Head lice

Head lice aren't always immediately noticeable. But they typically cause the following symptoms:

• Tingling on your scalp or the feeling that something is moving in your hair
• Itching where the lice have bitten, and sore areas of skin from scratching
• Trouble sleeping due to the itching because lice are nocturnal (active at night)

Head lice are most common in children. They nearly always spread through direct hair contact, for instance when children huddle together while playing or snuggling.

Although some people think head lice are a sign of uncleanliness, the lice don't care whether your hair is clean or dirty. They feed on blood. So anyone can get head lice.

Girls are somewhat more likely to be affected than boys. That's probably because girls do more (and longer) activities with their heads close together than boys do. Hair length, density or structure don't have any effect on your risk of getting head lice – but it's more difficult to find the parasites in long, thick and curly hair.

Head lice are quite common, especially among children between the ages of 3 and 12 years. Although no exact figures are available, it is estimated that about 1 to 3% of all children in Germany have head lice.

It is quite common for there to be outbreaks at child care centers and schools. The lice typically appear in the first few months following the summer break – that is, late summer and early fall.

You can check whether your child (or you) have head lice by using a special fine-toothed lice comb. There is no need to go to the doctor. Lice combs are available at pharmacies, drugstores or medical supply stores.

It is best to first wet the hair and then carefully comb it section by section, from the roots to the tips, at least twice. If the hair is long, curly, or particularly thick, it helps to apply hair conditioner beforehand so that the comb can move through the hair more easily. It is best to wipe the comb on a paper towel after each strand. This makes it easier to spot any head lice.

Full-grown head lice are 2 to 3 mm long. Their bodies are flat, wingless and grayish-brown in color. Unlike fleas, lice can't jump. But their six legs allow them to hold on tight to human hair and crawl along it. Because head lice are so small, it’s difficult to see them in thicker areas of hair. You can use a magnifying glass to help you find smaller lice.

Head lice usually lay their eggs (nits) along the hairline around the temples, on the nape of the neck or behind the ears. These stick firmly to your hair, usually close to the scalp (less than one centimeter away).

Other small objects found in hair, like dandruff or scabs, may be mistaken for lice. But they don’t stick to the hair and will fall out when shaken.

There is no surefire way to prevent head lice. But there are a number of things you can do to stop head lice from spreading if a child has them. The lice are almost always passed on to other children through direct hair-to-hair contact.

Because head lice need to feed on blood every 4 to 6 hours, they generally can't survive very long away from the scalp. Lice that fall off your head will very soon get weak and die within 2 to 3 days at room temperature. The eggs also have to be close to the scalp because they need warm temperatures to be able to hatch. So you are unlikely to get lice through contact with objects. It can't be ruled out completely, though. If you want to be on the safe side, you can make sure that children don't share things like hats, scarves or hairbrushes. You can also

• thoroughly clean combs, brushes and hair accessories with hot water and soap and set them aside for a few days,
• wash used bedding, pajamas, clothing and towels at 60 degrees Celsius (140 degrees Fahrenheit) or put them in the dryer,
• put clothing and objects like soft toys that can't be washed at over 60 degrees Celsius in a sealed plastic bag for 3 days.

Pets don't need to be treated: Head lice only live on humans, not on animals. It is also not necessary to disinfect your home or to use insecticides.

Treatment is needed only if you find live lice or eggs that are capable of living. Then it's important to act quickly, though, to stop them from spreading further. Treatments for head lice include:

• Insecticide-based treatments
• Silicone-based treatments (dimethicone or dimeticone)

Plant-based treatments (for example coconut oil) are also available. There’s a lack of good research on their effectiveness, though. The same is true for home remedies such as olive oil or mayonnaise.

Head lice have now built up a resistance to some insecticides, so these products are less effective than they used to be. Treatments with silicone oil are becoming more popular. They don't contain insecticides and there are no problems related to resistance. Silicone-based treatments cover the lice with a layer of oil, causing them to suffocate.

Most of these treatments need to be re-applied after about 7 to 10 days. To find out exactly how to use the product you have, you can read the package insert. In Germany, most head lice treatments are covered by health insurers if they are prescribed for children under the age of 12 years. They can be picked up from pharmacies. You can usually get a prescription from the pediatrician's office by calling and asking for one.

Combing out the hair with a lice comb is not enough when used as the only treatment. But it's important to use the comb in order to check whether the treatment has been successful. Experts recommend re-combing the hair every 3 days for at least 2 weeks after applying a head lice treatment.

If your child still has a few nits after being treated for head lice, but you have not found any lice for a while, the parasites are probably gone. Nits or parts of nits may stick to hair for weeks after having head lice. You can tell roughly how old the nits are based on their distance from the scalp. Hair grows at a rate of about one centimeter per month. So any nits that are more than one centimeter away from the scalp are probably older eggs that won’t live.

A lot of people still think that lice prefer dirty hair – so it can be uncomfortable or embarrassing for parents and children. But there is no link between personal hygiene and head lice.

Because head lice can spread so quickly, the parents or guardians of a child with head lice are required by law to tell public institutions (like the child care center or school) that their child has head lice. You may feel a bit awkward when informing them, but there's no reason to be embarrassed. Head lice are a frequent problem at most child care centers and schools. It is also important to tell family members and friends who recently had physical contact with the child.

According to German law, children who have head lice must stay away from their child care center or school until they are free of lice. They can return the next day if they have been given a treatment that is known to be effective. You can ask your pediatrician or pharmacist about which products qualify and which are paid for by public health insurers in Germany. Many places only ask for a statement from the parents confirming that the child has been treated. Others ask to see a note from the doctor.

When people are ill or need medical advice, they usually go to see their family doctor or pediatrician first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.