Head lice are tiny wingless insects. They live among human hairs and feed on blood
from the scalp.
Head lice are a common problem, especially for kids. They spread easily from person
to person, and sometimes are tough to get rid of. Their bites can make a child's scalp
itchy and irritated, and scratching can lead to infection.
Head lice are annoying, but they're not dangerous and they don't spread disease.
They're not a sign of poor hygiene — head lice need blood and they don't care
whether it's from someone who's clean or dirty.
It's best to treat head lice right away to prevent them from spreading.
What Are the Signs & Symptoms of Head Lice?
Even though they're tiny, you can see head lice. Here's what to look for:
Lice eggs (nits). These look like tiny yellow, tan, or brown
dots before they hatch. Lice lay nits on hair shafts close to the scalp, where the
temperature is perfect for keeping warm until they hatch. Nits look a bit like dandruff,
but aren't removed by brushing or shaking them off.
Unless a child has
many head lice, it's more common to see nits in the hair than live lice crawling on
the scalp. Lice eggs hatch 1–2 weeks after they're laid. After hatching, the
remaining shell looks white or clear and stays attached to the hair shaft. This is
when it's easiest to spot them, as the hair is growing longer and the egg shell is
moving away from the scalp.
Adult lice and nymphs (baby lice). Adult lice are no bigger than
a sesame seed and are grayish-white or tan. Nymphs are smaller and become adult lice
about 1–2 weeks after they hatch. This life cycle repeats itself about every
3 weeks. Most lice feed on blood several times a day, and they can survive up to 2
days off the scalp.
Scratching. With lice bites come itching and scratching. This
is due to a reaction to the saliva (spit) of lice. But the itching doesn't always
start right away. It depends on how sensitive a child's skin is to the lice. It might
take weeks for kids with lice to start scratching. They may complain, though, of things
tickling or moving around on their heads.
Small red bumps or sores from scratching. Some kids have mild
irritation from scratching, while others may get a bothersome rash. Scratching a lot
can lead to a bacterial infection.
Watch for swollen lymph nodes (glands) on the back or front of the neck, and red,
tender skin that might have crusting and oozing. Doctors can treat a skin infection
with an antibiotic.
How Can I Check My Child for Head Lice?
Look for lice and nits on the scalp, behind the ears, and around the nape of the
neck. It's rare for lice to be in eyelashes or eyebrows.
It can be tough to find a nymph or adult louse. Usually, there aren't many of them
and they move fast. Look for nits attached to the hair near the scalp. They can look
like dandruff or dirt. To tell them apart, pull on the little speck with your fingers
— dandruff and dirt can be removed, but nits stay stuck. A magnifying glass
and a bright light can help with your inspection.
The best way to check is by using a fine-tooth comb on wet hair. After applying
lots of conditioner, comb the hair out in very small sections, and look for lice or
nits on the comb. You can wipe the comb onto a tissue or paper towel where it will
be easier to see them.
If your child is itchy and scratching their head but you're not sure if it's lice,
ask your child's doctor or the nurse at school or childcare center to take a look.
Medicine: Medicated shampoos, cream rinses, and lotions are available
that kill lice. These may be over-the-counter (OTC) or prescription medicines. If
you buy OTC, be sure it's safe for your child's age. While some over-the-counter shampoos
are safe for kids as young as 2 months, others are safe only for kids 2 years and
In some areas, lice have developed resistance to some medicines. This means they
no longer work to kill the lice. Ask your doctor or a pharmacist to recommend a medicine
known to work in your area. The doctor also can prescribe a medicated shampoo or lotion.
For very resistant lice, the doctor might recommend taking medicine by mouth.
Whether the medicine is OTC or prescription, always follow the directions closely.
Applying too much can be harmful. Applying too little won't work.
Removing by hand: Removing lice and nits by hand can finish the
job if the medicine did not completely rid your child of lice (no medicine is 100%
effective). It is also an option for anyone who doesn't want to use an insecticide.
