Family health

What does lice look like?

Don’t panic, even experienced parents miss them. The first things to ask are what does lice look like and how to spot them. The good news is that after you see this, you'll never forget.

If your child’s scalp is a little itchier than usual or you’ve received the dreaded lice notification from school or daycare, it’s time to check your kid’s head for lice and nits. But what does lice look like? For first-time and experienced checkers alike, it can be tough to know exactly what you’re looking for. We talked with Anne-Marie Faulkner, a retired registered nurse and teacher who works at a lice removal service in Ottawa. She estimates that she has dealt with more than 4,000 cases of lice over the years.

What do nits look like?

Nits (or louse egg) in the hair

Photo: iStockphoto

Nits, or lice eggs, are found on individual hairs, stuck very firmly on one side of the hair rather than encircling the strand.“Live eggs are dark brown or grey and positioned about two or three millimetres from the scalp,” says Faulkner. Empty eggshells that have hatched are oval in shape (about the size of a sesame seed) and tend to be tan or light yellow. “You may also see what look like tiny grains of sand, which are the poop from the bugs themselves,” says Faulkner. “They’re dark brown in colour, polka-dotted on the scalp.”

What does lice look like?

A head louse

Photo: iStockphoto

combing lice out of a girl's hair 3 steps for treating head lice Adult lice are about the size of a small ant, about two to four millimetres long, and range in colour from beige to brown to grey. They have six legs, no wings and pointy bodies. When lice first hatch from their eggs, they’re called nymphs, and they look just like adult lice but smaller, about the size of a sesame seed. The babies are clear in colour for the first few hours. “You can see right through them, so it’s very difficult to see them in your hair,” says Faulkner. “After they’ve had their first blood meal [after biting you], they turn red, so you’ll sometimes see little red dots climbing around your hair.”

It takes about 24 hours for lice to turn brown or grey. Lice bites, which are small red bumps on the head, neck and shoulders, often cause an itchy scalp. However, you can have an itchy scalp without lice (due to dandruff and other skin conditions) or have lice without an itchy scalp.

What does lice look like in light, blonde or red hair?

Lice in light coloured hair

Photo: iStockphoto

Because lice come in a range of colours, including grey, brown and beige, they might blend into light hair or stand out. The eggs range in colour, too, but they tend to be brown and show up against lighter hair on the scalp.

What does lice look like in dark, brown or black hair?

Lice in dark hair

Photo: iStockphoto

According to the Centers for Disease Control and Prevention, lice can look darker in darker hair. “You tend to see lighter, sandy-coloured lice in lighter hair and darker lice in darker hair,” says Faulkner. “But you can also see lighter lice on a dark head and vice versa.”

How do I look for lice and nits?

Combing lice out of the hair

Photo: iStockphoto

You’re most likely to see adult lice when you’re combing them out of the hair rather than inspecting the scalp. “Most of the time, you won’t see the bugs crawling around because they’re very shy if they sense light or vibration,” says Faulkner. “If you’re looking on the left side, they’ve probably already skedaddled over to the right side.”

Instead, you’re looking for the nits. Have your kiddo sit under a bright light, and look for the nits close to the scalp (a magnifying glass may help). To part the hair, Faulkner recommends using a pencil or, better yet, a double-pointed knitting needle. Slide the pencil or knitting needle across the head, going from top to bottom and side to side in small sections.

You have to check the whole head, but it makes sense to pay particularly close attention to a few areas. According to Faulkner, the majority of nits are attached to the hair at the nape of the neck and behind the ears because those are warm areas. However, if your child has long hair and regularly wears it in a ponytail or bun, the nits will be in that spot where the ponytail gathers because that’s where it’s warmest. About five to 10 percent of nits tend to be near the front hairline.

If there’s an outbreak of lice at your child’s school, daycare or extracurricular group, check their hair daily or every couple of days.

How do I treat lice?

The Canadian Paediatric Society’s 2018 position paper on head lice recommends over-the-counter shampoos and creams that contain insecticides, such as pyrethrins (found in R&C Shampoo) and permethrin (found in Nix), as the first-line treatment. Non-insecticidal treatments that contain isopropyl myristate (found in Resultz), which dissolves the lice’s exoskeletons so they dehydrate and die, and silicone oil (found in Nyda), which suffocates the lice and nits, are also approved by Health Canada.

