How to prevent—and treat—lice in children

Endless coughs and sneezes, runny noses, and unexplained itchy bumps—kids seem to be a magnet for germs. In our parent’s guide to childhood illnesses, we talk about the symptoms and treatments for the most common conditions. Read the full series here.

What are lice? | Symptoms of head lice | Diagnosis | Lice treatment for kids | Home remedies for lice | Prevention

One afternoon, as the toddlers in my class at the daycare were slowly waking up from naptime, I sat with two sleepy children in my lap as we quietly read stories. This serenity was quickly interrupted when I saw an insect scurrying through one of the children’s hair. I quickly put both children down and double-checked that my eyes had not deceived me. Later that day, a phone call from the child’s mother confirmed my suspicions—the child had lice. So did their sibling in another class. Thus began the occasional daycare phenomenon I like to call “lice panic.”

While irritating, lice are not generally dangerous, but they do cause quite a stir!

What are lice?

Head lice are tiny insects that live on human hair and feed on blood from the scalp. They pass easily from person to person, particularly from close contact, but can also be spread from shared objects such as hats and hairbrushes. They do not fly or jump. Head lice are not dangerous and do not spread disease.

Head lice are different than body lice. As the names suggest, head lice live on the head, and body lice live on the body. They are different parasites with different causes and treatments. For the purposes of this article, “lice” will refer to head lice.

How common are lice?

Approximately 6 to 12 million infestations of lice occur each year among children 3 to 11 years of age in the United States.

“One of the times of year I tend to see a spike in lice cases is toward the end of the summer and early in the school year,” says Erum Ilyas, MD, the founder of Montgomery Dermatology in Pennsylvania. “Many are linked to camps and the beginning of the school year.”

While lice commonly spread through children in places like child care centers and schools, adults can catch lice, too—frequently from a family member with lice.

RELATED: How to keep kids healthy all year long

What do lice look like?

Lice are small (about 2-3 mm, the size of a sesame seed) wingless bugs that are usually pale and gray, though their color can vary. 

Lice lay eggs in casings called nits. The nits are about 0.8 mm long and 0.3 mm wide and are shaped like an oval. The nits remain stuck to the hair after the eggs hatch. They are yellow or white in color and can be hard to spot on some hair colors.

Newly hatched lice, called nymphs, are about the size of a pinhead (1.5 mm), and look like the adult lice they will become in about a week.

Symptoms of lice infestation include:

• Itching on the scalp (itching may last for up to a few weeks after the lice are gone)
• Sensation of something moving in the hair
• Difficulty sleeping (head lice are more active in the dark)
• Sores on the head from scratching/infections as a result of bacteria from the skin getting into the wounds
• Visible nits or lice 

It may take weeks before itching begins, but nits and lice can be seen on the hair before other symptoms occur, particularly behind the ears and near the neckline at the back of the head. It is more common to see nits than to see active, adult lice. Lice eggs/nits are usually found close to the scalp.

Do you need to see a doctor for lice?

“You do not need to see a doctor for lice if a family is confident (from past experience or Doctor Google) that they are dealing with lice,” says Ashanti Woods, MD, a pediatrician at Mercy Medical Center in Baltimore. “If uncertain if a child or family member is dealing with lice vs. bad dandruff vs. psoriasis, then yes, a physician or medical provider should be seen.”

“Most cases I see are either treatment-resistant cases, cases that involve spread among numerous family members that results in difficulty getting ahead of it, or recurrent cases,” Dr. Ilyas says.

Lice are often found during “lice checks,” where teachers or the school nurse will check each child’s head for lice after a student at the school has been diagnosed with lice or there is a suspected outbreak. 

Head lice treatment for kids

“There are over-the-counter treatments for lice,” says Tanya Kormeili, MD, a board-certified dermatologist in Santa Monica, California. “There are natural, non-pesticide treatments that include various oils and soaps. There are pesticide ones that are FDA approved.”

In addition to topical treatment, it is usually necessary to manually remove lice and nits from the hair shafts. “If you ever wondered about the expression, ‘nitpicker,’ you will know why it is such a profound statement!” says Dr. Kormeili.

