Advice on head lice

If you’re scratching your head (perhaps literally) over head lice, here’s some important advice.

First, know that head lice aren’t a sign of poor hygiene or an unclean living environment. Head lice rank as the second-most-common condition in school children (the common cold tops the list), affecting 1 in every 10 children.

What are head lice? 

Head lice are wingless insects about 3 millimeters long (the size of a sesame seed) and brown, tan, or gray in color. These parasites feed only on human blood.

How do head lice spread? 

Head lice spread through head-to-head contact or through the sharing of lice-infested personal items such as hats, towels, brushes, hair ties, or pillows. Lice can infest various parts of the body, but they’re found most often on the heads of 3- to 10-year-olds who are in preschool, elementary school, or child care centers. 

What are the symptoms of head lice? 

Children or adults with head lice often experience itching behind the ears or on the back of the neck. Eczema, dandruff, or an allergic reaction to hair products can also cause itching, so the only clear sign of head lice is the insects (or nits) themselves. 

How can I tell if my child has head lice? 

The American Academy of Pediatrics (AAP) provides steps for identifying head lice and nits on your child: 

  • Seat your child in a brightly lit room. 
  • Part the hair and look at your child’s scalp. 
  • Check for crawling lice, which can be difficult to find because they avoid light, and also for nits (eggs). Nits look like small white or yellowish-brown oval specks firmly attached to the hair. They’re typically found near the scalp, hairline, and back of the neck and behind the ears. Nits can be confused with dandruff or dirt particles. But if they are difficult to remove, they’re likely nits.

Will head lice harm my child? 

While ridding your child’s scalp of lice and their eggs can be quite a nuisance, the important thing to remember is that lice are completely harmless and don’t pose a health hazard to children. Schools often institute “no head lice/nit” policies but the AAP declared in 2010 that, because lice aren’t a health hazard, healthy children with head lice shouldn’t be sent home from school.

How are head lice treated? 

Initial treatments for head lice include over-the-counter shampoos or rinses and/or a manual “comb-out” method—combing your child’s damp hair daily for 2 weeks with a fine-toothed comb designed to remove nits. The AAP cautions that using the comb-out method alone often fails.

Many websites tout the effectiveness of home remedies such as herbal oils, margarine, mayonnaise, olive oil, and petroleum jelly, but there is no data to support their use.

The AAP recommends using products containing 1-percent permethrin lotion, an active lice-fighting ingredient. Follow the manufacturer’s instructions, repeating the treatment 7–10 days after the first application. For detailed advice from the AAP on treating lice, click here.

As a precaution, always check with your child’s health care provider before using any lice treatments containing pesticides, including those available without a prescription (over-the-counter).

What are the next steps? 

You’ll also need to wash your child’s clothes, towels, sheets, and hats—any cloth items he’s been in close contact with—in hot water and dry them on high heat. Vacuum all carpets and furniture or have them professionally cleaned. 

If over-the-counter remedies and/or the comb-out method don’t do the trick, your child’s health care provider can suggest treatment options. There may also be professionals in your community who specialize in treating cases of head lice and who can even come to your home to assist.

Last updated June 27, 2019

Suggested Reads