How to Get Rid of Head Lice

Children ages 3 to 11 are most likely to get these tiny bugs, especially when they spend time in close contact with other kids. Millions of infestations occur each year across the country among children in this age group. 

“Having head lice is fairly common, particularly among young children,” says Trieva Scanlan, MD, a pediatrician at Scripps Coastal Medical Center San Marcos. “Getting it has nothing to do with hair length or hygiene. Anyone who has direct head-to-head contact can become infested, no matter how often they bathe.”

Lice spread mostly through direct head-to-head contact. This often happens during: 

• Playtime or group activities at school 
• Sports activities 
• Sleepovers and slumber parties 
• Close contact at home with siblings 

Less commonly, they can spread through sharing personal items, such as: 

• Hats, helmets or headbands 
• Hair ribbons or scrunchies 
• Combs and brushes 
• Towels 
• Pillows 

Lice are not a sign of poor hygiene. Anyone — regardless of how often they bathe or shampoo — can get them. 

Head lice are tiny bugs, about the size of a sesame seed, and they move quickly through hair, which makes them hard to spot. They live on the scalp and in the hair close to the scalp and feed on small amounts of blood. 

They lay eggs called nits, tiny white or yellowish-brown oval specks that cling to the hair shaft near the scalp, most often behind the ears or at the nape of the neck. 

Their life cycle has three stages: 

1. Nits (eggs) hatch in about 7–10 days. 
2. Nymphs (young lice) mature into adults in about a week. 
3. Adult lice can live up to 30 days and lay up to 10 eggs per day. 

Contrary to popular belief, lice don’t jump or fly. They crawl, which causes a tickling sensation of something moving in the hair. The itching is an allergic reaction to lice saliva, not the bite itself.  

“It can take several weeks to feel the itching of an initial infestation, so you may not be aware of a lice problem until it has spread to close contacts,” Dr. Scanlan says. “The best way to protect the rest of the family is with prompt treatment.”  

Pediatricians and school nurses recommend routine checks. 

“If you notice your child scratching his or her head or are notified of an outbreak at school, do a thorough check,” Dr. Scanlan advises. Diagnosis is best made by finding a live nymph or adult louse on the scalp or hair of a person.  

How to check:

• Use bright lighting  
• Use a fine-toothed lice comb 
• Section the hair and comb from the scalp outward 
• Focus on areas behind the ears and neck 
• Look for crawling bugs and nits attached to the base of the hair follicle 

You can spot lice and nits with your eyes, though a magnifying lens can help. Don’t confuse nits with dandruff, which is loose and not attached to the hair.  

The comb-out method helps remove lice and nits, but it usually doesn’t work alone to get rid of lice. The American Academy of Pediatrics says the most effective way to get rid of lice is with head lice medicine, which can be found in local stores. “Make sure to use the medication correctly and pay special attention to instructions on the label,” Dr. Scanlan advises. “Store it safely. Never let the child apply the medicine.”  

Most head lice can be treated at home with: 

• Over-the-counter (OTC) lice medication 
• Careful nit combing 
• Follow-up treatment, if needed 

Talk to your child’s pediatrician before starting treatment, especially if your child is very young, has asthma, skin conditions or allergies. 

Two common over-the-counter options are: permethrin and pyrethrin. “These are the least toxic formulas,” says Dr. Scanlan.  

Permethrin (Nix): For children two months and older.  

Pyrethrin (RID): For children two years and older.  

These treatments are applied to the hair and scalp, then rinsed out. They work to kill lice, but not always the eggs, which is why follow-up care matters. 

To reduce the chance of lice coming back: 

• Use a metal nit comb to remove remaining eggs 
• Check the scalp daily for several days 
• Repeat treatment in 7-10 days if recommended on the label 
• Never let children apply the medicine themselves 
• Store medication safely out of reach 

Some families also choose professional lice removal services to help with thorough nit removal. 

Some parents try home remedies, using mayonnaise, olive oil, margarine, butter or similar substances, to suffocate lice and make them easier to remove. However, there is no scientific proof that these methods consistently work. 

Avoid using fumigators, foggers or lice sprays in your home. They’re not necessary and may be harmful. 

The most important treatment happens on the scalp, not in your house. 

Head lice can’t survive long away from the human scalp (usually 1-2 days) but it’s still a good idea to clean items that have had direct contact with your child’s hair. 

• Wash clothing, pillowcases and bedding used in the last 48 hours 
•  Wash in hot water and dry on high heat 
• Soak combs and brushes in hot water for 5-10 minutes
• Vacuum furniture, rugs and car seats

You do not need to treat your pets. Lice only live on people. 

In most cases, children can return to school once treatment begins. 

Many medical experts discourage strict “no-nit” policies, since nits alone don’t always mean an active infestation — and keeping kids home doesn’t prevent spread as effectively as prompt treatment and checks. Nits are not easily transmitted to others, and some may even be empty shells or dead eggs. 

If you’re not sure, ask your child’s school nurse or pediatrician. 

To reduce the risk of reinfestation: 

• Avoid head-to-head contact during outbreaks 
• Tie long hair back (ponytail or braid) 
• Don’t share hats, brushes, headbands or helmets 
• Check siblings and close contacts 
• Do routine checks during school outbreaks 

Call your pediatrician if: 

• Over-the-counter treatments don’t work 
• You’re not sure if it’s lice 
• Lice keep coming back 
• Your child has scalp sores, rash or signs of infection 
• Your child is very young or has sensitive skin 

Prescription treatments may be needed in cases of resistant lice or repeated infestations.

Head lice are frustrating — but manageable. With prompt treatment, careful nit combing and simple cleaning steps, most families can clear an infestation quickly without panic or shame.

The key is acting early. Follow treatment directions and check close contacts to prevent reinfestation. If lice keep returning or you have questions, your child’s pediatrician can help guide next steps.

For a quick, step-by-step overview, view our infographic on how to deal with a head lice infestation — including how to check, treat and prevent lice from coming back.