What do lice look like on a child's head?

Understanding Head Lice

What are Head Lice?

Size and Shape

Head lice that infest a child’s scalp are tiny, flattened insects measuring roughly 2–4 mm in length. Their bodies are oval‑shaped and laterally compressed, allowing them to move easily through hair shafts. The head is broader than the thorax, giving the insect a slightly teardrop silhouette when viewed from above.

Key dimensions and form characteristics:

Length: 2 mm (young adults) to 4 mm (fully mature); nymphs range from 1 mm to 2 mm.
Width: 1 mm at the widest point of the thorax.
Body outline: Dorsally smooth, ventrally ridged; no wings.
Legs: Six short, clawed legs positioned near the posterior, each ending in a hook for gripping hair.
Color: Varies from pale gray to brown; may darken after feeding on blood.

The flattened, egg‑shaped body enables the parasite to cling tightly to individual hair strands, making visual detection on a child’s head possible when the lice are alive and moving.

Color and Appearance

Lice that infest a child’s scalp are tiny, wing‑less insects whose visible traits aid rapid identification. Adults measure 2–4 mm in length and display a flattened, elongated body. Their exoskeleton is semi‑transparent, allowing underlying blood to give a faint reddish or brownish hue. The head bears six short, claw‑like legs equipped with pointed tarsal claws that cling tightly to hair shafts.

Body shape: oval, dorsally convex, ventrally flattened
Color: pale gray to light brown; translucency may reveal a pinkish tinge from blood meals
Legs: six, each ending in a pair of sharp claws for gripping hair
Antennae: two short segments, barely visible without magnification

Nymphs, the immature stages, resemble adults but are smaller (1–2 mm) and lighter in color, often appearing almost colorless. Their bodies are more translucent, making them difficult to see against the scalp. Eggs, known as nits, are oval, 0.8 mm long, and firmly attached to the hair shaft near the scalp. Nits are typically yellowish‑white when newly laid and darken to a tan or brown shade as the embryo develops.

Nymph coloration: nearly transparent, faint gray
Size progression: increases by roughly 0.5 mm with each molt
Nit appearance: smooth, elongated, color shift from white to tan‑brown with age

These visual markers—size, translucency, subtle coloration, and the distinctive clawed legs—provide reliable criteria for recognizing head lice on a child’s hair.

Life Cycle of Head Lice

Nits («Eggs»)

Nits are the oval, white‑to‑tan eggs laid by head lice and are most commonly found attached to hair shafts near the scalp. Each nit measures about 0.8 mm in length, comparable to a pinhead, and has a smooth, slightly glossy surface. The shell is semi‑transparent, allowing the developing embryo to be seen as a tiny dark spot inside. Because nits are cemented to the hair with a strong, protein‑based glue, they remain firmly in place even after washing.

Location: usually within ¼ inch of the scalp, where temperature supports incubation.
Color progression: white → yellowish → brown as the embryo matures.
Shape: elongated oval, with one end slightly pointed where the operculum (hatch opening) resides.
Attachment: a thin, silvery thread secures the nit to the hair strand; removal requires gentle pulling or a fine‑toothed comb.

Distinguishing nits from dandruff or hair debris relies on their attachment and size. Dandruff flakes are loose, easily brushed away, and lack a permanent bond to the hair. Nits stay fixed despite combing and often appear in clusters behind the ears, at the nape, or along the hairline. Early detection focuses on visual inspection of the hair shaft, using a magnifying lens or a lice‑comb to separate strands and reveal the characteristic oval eggs.

Nymphs («Young Lice»)

Nymphs, often called “young lice,” are the immature stage of head lice that appear after eggs hatch. They measure 1–2 mm in length, roughly half the size of adult lice, and are pale‑gray to light‑brown in color. Their bodies are oval, flattened, and lack fully developed wings. Unlike adults, nymphs have shorter legs and less pronounced antennae, making them appear smoother and less defined.

