Head Lice in Kids: How to Check, Treat and Prevent Reinfestation

Quick answer: head lice are tiny insects that live on the scalp and spread mainly through direct head-to-head contact. They are a nuisance, not a sign of poor hygiene, and they do not spread disease. To check, comb wet, conditioned hair section by section with a fine-tooth lice comb. Treat with an over-the-counter product such as permethrin or pyrethrins, or ask your doctor about prescription options like spinosad, malathion or ivermectin lotion, following the label exactly and repeating if directed. Wash bedding and hats used in the past two days in hot water, check everyone in the household and do not use pesticide sprays in the home. The American Academy of Pediatrics says children with lice do not need to miss school.

A note home from school about lice can make any parent’s scalp itch. The good news is that head lice are common, treatable and not dangerous. Millions of children get them each year, most often between ages 3 and 11. Knowing what works and what is a myth saves time, money and worry. This guide is part of our family safety guide.

Sources: American Academy of Pediatrics (AAP) clinical report on head lice, updated in 2022, and HealthyChildren.org; Centers for Disease Control and Prevention (CDC) head lice guidance; U.S. Food and Drug Administration (FDA) information on approved lice treatments. This is general information, not medical advice. Talk with your child’s doctor before treating infants, if your child has scalp conditions or if treatment does not work.

What Head Lice Are

Head lice are small, wingless insects that live on the human scalp and feed on tiny amounts of blood. They cannot survive long away from a human head, usually only a day or two.

Stage	What it looks like	Where you find it
Nit (egg)	Tiny oval, yellow-white to tan, glued firmly to the hair shaft	Close to the scalp, often behind the ears and at the nape of the neck
Nymph	A smaller version of the adult	On the scalp and hair
Adult louse	About the size of a sesame seed, grayish-white to tan, six legs	Moving quickly on the scalp; avoids light

Nits found within about a quarter inch of the scalp are more likely to be alive. Nits farther out on the hair shaft are usually hatched or dead, especially after treatment.

How Lice Spread

• Head-to-head contact is by far the most common route, such as during play, sports, sleepovers or hugging.
• Sharing items like hats, combs, brushes, helmets and pillows is a much less common route.
• Pets do not spread head lice. Human lice do not live on dogs or cats.
• Lice cannot jump or fly. They crawl.

Having lice has nothing to do with cleanliness. Lice can live in clean or dirty hair.

Signs of Head Lice

• Itching of the scalp, neck and ears, caused by a reaction to louse bites
• A tickling feeling of something moving in the hair
• Irritability or trouble sleeping, since lice are more active in the dark
• Sores from scratching, which can occasionally become infected

Some children have lice without any itching, especially during a first infestation. That is why checking matters.

Itching can also continue for several days after successful treatment, because the skin is still reacting to old bites or to the treatment itself. Ongoing itching alone does not always mean treatment failed. Check again with a comb, and talk with your doctor if you still find live lice or if the scalp looks irritated. Fevers often come with other childhood illnesses, but not with lice; if your child has a fever, our guide to fever in kids explains when to call.

How to Check for Lice

A fine-tooth lice comb is the most reliable tool. Metal combs with long, closely spaced teeth work best.

1. Wet the hair and apply plenty of conditioner. This slows lice down and makes combing easier.
2. Detangle with a regular comb.
3. Divide hair into small sections and clip them out of the way.
4. Comb each section from the scalp to the ends with the lice comb.
5. Wipe the comb on a white paper towel after each pass and look for lice or nits.
6. Check behind the ears and the nape of the neck carefully.
7. Rinse the hair and clean the comb in hot, soapy water.

Use bright light or sunlight, and a magnifying glass if needed. Dandruff, hair spray droplets and dirt can look like nits, but they brush off easily. Nits stick firmly to the hair.

Who Else to Check

If one child has lice, check everyone in the household. Treat only those with live lice or nits close to the scalp. Family members who share a bed with an affected person are sometimes treated at the same time; ask your doctor.

Treatment Options

Follow the product label exactly. Most treatment failures come from not following directions, skipping the second treatment or reinfestation.

Over-the-Counter Treatments

Active ingredient	Notes
Permethrin 1% lotion or creme rinse	Kills live lice but not all eggs; a second treatment is often needed about 9 days later
Pyrethrins with piperonyl butoxide	Made from chrysanthemum extracts; avoid if allergic to chrysanthemums or ragweed; usually repeated
Ivermectin 0.5% lotion	Became available over the counter in the United States in 2020; one application is often enough

Resistance to permethrin and pyrethrins has been reported in some areas, so if a product does not work after correct use, talk with your doctor.

Prescription Treatments

• Spinosad 0.9% suspension: kills lice and eggs, often needing only one application.
• Malathion 0.5% lotion: flammable; keep away from heat, hair dryers and flames.
• Oral ivermectin: sometimes prescribed for hard-to-treat cases.

Lindane shampoo is no longer recommended as a first treatment because of the risk of serious nervous system side effects.

Tips for Using Treatments

• Do not use conditioner or combination shampoo-conditioner before applying a lice treatment unless the label says to, since it can coat the hair and reduce effectiveness.
• Apply to dry or wet hair as the label directs.
• Leave on only for the recommended time.
• Do not rewash hair for one to two days after some treatments, as directed.
• Comb out nits afterward with a fine-tooth comb.
• Check every two to three days for two to three weeks.
• Repeat if the label or your doctor says so, usually about 7 to 9 days later.
• Do not use extra or more frequent doses to try to speed things up.

