
Do head lice spread disease?
Head lice should not be considered as a medical or public health hazard. Head lice are not known to spread disease. Head lice can be an annoyance because their presence may cause itching and loss of sleep. Sometimes the itching can lead to excessive scratching that can sometimes increase
Can head lice be spread by sharing sports helmets or headphones?
Head lice are spread most commonly by direct contact with the hair of an infested person. Spread by contact with inanimate objects and personal belongings may occur but is very uncommon. Head lice feet are specially adapted for holding onto human hair. Head lice would have difficulty attaching firmly to smooth or slippery surfaces like plastic, metal, polished synthetic leathers, and other similar materials.
Can wigs or hair pieces spread lice?
Head lice and their eggs (nits) soon perish if separated from their human host. Adult head lice can live only a day or so off the human head without blood for feeding. Nymphs (young head lice) can live only for several hours without feeding on a human. Nits (head lice eggs) generally die within a week away from their human host and cannot hatch at a temperature lower than that close to the human scalp. For these reasons, the risk of transmission of head lice from a wig or other hairpiece is extremely small, particularly if the wig or hairpiece has not been worn within the preceding 48 hours by someone who is actively infested with live head lice.
Can swimming spread lice?
Data show that head lice can survive under water for several hours but are unlikely to be spread by the water in a swimming pool. Head lice have been seen to hold tightly to human hair and not let go when submerged under water. Chlorine levels found in pool water do not kill head lice.
Head lice may be spread by sharing towels or other items that have been in contact with an infested person’s hair, although such spread is uncommon. Children should be taught not to share towels, hair brushes, and similar items either at poolside or in the changing room.
Swimming or washing the hair within 1-2 days after treatment with some head lice medicines might make some treatments less effective. Seek the advice of your health care provider or health department if you have questions. http://www.cdc.gov/parasites/lice/head/gen_info/faqs.html

The CDC discusses treatment of head lice in Treatment Frequently Asked Questions (FAQs):

