Preschool (3–5 years) · School age (5–12 years) · Illness & symptoms, School & sports
Head lice: how to check, treat and stop the cycle
Lice are a nuisance, not a health hazard, and not a sign of poor hygiene. Check with a fine comb on wet hair, treat with an over-the-counter permethrin or a newer prescription product, comb out nits, and repeat as directed. Children can stay in school.
Key takeaways
- Live lice or nits within a quarter inch of the scalp mean active infestation; nits further out are old
- Over-the-counter 1% permethrin (from age 2) or pyrethrin, applied exactly as directed and repeated on day 9
- Resistance is common; if live lice remain 24 hours after treatment, call us for a prescription (ivermectin lotion, spinosad)
- Wet-combing with a metal nit comb every 3 days for 2 weeks clears most cases, even alone
- No need to bag the house for weeks: wash bedding and hats in hot water, dry on high, and vacuum
How to check
Wet the hair, add conditioner, and comb from the scalp to the ends with a metal nit comb, section by section, wiping the comb on a paper towel after each pass. Look behind the ears and at the nape. Live lice are the size of a sesame seed and move; nits are tiny oval eggs glued to the hair shaft near the scalp. Dandruff flakes off easily; nits do not.
Treatment
- Choose a product: over-the-counter 1% permethrin lotion (age 2 and up) or pyrethrin shampoo (age 2 and up); for babies and toddlers under 2, wet-combing only, or call us
- Apply to dry hair exactly as the label says, leave for the stated time, rinse; do not use conditioner before it
- Comb out nits with the metal comb, and again every 2 to 3 days
- Repeat the treatment on day 9 to catch newly hatched lice
- Check everyone in the house and treat only those with live lice
Lice in many areas are resistant to permethrin and pyrethrin. If you see live lice a day after a correct treatment, call us: prescription ivermectin lotion, spinosad or malathion work, and some need only one application.
Cleaning without panic
Lice live only a day or two off a head and do not jump or fly. Wash bedding, towels, hats and recent clothing in hot water and dry on high; seal what cannot be washed for two weeks; soak combs and brushes in hot water; vacuum sofas and car seats. No sprays, no fumigation.
School and daycare
The AAP and school nurses recommend that children stay in school with lice and finish the day; treatment happens at home that evening. “No-nit” policies are outdated. Tell close contacts so they can check. Remind children not to share hats, brushes, helmets or headphones, and to keep long hair tied up.
When to call us
- Live lice 24 hours after a correct treatment, or a second failed treatment
- A child under 2 with lice
- Scalp sores that are weeping or crusted, swollen neck glands, or fever
- Repeated infestations over months
Go to the emergency room or call 911 if…
- Difficulty breathing or facial swelling after a treatment product
Questions parents ask
Do home remedies like mayonnaise or tea tree oil work?
Smothering treatments do not reliably kill lice or nits, and essential oils can irritate skin. Wet-combing is the effective non-chemical method.
Should we cut my child’s hair?
No. Length does not matter; lice live at the scalp. Tying hair back helps prevent spread.
Not sure? Ask us
Call or text the office during hours, or send a portal message. For emergencies call 911.
(770) 615-7000Trusted further reading
- HealthyChildren.org (opens in new tab)American Academy of Pediatrics