Head Lice in Children: Symptoms, Causes, Diagnosis and Treatments

Head Lice in Children: Symptoms, Causes, Diagnosis and Treatments

A tiny, wingless parasitic that lives among the human hair, is what is called as the head louse. It feeds on tiny amounts of blood drawn from the scalp and is pretty common among children. There arises no doubt that how tough it is to get rid of them but they are not at all dangerous. However, your child may suffer from excessive itching sometimes and scratching can lead to infection. Head lice can spread from person to person, thereby it is best to treat this quickly once you get aware of them.

Head Lice in Children: Parents Need to Know

Symptoms of head lice in children

Head lice are tiny but can be easily seen by the naked eye. Here are some of the symptoms you need to look for:

Lice eggs

These appear as tiny yellow, tan, or brown dots before they hatch. Nits are laid on hair shafts by the lice very much closer to the scalp because the temperature is perfect to keep them warm. These may look like dandruff but can not be removed by brushing or shaking. It takes up to 2 weeks for the lice eggs to hatch after they are laid. The left-out shell remains attached to the hair and appears white or clear after hatching. It thus becomes easier for one to spot them during this time.

Adult lice and nymphs

The adult lice are greyish-white or tan. It takes about 1 to 2 weeks for the nymphs to become adult lice after they hatch. If adequate treatment is not provided, the process is repeated about every 3 weeks. Head lice can survive off the scalp for up to 2 days because it feeds on the blood several times a day.


Scratching occurs due to the reaction to the saliva of the lice. It is not necessary that the itching will start right away, instead it depends on how sensitive a child’s skin is to the lice. It may also take several weeks for some kids to start scratching.

Small red bumps

Excessive scratching may cause a bacterial infection which may cause swollen lymph glands and red, tinder skin. Your doctor may recommend you oral antibiotics in order to treat the infection if this is the case.

It is actually easier to be able to see the lice using a fine-tooth comb by parting your child’s hair into small sections. You can check this on the scalp, behind the ears. These are rarely to be found on eyelashes or eyebrows.

It is thus important for you to see a doctor in case your child shows any of the above symptoms. However, not al children may show the classic symptoms of head lice. Some can be symptom free as well.

Are Lice Infectious?

Yes, they are highly infectious because they can spread quickly from person to person. As stated above, lice cannot fly or jump but have specially adapted claws that enables them to crawl and cling to the hair. Although, head to head contact is the primary cause for its spread but other factors like bed linens, sharing clothes, combs, hats or brushes may also stand out to be one of the reasons. But why are kids more prone to catching lice? This is because kids generally share personal items and also tend to have close physical contact with each other.

Treatment for head lice in children

If your child has developed head lice, he/she may be recommended to use a medicated shampoo, cream rinse or some lotion that can kill the lice. However, these medications will depend highly on what all treatments have earlier been tried. It may take several days for the treatment to stop the itching and in case of a very resistant lice, an oral medication may also be prescribed.

Apart form this, you have to make sure that the prescribed medicine is safe for your child according to his age. Over the counter shampoos are safe for kids who are as young as 2 months whereas other medicines are not recommended for kids who are less than 2 years of age. So, you will need to have the confirmation regarding the same from your doctor. For kids who are younger than 2 months old, do not use nay medicated lice treatments. For them, you will need to remove the lice by hand.

Also, these products are insecticides so it is important for you to follow the directions a stated on the product. Applying or using the product too often or more than what is prescribed may prove to be detrimental. Not only this, but this may also fail to provide any results.

Prevention for head lice in children

Given below are some of the ways that can help to prevent lice re-infestation. Read below:

  • Vacuum carpets and other furniture in your home or car and throw away the bag.
  • Soak any hair care items in medicated shampoo for an hour including hair ties or bands, headbands, combs, barrettes etc.
  • Go for dry cleaning in case of anything that cannot be washed, for instance stuffed animals.
  • Wash all bed linens or clothing that has been recently used or worn by any person in the family who is infested and then put all of it in the dryer for at least 20 minutes.
  • Do not make use of a shampoo or a conditioner before applying the medication.
  • Do not make use of more than one medication at a time.
  • Do not use kerosene or any other chemicals that are highly flammable on your child’s hair to treat lice.


