Head Lice
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American Academy of Pediatrics




How do I know if my child has lice?

The most common symptom of head lice is itching, especially behind the ears or at the back of the neck. However, an itchy scalp may also be a symptom of other conditions such as eczema, dandruff, or allergic reactions to hair products.

Head lice are often difficult to find. A positive diagnosis of an active case of head lice can only be made if you find live lice. Nits can remain on the hair for months but do not indicate an active infestation.

How to check for head lice

To check your child for head lice, follow these steps

  • Seat your child in a brightly lit room, in an area where you can easily examine the head from different angles.
  • Part the hair and look at your child's scalp. Nits will look like small white or yellow-brown specks. They will be firmly attached to the hair. Nits may be easier to see at the hairline at the back of the neck or behind the ears. Live lice will move quickly away from the light.
  • Comb through your child's hair in small sections using a fine-tooth comb. After each comb-through, wipe the comb on a wet paper towel. Examine the scalp, comb, and paper towel carefully.
You may need to use a magnifying glass. It is often difficult to tell the difference between dandruff or other hair debris and nits. However, dandruff is much easier to comb out of the hair while nits are much harder to remove.

Treatment for head lice

In the past, the only way to get rid of head lice was to comb them out or, in some cases, shave the child's head. Today, chemical treatments for head lice are available and can be found at your local drug or discount store. Most of these products contain 1% permethrin as a cream rinse, which has proven to be a very effective treatment for head lice. Although head lice treatments also are available by prescription, they are not usually the first choice for treating head lice.

In general, there are 3 steps in treating head lice. Because it is possible for head lice to show resistance to these treatments, see your pediatrician if you have followed these steps but your child still has live lice.

Step 1: Kill the lice.

Head lice treatments come in a variety of forms such as shampoo, cream rinse, gel, and mousse. Most need to be applied to dry hair because wet hair can dilute the chemicals in the treatment. Keep the treatment on the hair for the full amount of time recommended by the manufacturer. While lice treatments are effective at killing live lice, they may not always kill all of the eggs. For this reason, a second treatment is usually necessary 7 to 10 days after the first treatment.

Step 2: Comb out the nits.

This step is not necessary to prevent lice from spreading; however, it may make you and your child feel better knowing the nits are removed. It may also prevent your child from being misdiagnosed with an active case of head lice. And it will help prevent your child from becoming reinfested from any eggs that were not killed at first.

Nits can be combed out after the treatment has been applied to the hair. Many products include a special comb. Carefully read the directions that come with the treatment for proper combing instructions.

Combing out the nits often takes a great deal of time and patience. During this step you may want to give your child something to do, such as a book to read.

Continue to check your child's hair daily for 2 weeks after treatment. If you still see nits in your child's hair, use a fine-tooth comb (or try using your fingernail) to remove them.

Step 3: Prevent lice from spreading.

You do not need to throw away any items belonging to your child, but you may want to follow these prevention tips

  • Wash your child's clothes, towels, hats, and bed linens in hot water and dry on high heat.
  • Soak combs and brushes in boiling hot water for 5 to 10 minutes.
  • Vacuum furniture, carpeting, car seats, and other fabrics that your child was in contact with 24 to 48 hours before treatment.
  • Items that your child has been in very close contact with that cannot be washed, such as stuffed animals or toys, can be placed in a plastic bag for 2 weeks (by which time any live lice would die).
  • Do not spray pesticides in your home because they can expose your family to dangerous chemicals.
  • Check other members of your household for lice and, if present, treat these persons and manage their personal items as outlined previously.
Remember that live lice cannot live more than 24 to 48 hours off the head, so extraordinary cleaning measures are usually not necessary. It is better to spend the time properly treating the child with head lice.

Home remedies

You may have heard of home remedies that involve "washing" your child's hair with thick or oily substances such as petroleum jelly, mayonnaise, tub margarine, herbal oils, or olive oil and leaving it on the hair overnight (the child sleeps wearing a shower cap). The theory is that coating the hair with these substances will smother the lice. These remedies have not been scientifically proven to work. However, they certainly won't hurt your child. Home treatments that should be avoided include coating your child's hair with any toxic or highly flammable substances such as gasoline or kerosene, or using products that are intended for use on animals.


While having head lice may be embarrassing to you or your child, it does not put your child at risk for any serious health problems. If your child has head lice, work quickly to treat the condition and prevent the lice from spreading. You may need to repeat the treatment to ensure all the lice are gone.

If you are unsure about how to detect head lice, suspect your child has lice, have tried to treat a case of head lice only to have them return, or have additional questions about treating head lice, call your pediatrician.



Published online: 3/07
Source: Head Lice: Every Parent's Concern (Copyright 2003 American Academy of Pediatrics)

Healthcare professionals may order this publication in multi-copy packs.
Parents can find more information on this topic in Caring for Your Baby and Young Child: Birth to Age 5. To order a copy of this book visit the AAP Bookstore.


The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.




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