What to do if your child has head lice
Every year, millions of people get head lice. Unfortunately for parents and guardians of young children, head lice are very common in schools. In the U.S., between 6 and 12 million children ages 3 to 12 years old get head lice each year.1 Although they are a nuisance, they don’t spread diseases and aren’t a health hazard.2
Read on to learn more about how people get head lice, how to treat head lice and how to prevent new infestations.
What are head lice?
Lice are parasitic insects that are found on people's heads and bodies. They survive by feeding on human blood.2
Head lice are usually found on your scalp, but can also be on your eyebrows or eyelashes.2
What do head lice look like?
An adult louse (singular lice) is typically about 2–3mm long, or about the size of a sesame seed.2
What do head lice eggs look like?
Lice eggs are called nits. They are typically yellow, brown or tan and about the size of a pinhead. Nits may appear glued to the hair. Once they hatch, they leave behind clear or white shells.3
How do you know if you have head lice?
At first, head lice may not be noticeable. The most common sign is an itching feeling on the scalp. This is caused by an allergic reaction to the louse bites. It can take up to 6 weeks for itching to start the first time someone has head lice.2
Other common symptoms may include:2, 3
- A crawling or tickling sensation in the hair
- Sores or red, irritated skin on the scalp or back of the neck from scratching
The best way to tell if you have lice is to see them. They can be difficult to see since they are very small, avoid light and move quickly. Using a magnifying glass may help you see them.2
If you don’t see adult lice or a nymph (young louse), you may see nits on the base of the hair about 1/4 inch from the scalp.2
If you look at the hair under a magnifying glass, you may see dandruff, lint or dirt. These will comb out of the hair easily. Nits will be hard to remove.4
Check with a health care provider if you’re unsure whether treatment is needed.
How do you treat head lice?
There are several types of medications you can use to treat head lice. Some are shampoos. Most treatments for head lice are over-the-counter (OTC), but some need a prescription. These medications are considered safe when used as directed. They may cause mild itching or burning. Check with your health care provider before treating young children.4, 5
If treatment is necessary, follow these steps:4, 5
- Use the medication as directed on the box or label. You may need more than one box for long hair.
- Avoid using the treatment in the shower — use a hose or water from the sink to rinse out the treatment.
- Put on clean clothes after the treatment.
- If you see live lice 8–12 hours after treatment, remove with a lice or flea comb. You don’t need to re-treat right away, as it may take time to kill all the lice.
- After 8–12 hours, if you don’t see dead lice, or the lice are still very active, talk to your provider about options for re-treating or trying a different medication.
- If the first treatment works, wait 2 days to wash your hair so the medication can continue to work.
- After treatment, check hair and remove lice and nits every 2–3 days for 2–3 weeks.
- About 1 week after the first treatment, you may need to re-treat as recommended on the package (this can help kill the surviving lice that hatched after the first treatment).
- Wait 2 days to wash your hair and then continue to comb hair with the lice comb once per day for 2 weeks.
- Using a lice comb is important if school requires the child to be “nit-free” before returning.
An alternative to using lice medication is to shave the scalp bald.
Who should be checked after lice is found in your home?
If you or someone in your house has head lice, you need to check for an active infestation. Everyone who lives in the house and anyone in close contact needs to be checked. You do not need to check animals or pets.4, 5
Dermatologists suggest checking close contacts for head lice. You don't want to treat anyone who doesn't have head lice. Close contacts who don’t have lice should continue to be checked for 10–15 days after the first discovery.4
How to prevent the spread of lice infestation
Because they are common, it’s easy for kids to get lice at school or other places they play. To help prevent your child from getting head lice, teach them not to share the following items:2, 6
- Hygiene supplies, like brushes and combs
- Hair accessories
- Clothing, such as hats, scarves, coats, sports uniforms
- Helmets
- Towels
- Headphones or earbuds
Just hearing the words “head lice” can make a person’s head itch. Knowing the risks, signs and treatment may help you and your family be prepared.
Frequently asked questions about head lice
Head lice typically spread through direct contact with someone’s hair who has lice. Head lice crawl, but they can’t jump or fly.6
- Machine wash clothes, towels, bed sheets, stuffed animals and other things the person with lice used in the 2 days before treatment. Use hot water (130°F) and a hot dryer cycle.2
- Items that can’t be washed, such as hair accessories, helmets and headphones, can be sealed in plastic bags in the freezer overnight or kept in the sealed bags for 2 weeks.2
- Clean combs and brushes by soaking them in hot water (at least 130°F) for 5–10 minutes.2
- Vacuum the floor and furniture, such as couches and mattresses, especially where the person with lice sat. You don’t need to spend a lot of time or money cleaning your house to keep lice away.2
- Do not use sprays or fogs. They are not needed for lice and can be dangerous if you breathe them in or get them on your skin.2
If treating head lice at home isn't working, or it feels too hard to handle by yourself, you should talk to your provider. They might suggest a prescription medicine. The Food and Drug Administration (FDA) has approved some prescription medicines to treat head lice:4
- Benzyl alcohol lotion: This medicine treats head lice for people 6 months and older. Pregnant or nursing women can use this medicine.
- Ivermectin lotion: Ivermectin can treat head lice in babies 6 months and older. You usually need to use it only once, and you don’t have to comb out nits.
- Malathion lotion: Malathion is approved for people ages 6 and older. It kills lice and their eggs. Don’t let malathion get in anyone’s eyes, don’t smoke while using and keep away from flames.
- Spinosad suspension: This medicine works for head lice in people 6 months and older. Like ivermectin lotion, you usually need to use it only once and you don’t have to comb out nits.
- Lindane shampoo: Providers use it when other treatments don’t work. Only use Lindane as directed. It can be harmful if not used correctly.
Also call your provider if your child shows signs of an infection from scratching. This may include a fever, sores that won’t heal, pain or tenderness on their head and redness or swelling on their scalp.7
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