Head Lice

Medically reviewed by Drugs.com. Last updated on May 20, 2019.

What are they?

Head lice are small, parasitic insects that infest hair on the head of people. Their six legs allow them to grasp and wander between hairs. They feed only on the blood of people, and feed once or more each day. They are more common on children than adults.

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A single insect is called a louse. A female louse can lay more than 100 eggs, called nits, in her lifetime. The female louse secretes a glue to attach each egg to a scalp hair, usually close to scalp level. They hatch about 8 days after they are laid, and grow to the adult stage about 9 to 12 days after hatching. Adult head lice survive just a few weeks on the scalp, but die within a day once removed from a person.

In general, a person infested with head lice will have fewer than a dozen live lice on his or her head at a time, although hundreds of developing, dead and hatched eggs may be present.


The most common symptom of a head lice infestation is itching. This is caused mainly by the louse’s saliva, which irritates the skin on the scalp. The itching can occasionally be severe enough to prevent sleep, and some people scratch so much that they cause additional skin infections. Head lice are not known to transmit any infections.


Because itching on the scalp may result from many causes other than head lice, a medical professional should diagnose a head-lice infestation, and this should be based on the finding of a live (crawling) louse. Louse infestations may be difficult to identify properly, since lice and their eggs are often hard to distinguish from other materials caught in the hair, such as dandruff, scabs, dirt or insects blown in by wind. In general, only those people with live (crawling) head lice should be treated. The eggs or nits of the louse appear as small white, tan or brown dots attached firmly to individual hairs. If nits are seen, then live lice should be sought before considering treatment.

Expected Duration

Head lice sometimes go away on their own because there are not enough insects to maintain the infestation, or they may persist for an indefinite period without treatment. With proper treatment, the infestation usually goes away within about two weeks.


Head lice are acquired by direct contact with an infested person’s hair. Only rarely would lice be transferred by shared combs, brushes, hats or other hair accessories.

It is not necessary to isolate infested people or keep children with head lice home from school. Head lice neither are caused by, nor a sign of, poor hygiene or housekeeping.


There are several treatment options to eliminate head lice. In some cases, several methods can be used together to ensure success. First, make sure you have seen a live louse. Do not treat if you’ve only seen objects you believe to be louse eggs (nits). If you find a live louse on one person in the home, then inspect all other adults and children for lice as well.

If the hair can be combed easily, then you can use a special louse comb or nit comb to remove lice and their eggs from the hair. This sometimes requires combing several times a week until no lice are seen for two or more weeks. Although combing alone may eliminate lice from some people, this method fails for others. If the process requires too much time or causes discomfort, then it is not a good option for treatment.

Pediculicides are special insecticide products (registered by the Food and Drug Administration) that are available over the counter and by prescription in drug stores. Do not apply any other kind of insecticide to the body or hair. Most pediculicides contain a class of chemicals called pyrethroids as the active ingredient. These usually are applied as a shampoo then washed off about 10 minutes later. A second treatment is often necessary, about 10 days later. Although these products work very well for many infestations, some head lice are resistant to them. If live (crawling) head lice are discovered a day after treatment, then you should speak with your doctor about other kinds of pediculicides that are available by prescription. Carefully read and follow the instructions on the product. Do not overtreat. If you have any questions about the use of the product, speak to your doctor or pharmacist.

Do not apply products that are not registered by the FDA as pediculicides. These include many kinds of essential oils, enzyme treatments, antibiotics, vegetable oils, or heat. Such treatments may waste time, money and effort, or may even harm the person being treated. Although head lice are only rarely found on clothes, towels and bed linens, you may want to launder or change any items that were in direct contact with the hair of the infested person during the last day or so. Washing items in hot water or drying them in high heat will kill lice and their eggs. Because head lice do not survive long once they are removed from a person, there is no need to clean or vacuum the home environment intensively.

When To Call a Professional

You should call your physician to confirm the presence of a head-lice infestation and to get help in determining how best to manage the problem. If you are unsure if the objects you see are lice or eggs, then you should have these examined before you treat.


The outlook for recovery from head-lice infestation is excellent. Head lice do not transmit other types of infections, nor do they produce symptoms other than itching. Active infestations that are treated according to directions will soon be eliminated.