Key visual cues for identifying nymphs on a child’s scalp:

Size: approximately the width of a pinhead.
Color: lighter than adult lice, sometimes appearing translucent.
Location: commonly found near the hairline, behind the ears, and at the nape of the neck, where the scalp is warm and humid.
Mobility: less active than adults; they move slowly and often remain close to the hair shaft rather than traversing long distances.

Nymphs develop through three successive molts before reaching adulthood. Each molt increases size and darkens coloration. Recognizing these characteristics enables early detection and effective treatment before the infestation progresses.

Adult Lice

Adult head lice are small, wingless insects measuring 2–4 mm in length. Their bodies are flattened laterally, allowing them to move easily through hair shafts. The exoskeleton is a dull gray‑brown color, often appearing slightly translucent when the insect is unfed. Six legs end in claw‑like tarsi that grasp hair strands tightly; each leg bears a pair of spines that aid in locomotion. Antennae are short, segmented, and typically hidden beneath the head.

Key visual cues for identifying mature lice on a child’s scalp include:

Size comparable to a sesame seed, larger than the oval eggs (nits) attached to hair shafts.
Body shape: elongated, broader at the abdomen, with a visible segmentation line.
Color: muted gray‑brown, sometimes appearing lighter after a blood meal.
Movement: rapid, erratic crawling across the scalp; occasional jumping when disturbed.
Presence of live, mobile insects rather than stationary, glued‑down eggs.

Observing these characteristics under good lighting enables accurate differentiation between adult parasites and their eggs, facilitating appropriate treatment decisions.

Identifying Lice on a Child's Head

Where to Look

Behind the Ears

Lice situated in the area behind a child’s ears are typically the same species as those found elsewhere on the scalp, but the region offers a sheltered environment that can make detection easier.

The insects are:

Length: 2–3 mm (about the size of a sesame seed).
Color: gray‑white to light brown; translucent when unfed.
Body shape: flattened, elongated, with six legs ending in claw‑like tarsi.
Antennae: short, barely visible without magnification.

Eggs (nits) attached to hair shafts near the scalp are:

Size: 0.8 mm, oval, and firmly glued.
Appearance: white or yellowish, resembling tiny specks of dandruff.
Placement: often found within ¼ inch of the skin, including the hair line behind the ears.

Live lice may be observed moving slowly, pausing to feed, or clinging to hair shafts. The skin behind the ears can appear irritated, with mild redness or a scratchy sensation caused by frequent biting.

Key indicators of infestation in this region:

Visible insects or nits on hair emerging from the ear border.
Persistent itching localized behind the ears.
Small red bumps or sores resulting from bites.

Prompt visual inspection of the hair and scalp area behind the ears, combined with a fine‑tooth comb, provides the most reliable method for confirming the presence of lice.

Near the Nape of the Neck

Lice that infest the hair near the nape of a child’s neck are typically gray‑brown, about the size of a sesame seed, and have a flattened, elongated body. Their six legs end in claw‑like tarsi that cling tightly to hair shafts, making them difficult to dislodge. Live insects move rapidly when the scalp is disturbed, often appearing as tiny, moving specks against the darker skin of the neck.

Body length: 2–3 mm; width: 1 mm.
Color: gray‑brown to tan; may appear lighter after feeding.
Legs: six, each ending in a curved claw for grip.
Antennae: short, visible only under magnification.
Nits: oval, 0.8 mm long, cemented to hair at a 45‑degree angle, usually found within 1 cm of the scalp.

Detection relies on close visual inspection of the hair at the base of the skull. Use a fine‑toothed comb on damp hair, pulling the hair taut to expose the area. Observe for live insects moving quickly or for immobile nits attached at an angle to the hair shaft. Prompt identification enables immediate treatment and prevents spread to other regions of the scalp.