The best course of action is a combination treatment. “Topical treatments (known as pediculicides), manual removal (known as wet combing), and/or oral treatment (for stubborn cases) are all documented ways of treating lice,” says Dr. Woods. “Home treatments (wet combing) do work, but patients may see a reemergence of their symptoms eventually. Therefore, a topical treatment is often superior to or best used with a home remedy.”

Over-the-counter lice treatment

Some over-the-counter (OTC) medications approved by the U.S. Food and Drug Administration (FDA) to treat lice include:

Prescription lice treatment

Some prescription medications approved by the FDA to treat lice include:

To treat lice with medication, use the following basic steps (check with the directions for the individual form of treatment and defer to those directions if there is a conflict in procedure):

1. Remove child’s clothing (to the comfort level of the child).
2. Apply and rinse the medication with warm water according to the instructions in the box or printed on the label. Pay close attention to how long the treatment needs to stay on.
3. Have the child put on clean clothes.
4. Check hair in eight to 12 hours—if a few live lice remain, but are moving slower than normal, do not re-treat. It may take longer than 12 hours to kill lice. Instead, use a fine-tooth comb to remove nits, dead lice, and remaining live lice (if any.)
5. Check hair, and comb with a nit comb (fine-tooth comb) every two to three days for two to three weeks to reduce the chance of a recurrence. Sometimes a second treatment may be necessary.

How to do “wet combing”:

1. Wet the child’s hair.
2. Comb through the child’s hair with a fine-tooth comb, one small section at a time. Special combs made specifically for nit-removal are available—check with pharmacies or online. Flea combs for pets are also effective.
3. After each comb-through, wipe the comb on a wet paper towel. Carefully check the comb, the child’s scalp, and the paper towel.
4. Repeat combing and checking until all of the hair has been combed.
   

Home remedies for lice

Natural remedies are available, but they may not be as effective. These involve suffocating the lice with things like mayonnaise, petroleum jelly, margarine, or olive oil.  

Essential oils such as ylang ylang or tea tree oil are not recommended as they can cause allergic skin reactions. Never use chemicals such as gasoline or kerosene (as a treatment for lice or anything else).

“[Treating lice] is time consuming and psychologically hard,” Dr. Kormeili says. “You may feel itchy all over, and that is normal, because anyone who thinks about lice can feel itchy all over. It doesn’t mean you are infected everywhere!”

Some schools have a “no-nit” policy in which children who are being treated for lice cannot return until there are no signs of lice left, sometimes requiring a note from someone qualified to deem the child lice-free. Most doctors disagree with this policy, recommending instead that the child be treated at home for lice and return the next day.

Lice prevention

Contrary to popular misconception (and schoolyard taunts), lice have no preference for dirty or clean hair. Hygiene habits have no influence on head lice.

“Because lice are spread by direct contact (head to head contact as in hats and helmets, sharing of combs, etc.), parents should emphasize the importance of keeping one’s hair and headgear to him or herself,” says Dr. Woods. “Also, children should avoid other children who are known to have lice as the condition is quite contagious.”

Some other steps to help prevent the spread of lice include:

• Combs and brushes used by an infested person should be soaked in hot water (at least 130 degrees Fahrenheit) for five to 10 minutes.
• Avoid laying on couches, beds, or pillows that have recently been used by an infected person.
• Don’t share personal items such as combs, brushes, towels, hats, and stuffed animals.
• Machine wash and machine dry (using high heat) any clothing, bedding, or items used by an infested person during the two days before treatment.
• Dry clean anything that is not machine washable, or place it in a sealed bag for at least two weeks.
• Large items that cannot be removed or washed may be treated with a home lice spray, such as Permethrin 0.5% home spray
• Vacuum the floor and furniture. Throw away the bag afterwards.
• Check other family members. Ask your healthcare provider to see if they recommend treating the entire family as a precaution.

While the internet is filled with suggestions for products that claim to repel and prevent lice, their efficacy and safety is questionable and not widely recommended.