Learn more about Head Lice

Associated drugs

Mayo Clinic Reference

External resources

Harvard T.H. Chan School of Public Health
Department of Immunology and Infectious Diseases
665 Huntington Ave. FXB 301
Boston, MA 02115
Phone: (617) 432-1023

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.


Head Lice in Children

What are head lice in children?

Head lice are tiny parasitic insects that can infest the skin. They live on people’s heads and feed on their blood. Head lice can cause intense itching.

There are two other types of lice: body lice and pubic lice. This health sheet will focus on head lice.

What causes head lice in a child?

Which children are at risk for head lice?

What are the symptoms of head lice in a child?

How are head lice diagnosed in a child?

How are head lice treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Lice are treatable. Treatment will include applying a medicated cream rinse or shampoo to your child’s hair. Many head lice medicines are available over the counter. Your child’s healthcare provider may prescribe a medicine if the OTC medicines did not work for your child.

Talk with your healthcare provider about which rinse or shampoo would be best for your child. Do not use two forms of treatment at the same time. If one treatment does not work, use a different treatment or call your healthcare provider for advice.

In addition to the medicated cream rinse or shampoo, treatment may also include:

  • Removing nits from wet hair with a fine-tooth comb.
  • Soaking combs and brushes in hot water with the shampoo for at least 15 minutes.
  • Checking all other household members closely to see if anyone else needs to be treated.
  • Washing all bedding and clothing in hot water (130°F or 54°C), or sealing items that cannot be washed in a plastic bag for 2 weeks.

Children can return to school or daycare the day after their first treatment for head lice.

What can I do to prevent head lice in my child?

You can help prevent head lice by:

  • Avoiding close physical contact with someone who has lice
  • Encouraging your child not to share hats, combs, brushes, towels, or other personal items.
  • Washing bed sheets, blankets, and other personal items to prevent lice from infesting other people.
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When should I call my child’s healthcare provider?

Key points about head lice in children

  • Head lice are tiny parasitic insects that can infest the skin on a person’s scalp.
  • Lice are highly contagious, spreading from person to person by close body contact, and by shared clothes and other personal items.
  • The eggs laid by lice can usually be seen. This makes it easy for your child’s healthcare provider to diagnose.
  • Lice are treatable. Some medicines are available over the counter, but talk with your child’s healthcare provider if you are unsure of the diagnosis.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.


Nits and head lice in children (ages one to five)

In this article

What are head lice and nits?

Head lice are tiny insects that live in hair (NHS 2018) . They lay eggs along the hair shaft, known as «nits», although most parents use this term for both the insects and the eggs (NHS 2018) .

Adult head lice are very small: about 3mm long, or the size of a sesame seed. Nits are even smaller and look a bit like dandruff, except that they tend to stick to the hair (NICE 2016) .

It takes about seven to 10 days for an egg to hatch, and adult lice can live on the scalp for about 30 days. They survive by sucking tiny amounts of blood from the scalp. During their lifespans, female lice can lay up to 150 eggs (NICE 2016) .

Head lice and nits are usually completely harmless, but if left unchecked, an infestation can last for a long time and be very irritating for your child (NICE 2016) . Fortunately, there are several treatment options available (NHS 2018) .

How might my child catch head lice?

Head lice are very common, especially in children between the ages of four and 11 (NICE 2016) . Younger children can easily catch them from playing with older siblings, or from nursery or preschool (NICE 2016) . They’re not a sign of poor hygiene, and are found just as often in clean hair (NICE 2016) .

Head lice can’t jump, fly, or swim. They need close, head-to-head contact to be able to crawl from one head to another (NICE 2016) . That’s why they’re most common among children who work and play together quite closely at school (NHS 2016) .

Sharing hats, combs or pillows is very unlikely to spread head lice, so there’s no need to wash and sterilise these. And head lice can only be transmitted from human to human, so there’s no risk from household pets (NICE 2016) .

Head lice can affect anyone, including adults (NICE 2016) . But your child may be more likely to get head lice if:

  • she’s a girl – evidence suggests that head lice are more common in girls than boys
  • she has long hair
  • she has brothers or sisters
  • (NICE 2016)

However, the most important factor is whether or not your child comes into close contact with other children who have nits (NICE 2016) . If so, there may be little you can do to prevent your child getting them, though there are plenty of ways to treat them (NHS 2018) .