On the Crown of the Head

Lice that infest a child’s scalp are most visible on the crown, where hair density is highest and the temperature is optimal for the insects. Adult head‑lice are about 2–3 mm long, flattened, and shaped like a tiny cigar. Their bodies are a pale gray‑brown, often appearing translucent when the head is illuminated. Legs are six in number, each ending in tiny claws that grasp hair shafts; movement is rapid, giving a “jumping” impression.

Nits (lice eggs) are firmly attached to the base of hair strands near the scalp. On the crown they appear as oval, whitish‑yellow or tan specks, typically 0.8 mm in length. The shells are smooth, with a pointed end that points toward the scalp and a broader end toward the hair tip. Nits are difficult to dislodge because the cement produced by the female louse creates a strong bond.

Typical visual cues on the crown include:

Small, mobile insects that can be seen crawling among hair fibers.
Tiny, elongated bodies that move quickly when the head is brushed or shaken.
White or yellowish ovoid shells attached close to the scalp, often in clusters.
Absence of visible blood after removal, distinguishing lice from other scalp parasites.

How to Spot Lice and Nits

Visual Inspection

Visual inspection of a child’s scalp provides the most direct evidence of an infestation. The adult parasite measures 2–4 mm, appears as a flattened, elongated body, and is typically tan to grayish‑brown. Its six legs end in claw‑like tarsi that grasp hair shafts. Lice are most often found near the hairline, behind the ears, and on the nape of the neck, where hair density is greatest.

Key visual cues include:

Live insects: tiny, mobile, dark‑colored bodies that move quickly when the hair is disturbed.
Nits: oval, white or yellowish eggs firmly attached to the base of a hair strand; they do not slide down the shaft.
Egg shells: after hatching, empty shells (nits) remain attached, appearing as translucent, slightly curved caps.
Scalp irritation: localized redness or small puncture marks where lice have fed.

A systematic scan should start at the forehead, progress to the temples, then the occipital region, using a fine‑toothed comb to separate hair and expose hidden parasites. The presence of any of the items listed above confirms an infestation and guides subsequent treatment decisions.

Combing for Lice

Lice on a child's scalp are tiny, wingless insects about the size of a sesame seed, measuring 2–4 mm in length. Their bodies are flat, oval, and gray‑brown, with six legs that end in sharp claws for gripping hair shafts. Adult females carry up to ten eggs (nits) attached firmly to the base of each strand, appearing as tiny, oval, white or yellowish shells that are difficult to see without close inspection.

Effective removal relies on a fine‑toothed lice comb applied to dry or slightly damp hair. The process involves:

Sectioning the hair into manageable portions.
Starting at the scalp, drawing the comb through each section in a slow, steady motion toward the ends.
Wiping the comb blade with a tissue after each pass to eliminate captured insects.
Repeating the combing every 2–3 days for two weeks to catch newly hatched lice before they mature.

Consistent combing reduces the population by physically extracting both live lice and nits, providing a non‑chemical method that works across all hair types. Regular inspection after each session confirms progress and prevents reinfestation.

Differentiating Lice from Other Conditions

Dandruff

Dandruff consists of small, white to grayish flakes that detach from the scalp and fall freely or cling loosely to hair shafts. The particles are lightweight, irregularly shaped, and lack any adhesive quality. In contrast, head‑lice eggs (nits) are oval, firmly attached to the hair shaft near the scalp, and remain in place until hatching.

Key differences between dandruff and lice eggs:

Size: dandruff flakes measure 0.5–2 mm; nits are 0.8 mm long.
Attachment: dandruff is not glued to hair; nits are cemented with a sticky substance.
Color: dandruff appears white or gray; nits are translucent to yellowish.
Location: dandruff distributes across scalp and shoulders; nits concentrate within ¼ inch of the scalp, often behind ears and at the nape.

Misidentifying dandruff as lice can lead to unnecessary treatment. Accurate visual assessment, supplemented by a fine-tooth comb, distinguishes the two conditions reliably.