Is mayonnaise effective for treating head lice?
CDC does not have clear scientific evidence to determine if suffocation of head lice with mayonnaise, olive oil, margarine, butter, or similar substances is an effective form of treatment.
If the treatment for head lice doesn’t seem to be working, does this mean the lice are resistant and I need a different treatment?
The following are several common reasons why treatment for head lice may fail sometimes:
1. Misdiagnosis. The symptoms are not caused by an active head lice infestation.
2. Applying the treatment to hair that has been washed with conditioning shampoo or rinsed with hair conditioner. Conditioners can act as a barrier that keeps the head lice medicine from adhering to the hair shafts; this can reduce the effectiveness of the treatment.
3. Not following carefully the instructions for the treatment that is used. Some examples of this include not applying a second treatment if instructed to do so, or retreating too soon after the first treatment before all the nits are hatched and the newly hatched head lice can be killed. Another reason is retreating too late after new eggs have already been deposited.
4. Resistance of the head lice to the treatment used. The head lice may have become resistant to the treatment. If the treatment used does not kill the head lice, your health care provider and pharmacist can help you be sure the treatment was used correctly and may recommend a completely different product if they think the head lice are resistant to the first treatment.
5. Reinfestation. The person was treated successfully and the lice were eliminated, but then the person becomes infested again by lice spread from another infested person. Sometimes reshampooing the hair too soon (less than 2 days) after correctly applying and removing permethin can reduce or eliminate any residual (continued) killing effect on the lice.
Is there a treatment recommendation for certain age groups?
Before treating young children, please consult the child’s doctor, or the health department for the recommended treatment based on the child’s age and weight.
Are there any side effects from using these chemical treatments for head lice?
Treatments for head lice are generally safe and effective when used correctly. Some treatments may cause an itching or a mild burning sensation caused by inflammation of the skin on the scalp. Most products used to treat head lice are pesticides that can be absorbed through the skin. Therefore, all medicines used for the treatment of lice should be used with care and only as directed.
Is it necessary to remove all the nits?
No. The two treatments 9 days apart are designed to eliminate all live lice, and any lice that may hatch from eggs that were laid after the first treatment.
Many nits are more than ¼ inch from the scalp. Such nits are usually not viable and very unlikely to hatch to become crawling lice, or may in fact be empty shells, also known as casings. Nits are cemented to hair shafts and are very unlikely to be transferred successfully to other people.
However, parents may choose to remove all nits found on hair for aesthetic reasons or to reduce the chance of unnecessary retreatment.
More on: Head Lice Treatment
Where can I go to have the nits removed from hair?
CDC does not make recommendations about businesses that may offer such services. Your health care provider or local health department may be able to provide additional guidance. Removal of all nits after successful treatment with a pediculicide is not necessary to prevent further spread of head lice. Removal of nits after treatment with a pediculicide may be done for aesthetic reasons, or to reduce diagnostic confusion and the chance of unnecessary retreatment. Because pediculicides are not 100% ovicidal (i.e. do not kill all the egg stages), some experts recommend the manual removal of nits that are attached less than1 cm of the base of the hair shaft.
Why do some experts recommend bagging items for 2 weeks?
Head lice survive less than one or two days if they fall off the scalp and cannot feed. Head lice eggs (nits) cannot hatch and usually die within a week if they do not remain under ideal conditions of heat and humidity similar to those found close to the human scalp. Therefore, because a nit must incubate under conditions equivalent to those found near the human scalp, it is very unlikely to hatch away from the head. In addition, if the egg were to hatch, the newly emerged nymph would die within several hours if it did not feed on human blood.
However, although rarely necessary, some experts recommend that items that may be contaminated by an infested person and that cannot be laundered or dry-cleaned should be sealed in plastic bag and stored for 2 weeks to kill any lice that already are present or that might hatch from any nits that may be present on the items.
Should my pets be treated for head lice?
No. Head lice do not live on pets. Pets do not play a role in the spread of head lice.
Should household sprays be used to kill adult lice?
No. Using fumigant sprays or fogs is NOT recommended. Fumigant sprays and fogs can be toxic if inhaled or absorbed through the skin and they are not necessary to control head lice.
Do I need to have my home fumigated?
No. Use of insecticide sprays or fogs is NOT recommended. Fumigant spray and fogs can be toxic if inhaled or absorbed through the skin and they are not necessary to control head lice.
Routine house cleaning, including vacuuming of carpeting, rugs, furniture, car seats, and other fabric covered items, as well as laundering of linens and clothing worn or used by the infested person is sufficient. Only items that have been in contact with the head of the infested person in the 48 hours before treatment need be considered for cleaning.
Should I have a pest control company spray my house?
No. Use of insecticide sprays or fogs is NOT recommended. Fumigant spray and fogs can be toxic if inhaled or absorbed through the skin and they are not necessary to control head lice.
Routine vacuuming of floors and furniture is sufficient to remove lice or nits that may have fallen off the head of an infested person.
Will laundering kill head lice?
Washing, soaking, or drying items at a temperature greater than 130°F can kill both head lice and nits. Dry cleaning also kills head lice and nits. Only items that have been in contact with the head of the infested person in the 48 hours before treatment should be considered for cleaning.
Although freezing temperatures can kill head lice and nits, several days may be necessary depending on temperature and humidity; freezing is rarely (if ever) needed as a means for treating head lice.
Which medicine is best?
If you aren’t sure which medicine to use or how to use a particular medicine, always ask your physician, pharmacist, or other health care provider. CDC does not make recommendations about specific products. When using a medicine, always carefully follow the instructions contained in the package or written on the label, unless the physician and pharmacist direct otherwise. http://www.cdc.gov/parasites/lice/head/gen_info/faqs_treat.html

Resources:

Head Lice
http://kidshealth.org/parent/infections/common/head_lice.html

Head Lice.org
http://www.headlice.org/

10 Things to Know About Head Lice
http://inhealth.cnn.com/quick-guide-to-head-lice/10-things-to-know-about-head-lice/

Head lice don’t take summer off http://www.cnn.com/2013/06/17/health/head-lice

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Tags: AAP, American Association of Pediatrics, Back to school: Head lice, body lice, Centers for Disease Control, Head Lice, research, science, treating head lice