Head Lice: Causes, Symptoms, Prevention, And When To See A Doctor

Lice aren’t always preventable and getting them isn’t a sign of poor hygiene—it just means there has been close contact with someone who had them. Lice infections occur across all socioeconomic groups, and lice actually prefer clean hair (1). If your child’s school sends home a lice notice, these steps can help reduce the risk of your child catching lice.

• Encourage Kids to Avoid Sharing Hair Accessories: Like brushes, hats, scarves, and headphones.

• Keep Long Hair Tied Back: Lice have an easier time attaching to loose hair. If you’ve received notice of lice in a classmate at school, keep your child's long hair tied back.

• Check for Lice at Least Once a Week During Outbreaks at School: Pay close attention to the nape of the neck, behind the ears, and the crown of the head.

• Use Natural Deterrents: Essential oils like tea tree, lavender, geranium, and cedarwood may help deter lice. These can be diluted and sprayed on the hair and also on clothing and backpacks. 

If your child has lice, act quickly! The less time lice are present, the less time they have to spread. Currently, the CDC does not recommend children with lice be sent home from school early, but it does recommend treating lice at least once before sending your child back to school.

To treat lice at home, start with manual removal using wet combing, and use medicated treatment only if necessary. 

Note: You’ll need to repeat treatment every 2-3 days for 1-2 weeks since:

• Nits hatch in 7-10 days, so any missed eggs can lead to reinfestation.

• Newly hatched nymphs take 9-12 days to mature, meaning consistent combing prevents them from becoming adults that lay more eggs.

• Lice treatments may not kill all eggs, so manual removal ensures thorough elimination.

1. Wet Combing With Conditioner (Recommended First Step for Lice) 

Wet combing with conditioner is one of the safest and most effective ways to remove lice and nits (2). This method does not involve harsh chemicals and should be used for everyone in the household.

How to Wet Comb for Lice Removal: 

• Wet the Hair – Lice move slower in wet hair, making them easier to catch.

• Apply Lots of Conditioner – This helps immobilize lice and makes combing easier. 

• Use a Fine-Toothed Lice Comb – Work in small sections, starting at the scalp and combing down to the ends of the hair.

• Wipe the Comb on a White Paper Towel – Look for lice and nits after each pass.

• Repeat Every 2-3 Days for Two Weeks – This ensures that any newly hatched lice are removed before they can lay eggs.

Important: If one family member has lice, it is recommended that everyone in the household be checked and treated with wet combing as a precaution.

2. Use Medicated Lice Shampoo If Necessary 

If lice persist despite wet combing several times, consider using a medicated lice treatment. Over-the-counter options include:

• Permethrin (Nix) – Kills active lice but may not kill all eggs.

• Pyrethrin-based products (Rid) – Derived from chrysanthemums but not always effective due to resistance.

Important Notes on Using Lice Shampoo:

• Always follow instructions carefully!

• Some lice have developed resistance to over-the-counter treatments, making manual removal even more important.

3. Wash Personal Items 

Lice cannot survive for over 48 hours without a blood meal, but nits (lice eggs) can survive for up to 10 days off the scalp, though they require warmth from the scalp to hatch (1). Proper cleaning ensures that any lice that fall off the scalp do not find a new home and that lingering nits do not hatch and restart the cycle.

• Machine wash bedding, clothing, and hats in hot water (130°F or higher) and dry on high heat.

• Vacuum mattresses, couches, car seats, and rugs.

• Soak combs, brushes, and hair accessories in hot water for at least 10 minutes.

• For stuffed animals and pillows, consider sealing them in trash bags and freezing for 48 hours.

While most lice cases can be managed effectively at home, you should contact your child’s healthcare provider if:

• Lice persist after two full treatment cycles (wet combing and/or medicated shampoo).

• Your child develops signs of a skin infection, such as increased redness, swelling, tenderness, yellow crusting, or pus from scratching.

• You’re unsure if what you’re seeing is lice or another scalp condition (like dandruff or eczema).

• Your child has a known allergy or skin sensitivity, and you’re concerned about using medicated lice treatments.

• Your child is under 2 years old, as treatment recommendations may differ for infants and toddlers.

A doctor can help confirm the diagnosis, offer guidance on next steps, and prescribe stronger treatments if needed. 

Lice are tiny parasitic insects that live on the scalp and spread easily through head-to-head contact. They cause itching and irritation and can be tough to get rid of. If your child has lice, act quickly: start with wet combing using conditioner, and use medicated shampoos only if needed. Repeat treatment every 2–3 days for 1–2 weeks to catch lice at all life stages. Wash bedding, clothing, and hair tools in hot water, and check everyone in the home. During school outbreaks, tie hair back, avoid sharing personal items, and consider using a natural lice spray with essential oils like tea tree and lavender for extra protection.