Dry Skin Flakes

Lice on a child’s scalp are live insects measuring 2–3 mm in length, gray‑brown in color, and shaped like flattened ovals. They cling tightly to hair shafts, especially near the nape of the neck and behind the ears. Live lice move when the hair is brushed or when the child’s head is disturbed, and their bodies are translucent enough to reveal a pale abdomen under the exoskeleton.

Dry skin flakes are microscopic pieces of dead epidermis, typically 0.1–0.5 mm in size. They appear as white or off‑white, powdery particles that detach easily from the scalp. Flakes accumulate on the shoulders, clothing, or in hair, but they do not adhere firmly to individual hair strands.

Key differences for accurate identification:

Size: lice are several times larger than skin flakes.
Mobility: lice move actively; flakes remain stationary.
Attachment: lice grip hair shafts with claws; flakes slide off with gentle combing.
Shape: lice have a defined body outline; flakes are irregular and lack a defined structure.
Color: lice show a gray‑brown hue; flakes are uniformly white or pale.

When examining a child’s head, focus on these characteristics to avoid mistaking dry skin debris for an infestation. Proper identification prevents unnecessary treatment and directs attention to appropriate scalp care.

Hair Product Residue

Hair product residue consists of dried oils, gels, sprays, or conditioners that remain on the scalp after application. It appears as a thin, often translucent film, sometimes forming clumps that can be brushed out or left as a glossy sheen. Residue does not move independently and lacks the segmented body typical of insects.

Lice on a child’s scalp are small, wing‑less insects about the size of a sesame seed. Their bodies are oval, flattened, and gray‑brown, with six legs ending in claw‑like tarsi that cling to hair shafts. Live lice may crawl quickly; nits (eggs) are firmly attached to the hair close to the scalp and appear as tiny, oval, white or yellowish shells.

Key differences for visual inspection:

Mobility – Residue stays static; lice move when the hair is disturbed.
Shape – Residue forms irregular patches; lice have a defined, elongated body.
Attachment – Residue can be brushed away; nits remain affixed even after thorough combing.
Color – Residue is usually clear or tinted by the product; lice are typically brownish, nits are white to yellow.

Accurate identification requires a fine‑toothed comb, bright lighting, and close examination of each hair strand. Removing product buildup with a clarifying shampoo can reduce visual confusion, allowing clearer observation of any true lice infestation.

Common Symptoms and Signs

Itching and Irritation

Lice are tiny, wingless insects about 2–3 mm long, gray‑brown, with a flattened body and six clawed legs that cling tightly to hair shafts. Their eggs, called nits, appear as oval, yellow‑white shells cemented within ¼ inch of the scalp.

The bite injects saliva that triggers a localized allergic response. Itching begins within 24–48 hours, intensifies after repeated feeding, and may persist for days. Continuous scratching produces erythema, mild swelling, and can open pathways for bacterial infection.

Key indicators of lice‑related irritation:

Sudden onset of intense scalp pruritus, especially after school or group activities.
Small, red punctate lesions where bites occurred.
Presence of live lice moving quickly through hair.
Nits firmly attached to hair close to the scalp, difficult to remove without a fine‑toothed comb.

Differentiation from other scalp disorders relies on visual confirmation of insects and nits, coupled with the characteristic pattern of itching and localized redness. Prompt identification and targeted treatment reduce discomfort and prevent secondary complications.

Sores and Scratches

Lice infestations on a child’s scalp frequently produce skin lesions that result from repeated scratching. The primary manifestation is a cluster of tiny, erythematous papules where the insects have bitten. These papules often develop into shallow, linear excoriations as the child rubs the area with fingernails. In severe cases, the lesions may become crusted or ulcerated, especially if secondary bacterial infection occurs.

Typical lesions include:

Red, raised papules measuring 1–3 mm in diameter.
Linear or irregular scratches ranging from superficial abrasions to deeper fissures.
Crusted or oozing sores that form when the skin barrier is breached.

