Advice on head lice

Here's some important advice if you’re scratching your head (perhaps literally) over head lice.

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 ten 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. These parasites feed only on human blood.

How do head lice spread? 

Head lice spread through head-to-head contact or sharing lice-infested personal items such as hats, towels, brushes, hair ties, or pillows. Lice can infest various body parts, but they’re most often found on the heads of 3- to 10-year-olds in preschool, elementary school, or childcare 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. 
  • Then, 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 resemble tiny white or yellowish-brown oval specks firmly attached to the hair. They’re typically found near the scalp, hairline, 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 entirely harmless and don’t pose a health hazard to children. Schools often institute “no head lice/nit” policies, but since 2010, the AAP has held that because lice aren’t a health hazard, healthy children with head lice shouldn’t be sent home from school, although they should be cautioned against close head contact until treatment can be completed.

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 two weeks with a fine-toothed comb designed to remove nits. However, 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 no data 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 healthcare provider before using any lice treatments containing pesticides, including those available without a prescription (over-the-counter).

What are the next steps? 

All household members and close contacts should also be checked for signs of lice and treated, if necessary. 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 work, your child’s healthcare provider can suggest treatment options. There may also be professionals in your community who specialize in treating cases of head lice and can even come to your home to assist.

Last updated December 6, 2021

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