How can I tell if my child has head lice?

Head lice are incredibly well-camouflaged in your child’s hair, and can be difficult to detect.

Many parents believe that children start itching the moment they get head lice. But the itch can actually take weeks or months to set in, and some children never feel an itch at all (Harding 2016) . On the other hand, when lice are going around, many children feel that they have an itchy scalp, even when they don’t have nits or lice (Harding 2016, NICE 2016) .

The only way to be certain whether your little one has head lice is to check for them (NHS 2016c) . The best way to hunt head lice is to use a special fine-toothed comb, sometimes called a detection comb or nit comb (NHS 2016c, NICE 2016) .

You can buy a nit comb from a pharmacy, or online (BAD 2017) . Ideally, choose one with plastic teeth, as metal ones can pull on your child’s hair. If the package says how far apart the teeth are, look for ones that are about 0.2mm to 0.3mm apart (NICE 2016) .

Although a detection comb can be used on dry hair, it’s much easier on wet hair with plenty of conditioner. This is because the conditioner traps the lice, so they can’t crawl away before you see them (NICE 2016) .

Here’s how to check your child for head lice by wet combing:

  1. Wash your child’s hair with her regular shampoo, then apply plenty of conditioner and leave it in.
  2. Comb her hair thoroughly with a wide-toothed comb to remove any tangles
  3. Use the detection comb from the roots of your child’s hair to the tips. Keep the comb in contact with her scalp as much as possible.
  4. After each stroke with the comb, check it for nits and lice. A magnifying glass may help with this. If you notice any nits or lice, wipe or rinse the comb.
  5. Continue combing your child’s hair in sections until you’ve covered the whole head, then rinse out the conditioner.
  6. If in doubt, repeat the process to check for any lice you may have missed.
  7. (NICE 2016)

You’re most likely to see the signs of head lice around the sides and the back of your child’s head (BAD 2017) . If she has head lice, you may be able to see:

  • Yellow-white eggs stuck to your child’s hair, close to her scalp.
  • White empty egg sacs (nits), also stuck to your child’s hair, but further away from her scalp.
  • Grey-brown adult head lice, visible on her scalp and hair.
  • (BAD 2017)

Lice droppings may also show up as dark specks on your child’s pillows or clothes (BAD 2017) . Some children can also develop a rash if they have a reaction to the lice droppings. And if your child scratches a lot, it may increase her risk of developing a skin infection, such as impetigo (NICE 2016) .

There’s no need to go to your GP to confirm that your child has lice (NHS 2018) , but if you’re unsure, or your little one has a rash on her scalp, you can always make an appointment.

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How do I get rid of my child’s head lice?

Unfortunately, there’s no quick fix for getting rid of your child’s head lice. The most effective ways are wet combing, or using chemical treatments (NHS 2016) .

Before treating your child, check everyone in your house for lice using the wet combing technique described above. Treat anyone who’s affected on the same day, to reduce the risk of re-infestation (NICE 2016) .

This simple method is the same as wet-combing your child’s hair to check for head lice. Repeat the numbered steps above every few days for two weeks (NHS 2018) . If you’re still finding live lice in your child’s hair after this time, talk to your pharmacist, who may be able to recommend a different treatment (NICE 2016) .

Wet-combing can be more time-consuming than using chemical treatments. However, it’s a lot cheaper, and may be a good option if your child has sensitive skin. It’s also entirely safe even if you’re pregnant or breastfeeding (NICE 2016) .

There are lots of different head lice treatments (insecticides) available for children. If you’ve found lice or nits in your child’s hair, ask your pharmacist which is the best option for you. Head lice in the UK are becoming resistant to some chemical treatments which contain permethrin (NICE 2016) .

It’s particularly important to check with your pharmacist if you’re pregnant or breastfeeding, or if your little one’s under two years old or suffers from asthma or skin conditions, as some treatments may not be suitable for you (NICE 2016) .

How you apply a chemical treatment varies slightly between brands, but it usually involves at least two applications, one week apart (NHS 2018) . Ask your pharmacist for tips on how to apply it, as each type of treatment has different instructions (NICE 2016) .