Wet Combing Without Chemicals

Combing wet, conditioned hair thoroughly every three to four days for at least two weeks can remove lice without medicine. It takes patience, and success depends on careful technique, but it is an option for families who prefer to avoid pesticides or for children too young for some products.

What About Home Remedies?

Mayonnaise, olive oil, petroleum jelly, essential oils and other home treatments are popular, but there is little good evidence that they work reliably. Some can be messy or irritate skin. Never use flammable or dangerous substances such as gasoline or kerosene on a child’s head.

Cleaning the Home

Lice do not live long off the head, so extensive cleaning is not needed. The CDC recommends a simple approach:

• Machine wash bedding, hats, scarves and clothing worn or used in the two days before treatment in hot water (130 °F), and dry on high heat.
• Seal items you cannot wash, such as stuffed animals, in a plastic bag for two weeks, or put them in a hot dryer for 30 minutes if safe for the item.
• Soak combs and brushes in hot water for 5 to 10 minutes.
• Vacuum floors and furniture where the affected person sat or lay.
• Skip fumigant sprays and foggers. They are not needed and can be toxic if inhaled or absorbed through the skin.

Keep lice treatments, like all medicines and pesticides, stored safely away from children. Our guide to poison prevention at home covers safe storage.

School and Child Care Attendance

The AAP advises that healthy children with head lice should not be excluded from school or allowed to miss school because of lice. By the time lice are found, a child has usually had them for weeks, so sending a child home mid-day does little to prevent spread. The AAP also discourages “no-nit” policies that keep children out of school until every nit is gone.

Policies vary by school and district, so check your school’s rules. Tell the school nurse if your child has lice so they can advise families quietly. For other reasons to keep children home, see our guide on when to keep your child home from school.

Preventing Reinfestation

• Teach children to avoid head-to-head contact during play and sports.
• Encourage children not to share hats, scarves, helmets, combs, brushes or hair accessories.
• Keep long hair in braids or buns during outbreaks.
• Check hair weekly during school outbreaks or after camps and sleepovers.
• Store coats and hats on separate hooks when possible.

Talking With Your Child About Lice

Children pick up on adult stress quickly. A calm explanation helps them cooperate with combing and avoids embarrassment.

• Keep it matter-of-fact. Explain that lice are tiny bugs that lots of kids get, that they are not dangerous and that you know how to get rid of them.
• Avoid blame. Do not suggest your child or another child is dirty. Lice spread through ordinary play.
• Make combing time bearable. Put on a show, audiobook or favorite music, offer a snack and take short breaks.
• Respect privacy. Older children may not want classmates or siblings to know. Let them decide who to tell, within reason.
• Praise patience. Treatment can take a couple of weeks, and staying positive helps everyone get through it.

Teasing about lice can hurt. Encourage your child to treat others kindly if lice show up in their class, too.

Telling Other Families

When your child has lice, it helps to quietly tell close contacts, such as families from a recent sleepover, sports team or carpool, so they can check their children. A short, neutral message works best, for example letting them know your child was found to have head lice, that you are treating it and that they may want to check their kids. Most parents appreciate the heads-up.

Lice During Camps, Sleepovers and Travel

Overnight camps and sleepovers bring lots of close contact, which is why lice sometimes follow children home.

• Check hair before camp so your child does not bring lice with them.
• Pack a personal pillow, brush and hair ties, and remind children not to share them.
• Check again within a few days of coming home, using the wet combing method.
• Ask about the camp’s lice policy ahead of time; many check campers on arrival.

When to Call the Doctor

• Your child is under 2 years old.
• Over-the-counter treatment does not work after two correct uses.
• The scalp is red, swollen, crusted or oozing, which may signal infection.
• You are not sure whether what you see is lice.
• Your child has allergies, asthma or a skin condition that could react to treatment.
• You are pregnant or breastfeeding and need treatment yourself.

Common Myths

• Myth: lice mean a dirty home. Lice spread through contact, not dirt.
• Myth: lice jump between heads. They crawl.
• Myth: pets carry lice. Human head lice do not live on animals.
• Myth: you must deep clean the whole house. Wash recently used items and vacuum; that is enough.
• Myth: children must stay home until nit-free. The AAP recommends keeping children in school.

Frequently Asked Questions

How do kids get head lice?

Mostly through direct head-to-head contact during play, sports or sleepovers. Sharing hats and brushes is a less common route.

What kills head lice best?

Over-the-counter permethrin, pyrethrins or ivermectin lotion work for many children when used exactly as directed. Prescription options include spinosad and malathion. Ask your doctor if treatment fails.

Do I need to wash everything in the house?

No. Wash bedding, hats and clothes used in the past two days in hot water and dry on high heat, bag non-washable items for two weeks and vacuum.

Can my child go to school with lice?

The AAP says healthy children with head lice should not miss school. Check your school’s policy.

How long do lice live off the head?

Usually only a day or two. Nits generally cannot hatch away from the warmth of the scalp.

Are home remedies like mayonnaise effective for lice?

There is little good evidence that they work reliably. Wet combing or approved treatments used as directed are better choices.