The itching sensation originates from the lice’s saliva, which contains irritants that trigger a localized inflammatory response. Persistent irritation promotes vigorous scratching, which transforms the initial papules into more pronounced wounds. Over time, the repeated trauma can lead to hyperpigmentation or scarring, particularly in children with sensitive skin.

Clinicians differentiate these findings from other scalp conditions by noting the distribution pattern—lesions concentrate around the hairline, nape, and behind the ears, matching the typical habitat of head‑lice. The presence of live insects or nits in the hair confirms the etiology. Absence of systemic symptoms such as fever or widespread rash helps rule out viral exanthems or allergic reactions.

Parents should inspect the scalp for the described lesions and for live lice or nits. Prompt removal of the parasites, combined with topical anti‑lice treatment, reduces scratching and prevents further skin damage. If sores become painful, exhibit pus, or fail to improve within 48 hours, medical evaluation is warranted to address possible secondary infection.

Difficulty Sleeping

Lice and their eggs appear as tiny, gray‑white insects about the size of a sesame seed, clinging to hair shafts close to the scalp. Nits are oval, firmly attached to strands, often visible as small, translucent specks near the hair roots. The insects move quickly, their bodies darkening to brown after feeding.

The presence of these parasites disrupts a child’s sleep in several direct ways:

Persistent scalp itching forces frequent scratching, which awakens the child repeatedly throughout the night.
Irritation of the skin creates a sensation of crawling that heightens alertness, preventing the onset of deep sleep.
Anxiety about infestation can cause mental agitation, leading to difficulty falling asleep and frequent awakenings.
Discomfort from secondary infections or inflammation intensifies pain, further fragmenting sleep cycles.

Effective management of the infestation eliminates the physical and psychological triggers, allowing the child to return to uninterrupted rest.

Next Steps After Identification

Confirmation by a Professional

A trained healthcare provider confirms an infestation by examining the scalp with a fine‑tooth lice comb and, when necessary, a magnifying loupe. The professional looks for live insects that are approximately 2–3 mm long, oval, and tan to grayish in color. Six short legs are visible on each side of the body, and the insects move slowly when disturbed.

Additionally, the expert checks for nits—tiny, oval, white or yellowish eggs firmly attached to the hair shaft within ¼ inch of the scalp. Nits are often mistaken for dandruff, but their cemented position and the presence of a curved, brown operculum distinguish them.

A definitive diagnosis results when both live lice and viable nits are observed in the same area of the hair. Absence of movement or only detached nits without accompanying insects leads the professional to rule out an active infestation.

Treatment Options

Treatment of head lice in children involves chemical, mechanical, and environmental strategies. Over‑the‑counter pediculicides containing permethrin (1 %) or pyrethrin with piperonyl butoxide are applied to dry hair, left for the recommended time, then rinsed. Resistance to these agents can occur; in such cases, a prescription medication such as ivermectin (topical 0.5 % lotion) or malathion (0.5 % solution) offers an alternative. Both require a second application 7–10 days after the first to eliminate newly hatched nits.

Manual removal eliminates live insects and eggs without chemicals. A fine‑toothed nit comb is used on wet, conditioned hair; sections are combed from scalp to tip, rinsing the comb after each pass. Repeating the process every 2–3 days for two weeks ensures complete eradication.

Environmental control reduces reinfestation risk. Items that contact the scalp—hats, hair accessories, pillowcases, and towels—should be washed in hot water (≥ 130 °F) and dried on high heat. Non‑washable objects can be sealed in a plastic bag for two weeks. Vacuuming carpets and upholstered furniture removes stray lice and nits.

Combination therapy—chemical treatment followed by thorough combing and environmental cleaning—produces the highest success rate. Monitoring the child’s scalp twice weekly for four weeks confirms elimination and prevents recurrence.