Red Flags & When to Go In Person for Lice (Pediculosis) in Children

Audience: pediatric

Lice (Pediculosis) are tiny insects that live on the scalp and hair, especially common in children. They cause itching and discomfort but are not dangerous. Many cases can be managed at home with over-the-counter treatments and good hygiene. Telemedicine can help guide families on how to check for lice, use treatments safely, and prevent spread. However, some situations need an in-person visit to a healthcare provider. These include severe itching that does not improve, signs of infection like redness or swelling, or if treatments do not work after several attempts. Recognizing these red flags helps ensure children get the right care quickly. This guide explains when to seek in-person care, what telemedicine can and cannot do, and how to prepare for a virtual visit about lice.

Red flags — go in person / ER

• Severe itching lasting more than 2 weeks despite treatment — seek in-person care to evaluate and adjust treatment.
• Signs of scalp infection such as redness, swelling, warmth, pain, or pus — urgent in-person evaluation needed.
• Persistent lice or nits after two or more appropriate treatments — in-person assessment recommended to consider prescription options.

What telemedicine can do

• Guidance on how to check for lice and nits.
• Advice on over-the-counter treatment use and safety.
• Education on prevention and hygiene measures.
• Support for mild cases without complications.

What telemedicine cannot do

• Physical removal of lice or nits.
• Diagnosis and treatment of scalp infections.
• Prescription medication evaluation when needed.
• Assessment of severe symptoms or complications.

What Are Head Lice?

Head lice are tiny insects that live on the scalp and hair. They do not spread disease but can cause itching and discomfort. Lice spread mainly through close head-to-head contact, common among children in schools and daycare. They do not jump or fly, and sharing hats or combs is less likely to spread lice than direct contact.

Common Signs and Symptoms

The main symptom of lice is itching on the scalp, especially behind the ears and at the back of the neck. You might see tiny white eggs (nits) attached to hair shafts close to the scalp. Sometimes, small red bumps or sores can appear from scratching. Itching may take a few weeks to start after lice first appear.

When to Use Telemedicine for Lice

Telemedicine can help you learn how to check for lice and nits correctly. A healthcare provider can guide you on safe treatment options, how to apply lice shampoos or comb out lice, and steps to prevent spreading to others. Telemedicine is useful if you have mild symptoms and want advice on home care.

Red Flags: When to See a Healthcare Provider In Person

Some situations need an in-person visit, including:

In-person care allows for a physical exam, possible prescription treatments, and checking for complications.

Preventing and Managing Lice at Home

To help manage lice:

Good hygiene and cleaning help prevent reinfestation.

What Telemedicine Cannot Do for Lice

Telemedicine cannot:

If these are needed, an in-person visit is important.

How to prepare for your tele-visit

• Have good lighting and a quiet space for the tele-visit.
• Gather any lice treatment products you have used or plan to use.
• Be ready to show the child's scalp and hair on camera if possible.
• Note any symptoms such as itching duration, severity, or signs of infection.
• Have questions ready about treatment steps and prevention.
• Ensure the child is comfortable and cooperative for the visit.

After your tele-visit

• Follow the treatment plan and instructions provided during the tele-visit.
• Use a fine-toothed comb daily to remove lice and nits.
• Wash bedding, hats, and clothes in hot water to prevent reinfestation.
• Monitor for any worsening symptoms or signs of infection.
• Schedule an in-person visit if red flags appear or treatment fails.
• Inform close contacts such as school or daycare if lice are found.

FAQs

Can lice spread to other family members?

Yes, lice spread mainly through close head-to-head contact. It is important to check all family members and treat those who have lice to prevent spread.

Are lice dangerous or do they cause illness?

No, lice do not spread disease. They cause itching and discomfort but are not harmful. However, scratching can sometimes lead to skin infections.

How long does it take to get rid of lice?

With proper treatment and combing, lice can often be eliminated within 1 to 2 weeks. It may take longer if treatments are not used correctly or if reinfestation occurs.

Can I use home remedies instead of lice treatments?

Some home remedies are not proven to work and may be unsafe. It is best to follow evidence-based treatments recommended by healthcare providers.

When should I seek in-person care for my child's lice?

Seek in-person care if itching is severe or worsening, if there are signs of infection like redness or pus, or if lice persist after multiple treatments.

Sources

1. Head Lice — MedlinePlus, U.S. National Library of Medicine.
2. Head Lice Treatment — Centers for Disease Control and Prevention (CDC).
3. Pediculosis (Lice) — Mayo Clinic.
4. Head Lice - Consumer Version — Merck Manuals.

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical care. If you notice any red flags or have concerns about your child's health, please seek evaluation by a healthcare professional in person.