And it is the only option for children 2 months old or younger, who should not use
medicated lice treatment.
To do this, use a fine-tooth comb on wet, conditioned hair every 3–4 days
for 3 weeks after the last live louse was seen. Wetting the hair temporarily stops
the lice from moving, and the conditioner makes it easier to get a comb through the
There's no need to buy electronic combs that claim to kill lice or make nits easier
to remove. No studies have been done to back up these claims. You also don't need
to buy special vinegar solutions to apply to the scalp before picking nits. Water
and conditioner works fine.
Though petroleum jelly, mayonnaise, or olive oil are sometimes used to try to suffocate
head lice, these treatments may not work. If medicine doesn't work and you want to
try these methods, talk to your doctor first.
A few important things to NOT do: Don't use a hairdryer after
applying scalp treatments. Some treatments for lice use flammable ingredients and
can catch on fire. Don't use pesticide sprays or hire a pest control
company to try to get rid of the lice; these can be harmful. Don't use
essential oils (such as ylang ylang oil or tea tree oil) to treat lice on the scalp.
They can cause allergic skin reactions and aren't approved by the U.S. Food and Drug
Administration (FDA). Don't ever use highly flammable chemicals
such as gasoline or kerosene on anyone.
Are Head Lice Contagious?
Head lice spread quickly from person to person, especially in group settings like
schools, childcare centers, slumber parties, sports activities, and camps.
They can't fly or jump, but they have claws that let them crawl and cling to hair.
They spread through head-to-head contact, and sharing clothing, bed linens, combs,
brushes, and hats.
Pets can't catch head lice and pass them on to people or the other way around.
Do Kids Have to Stay Home From School?
In the past, kids with head lice were kept home from school. But now doctors don't
recommend these "no-nit" policies. In most cases, a child who has lice should stay
at school until the end of the day, go home and get treatment, and return to school
the next day. While they are at school, kids should avoid head-to-head contact with
other kids. It can help to put long hair up in a bun, braid, or ponytail.
Can We Prevent Head Lice?
To get rid of head lice and their eggs, and to help prevent them from coming back:
Wash all bed linens, stuffed animals, and clothing used during the 2 days before
treatment (any lice that fell off before that will not be alive). Wash in very hot
water (130°F [54.4°C]), then put them in the hot cycle of the dryer for at
least 20 minutes.
Dry clean items that can't be washed. Or put them in airtight bags for 2 weeks.
Vacuum carpets and any upholstered furniture (in your home or car), and throw
away the vacuum cleaner bag.
Soak hair-care items like combs, barrettes, hair ties or bands, headbands, and
brushes in hot water or throw them away. Tell kids not to share these items.
Because lice easily pass from person to person in the same house, check all family
members. Treat everyone who has lice so they won't pass it back and forth.
Tell kids to try to avoid head-to-head contact at school (in gym, on the playground,
or during sports) and while playing at home with other children.
Every 3 or 4 days, check kids who had close contact with a person who has lice.
Then, treat any who have lice or nits close to the scalp.
Will They Ever Be Gone?
As many parents know, fighting head lice can be an ongoing battle. There's no doubt
that they can be hard bugs to get rid of.
If you've tried everything and your child still has lice, it could be because:
some nits were left behind (if you see nits far from the scalp — more than
½ inch (1 cm) — and no live lice, these are probably dead and treatment
likely isn't needed)
your child is still around someone who has lice
the treatment you're using isn't effective
If your child has lice 2 weeks after you started treatment or if your child's scalp
looks infected, call your doctor.
There are professional lice treatment centers that remove lice and nits for a fee.
These services are effective but often costly.
Remind your child that while having lice can be embarrassing, anyone can get them.
Having head lice is not a sign of dirtiness or poor hygiene. The pesky little bugs
can be a problem no matter how often kids do — or don't — wash their hair
Dealing with head lice can be frustrating, but be patient. Follow the treatments
and prevention tips from your doctor, and soon your family will be lice-free.