Carl Cummings, a Montreal paediatrician who co-authored the position paper, says not following the instructions on these medications is a common pitfall. “I think there’s a tendency to wash [the product] out too quickly and not let it sit long enough to have the proper effect,” he says. Cummings adds that it’s important to do a second follow-up treatment as instructed and that an itchy scalp after treatment doesn’t necessarily mean that the lice are still there—it could be that the original itchy scalp just takes a while to clear up. You still need to comb out the lice and nits after using the medication.

Are there home remedies for head lice?

Home remedies, such as applying thick hair gel or mayonnaise to suffocate lice, are not as effective as insecticides, according to Cummings. He says the data isn’t there to support using tea tree oil or essential oils either.

However, Faulkner and her colleagues are advocates of using plain conditioner and a very fine-toothed lice comb to get every last louse and nit out of the hair. You’ll probably have to do it every two or three days for a week for it to be 100 percent effective. “That’s our gold standard, and we find that it works best,” she says. The conditioner helps the comb move smoothly through the hair, which dislodges the eggs and removes them from hair. Just combing wet hair without conditioner isn’t as effective because wet hair can snarl and the comb won’t move through the hair as fluidly. Plus, the nits get stuck in the teeth of the comb, so you won’t be able to wipe them off as easily. “Put lots and lots of conditioner right down to the [scalp] skin and all the way up the ends of the hair,” she says. “Comb through small sections of hair, from each side, up from the top and down to the bottom.”

Regardless of what treatment you use, wash any items that have come in contact with your child’s head, such as hats and pillowcases, in hot water and toss them in a hot dryer for at least 15 minutes. If it’s something that can’t go in the dryer, like a brush or comb, store it in an airtight zip-top plastic bag for two weeks to kill any lice and nits. Cummings says that two weeks account for whatever point the egg is at in the cycle, plus time to hatch and die and some extra time just to be safe.

What does lice look like on a paper towel?

If you use a treatment that involves combing cream (either a commercial lice treatment or conditioner treatment) through the hair with a fine-toothed comb, wipe the comb on a white paper towel after you’ve run it through the hair. “Use your finger to spread it out and look at it under a bright light,” says Faulkner. If you see sesame-seed-shaped objects, those are the nits and lice, which can be brown or grey and stand out against the white paper towel. “The nits may look like they have tails that stick out the back,” says Faulkner. “This is where the glue that the mother louse uses to stick the nits to the hair has been peeled off by the comb.”

What are other bugs that look like lice and nits?

Faulkner says she has pulled all kinds of things out of hair, including fruit flies and fleas. If it hops or has wings, it’s not lice. Bits of leaves and other debris from playing outside can also fool parents.

“The single most common thing that people misidentify as lice and nits is dandruff,” says Cummings. Dandruff is white and can be flaked off easily with your finger. A form of dandruff called a hair cast looks like a tiny white cylinder that encircles the hair shaft but can be easily dislodged.

Desquamated epithelial cells (DEC) plugs, which are caused by overactive oil glands, can also be mistaken for nits, says Faulkner. “These plugs are white and go all the way around the [strand of] hair,” she explains. They’re quite sticky, but they have a rounded, irregular shape and you can slide them off the hair. In contrast, lice eggs are smoother and darker, attached to just one side of the hair strand and are much harder to remove.

How do kids get lice?

Most of the time, kids get lice from head-to-head contact, even from something as simple as bending over an activity sheet together at school. Teach your kids not to share hats, brushes, combs and hair accessories.

Some parents spritz their child’s head with a spray or use a shampoo that contains tea tree oil to try to repel lice. Cummings says that there is no compelling research on these products, but it’s fine to try them as long as they don’t cause an allergic reaction.

Yes, a case of lice is definitely a pain in the butt that can eat up lots of time, but try not to be freaked out or grossed out. It’s just a common part of childhood and parenthood. Get past the initial learning curve and you should be fine.

 Read more:
When my kid gave me lice I had a meltdown
Why one mom keeps NYDA Head Lice Treatment in her medicine cabinet