You’ll need to leave the chemical on your child’s hair for anything between 10 minutes and 12 hours for each application, depending on the instructions. Then rinse out and wet-comb her hair in sections with a fine-toothed comb, to remove any dead lice.

These treatments should kill any live lice, but they don’t necessarily destroy all the eggs, which is why a second application is usually recommended. You should also check for lice a few days after completing the treatment, and again a few days after that, to make sure that it’s worked. There’s no need to worry if you find any eggs at this stage. But if you find any live lice, you’ll need to treat your child again (NICE 2016) . Your pharmacist will be able to help you decide whether to try the same treatment again, or go for something else.

Avoid chemical treatments that claim to help prevent your child from catching nits in the first place (repellents), and don’t use head lice treatments unless you’re sure your child has live lice in her hair. There’s no evidence that these can help prevent your child catching head lice, and using them too often could be dangerous for your little one (NICE 2016) .

  • Electronic combs. These are battery-powered fine-toothed combs, which electrocute lice. But they’re not recommended because they’re expensive, and can pose a safety risk to your child.
  • Natural methods. You can buy shampoos and lotions containing essential oils, such as tea tree, eucalyptus or lavender, but there’s no evidence that they work.
  • (NICE 2016)

Should I keep my child away from nursery?

In most cases, it’s fine for your little one to go to nursery or preschool as normal while she has nits (NICE 2018) . Check with your childcare provider first though, to find out what their individual policy is. At the very least, they’ll be grateful to know that lice are going around, so they can advise other parents to check their children, too.

Not sure if it’s head lice? See which other conditions can cause an itchy scalp in our photo gallery of common skin conditions.


How to Prevent Head Lice in Children

Tens of millions of school aged children get head lice every year worldwide. To avoid having to deal with this condition, preventing head lice in children is a good solution.

But few people actually know how to prevent head lice.

Although this is not always possible, of course, we can still take basic measures such as avoiding direct head-to-head contact and applying natural oils or repellents . But there are some do’s and don’ts, as we will discuss below.

Now, you should know that there are some good products that can help repel head lice.

What you should NOT do to prevent head lice

1) Preventing head lice using chemical head lice shampoos:

When our child comes home with head lice, our most common reaction is panic, and we would do whatever we read or are told to get rid of it…sometimes to our own child’s peril.

What you should definitely not do is use chemical head lice treatments such as Nix or RID to prevent head lice. The manufacturers of head lice shampoos themselves have told parents they should never be using chemical lice shampoos to prevent lice in children.

Why? Partly because it contributes to making lice more resistant to these same treatments. And partly because these shampoos have dangerous side-effects when used many times and repeatedly.

But essentially because these shampoos cannot prevent lice . They can only treat head lice.

They are completely useless when it comes to preventing head lice. Just imagine taking aspirin when you don’t have any headache. This will not prevent you from actually having headache later on.

2) Keeping your child at home when he is not infested

You’ll think the best way to prevent head lice in kids (even toddlers and babies) is to keep them at home.

But this is not realistic, especially for school-aged children, as they will then have to catch up with lessons and homework, and moreover they will perceive this as a kind of punishment for something they are not responsible for. This is why no-nit policies in schools are very controversial.

Keeping your kids at home while you are treating them when they are already infested is a good measure though, until they are cured.

What you can do for effective head lice prevention in kids

– Preventing head lice braiding hair: for girls, braiding hair can be a good measure to protect them from getting head lice.

Girls should wear their hair up and avoid close contacts with other kids. This is still the best prevention measure without using any products.

– Preventing the spread of head lice with tea tree oil:
It is a good idea to use natural remedies to prevent head lice. You can use aromatherapy and essential oils such as tea tree oil or lavender oil on our children’s scalps, because these oils will act as repellents and keep head lice away.

But because these are natural products does not mean they can be used without caution.

You should always be careful and only put a few drops per day on the scalp. Click for more details on how to use tea tree oil for prevention of head lice.

– Preventing head lice using lice repel shampoos:
If you don’t feel comfortable with pure essential oils, you can also use lice repel shampoos, provided they are natural and harmless for your children, especially for infants and babies.

These shampoos are ready to use and usually contain enough essential oils to keep lice away.

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