Jewel Daniel knows that when the phone rings, it is likely a frightened, anxious parent on the line.

Daniel is owner of Lice Busters, Inc. in Charleston. Her work day involves removing head lice from the hair of children.

“Mostly, it’s panicked parents who have spent months dealing with it,” Daniel says. “There is a big stigma. A lot of people don’t want to think about it.”

The thought of head lice sends parents, teachers and children into an itchy frenzy, but despite the ick factor, it is extremely common and not a sign that a child is unclean, according to Stephen Stripling, a physician with Coastal Pediatrics.

“It is less hygiene and more situational – you shared a comb, shared a hat, had head-to-head contact,” Stripling says. “Basic shampooing probably doesn’t help once you have an infestation.”

Parents are often frustrated to learn their child may not show any symptoms of having a head lice infestation, Stripling says. The first sign may be actually seeing nits – lice eggs – on the hair shaft, often near the base of the scalp, or even adult lice. Some children may have an itchy scalp.

“As they feed on your skin, they suck blood,” he says. “If you have a sensitivity or allergy to the saliva, you may be itchy. Rarely, you can get secondary swelling in the lymph nodes in the back of the neck.”

Ellen Nitz, a nurse liaison with the Charleston County School District, said parents panic when told their child has head lice, but they shouldn’t feel they are all alone.

“It does happen,” she says. “It is a nuisance and it is a lot for a family to deal with. It’s not an emergency. It’s not dangerous. It’s not a health risk.”

Nitz says parents often face a big task in ridding their child and their home of lice, but it can be done.

“There is a lot of work, and quite frankly, a lot of expense to get rid of lice,” she says. “If that is an issue, we try to make sure we help them – either find them a resource or steer them in the right direction.”

Once a lice infestation has been seen, parents usually start with an over-the-counter lice shampoo, Stripling says.

“Most of the folks who have lice have tried an over-the-counter product,” Stripling says. “It’s a permethrin product that is one percent. That can be a good place to start.”

However, using a lice-killing shampoo is just the start. The dose must be repeated in 7–10 days, and a fine-toothed comb must be used repeatedly to remove nits. Stripling says the comb should be used on hair that has a conditioner or olive oil on it to lubricate the hair shaft and make removal easier.

“That mechanically gets rid of nits on the hair,” he says.

If active lice are still present after a couple of days, the treatment may have failed, Stripling says. In that case, parents should contact their child’s pediatrician for further instructions and possibly a different treatment.

Daniel is often called in to do the initial removal. She then teaches parents how to repeat the process in a few days.

“Most people are looking for white nits,” she says. “They vary from a creamy yellow to a brown or black, depending on what stage they are.”

Daniel is in the process of creating a lice removal kit for parents that she hopes will help them overcome their fears.

“They get so desperate,” she says. “It is about the process. Parents have the ability to do this if they have the time.”

Stripling cautions against using home remedies, which may be ineffective at best and even dangerous in some cases. He says some parents try to suffocate lice with mayonnaise or petroleum jelly, but he says those remedies are not well studied.

“Lice hatch in a cyclic rotation,” Nitz says. “You have to be diligent to make sure you don’t have live lice reemerge. Manual removal is the safest way to get rid of lice, but it’s very time consuming.”

Once the initial treatment of lice has been completed, parents should focus on ridding the home of lice and their eggs. Stripling says clothing and linens that have been in contact with the infected person in the two days prior to treatment should be washed in hot water and dried on high heat. Items that are not easily washed, such as stuffed animals and pillows, may be dry cleaned – Stripling says you should advise the dry cleaner about the lice – or keep them sealed in a bag for up to two weeks.

Schools face special challenges once one child has lice. Nitz says teachers are taught to be sure that hoodies, art shirts and other clothing are not stacked in the classroom and that birthday hats are not of the reusable fabric variety.

“When it’s happening to you, it’s a different story,” Nitz says. “We try to be extremely empathetic. If live lice are present, the child is sent to the school nurse. She verifies the lice and calls the parents. The child will not be allowed back in school until we see proof of treatment and there are no live lice.”

Prevention is really the key to stopping lice infestations, Daniel says. While it is difficult for children to avoid entirely, it is important for parents to teach their children not to share anything hair-related, such as brushes, hats or barrettes.

“I teach them that their hairbrush is like their toothbrush,” Daniel says.

And when parents get that dreaded call from the school nurse, Nitz says it is important to remember that this is often part of childhood.

“It doesn’t have the same stigma in other countries like it does in ours,” she says. “We do have a stigma that goes along with it. People are embarrassed and they tie it to hygiene, which is not the case.”

What do head lice look like?

Head lice are most often found on the scalp behind the ears and near the neckline at the back of the neck. Occasionally, they are also found on a person’s eyebrows and eyelashes.

There are three stages in the lifecycle of head lice, and each stage looks different.

Nits – Each day, a female louse lays three to six eggs, called nits. Nits are oval-shaped and very small – about the size of a knot in thread. Firmly attached to the hair shaft, nits often appear yellow or white, although they can sometime appear to be the same color as a person’s hair. Nits are hard to see, and people sometimes mistake dandruff, scabs and hair spray droplets for nits. Nits are also hard to remove.

Nymph – Within 7–10 days, a nit hatches into a baby louse called a nymph. A nymph has six legs and is tan to grayish-white in color. Nymphs feed on blood and mature into adults in about 9–12 days.

Adult – The adult louse is about the size of a sesame seed, has six legs, and is tan to grayish-white in color. It may look darker in people with dark hair. Adult lice feed on blood from the scalp, and each adult can live about 30 days on a person’s head. An adult louse will die within one or two days if it falls off the person.