What should you do if children are found to have lice?

Understanding Head Lice

What are Head Lice?

Head lice (Pediculus humanus capitis) are tiny, wing‑less insects that live on the scalp and feed on human blood. Adults measure 2–4 mm, are tan‑brown, and have six legs with clawed tarsi that cling to hair shafts. Nymphs resemble adults but are smaller and develop through three molts before reaching maturity. The life cycle lasts about 20–30 days: an egg (nit) is attached to the base of a hair strand, hatches in 7–10 days, and the emerging nymph matures within another 9–12 days.

Transmission occurs primarily through direct head‑to‑head contact; sharing hats, brushes, or pillows can also spread infestations. Lice cannot jump or fly, limiting spread to close personal interaction. Infested individuals often experience itching caused by allergic reactions to saliva, and may notice live insects or translucent nits near the scalp.

Key identification points:

Live insects moving quickly on the scalp or hair.
Nits firmly attached to hair shafts, within 1 cm of the scalp, resistant to removal.
Scalp irritation, redness, or secondary infection from scratching.

Understanding these characteristics enables prompt detection and informs subsequent treatment measures for affected children.

How to Identify Lice and Nits

Common Symptoms

Recognizing the signs of a lice infestation in a child is a prerequisite for effective intervention. Early identification prevents spread and guides appropriate treatment measures.

Small, white or yellowish eggs (nits) attached firmly to hair shafts, usually near the scalp
Live insects, about the size of a sesame seed, moving quickly through hair
Persistent itching on the scalp, neck, or ears, often worsening in the evening
Red or irritated spots on the scalp caused by scratching
Occasional sore spots or minor sores where lice have bitten

These indicators appear within days of contact with an infested individual and warrant prompt action to eliminate the parasites and limit transmission.

Visual Inspection Tips

When a child shows signs of infestation, the first reliable method of confirmation is a careful visual examination of the scalp and hair. Direct observation distinguishes live insects, eggs, or nits from debris and allows immediate decision‑making.

Use a fine‑toothed comb on wet, conditioned hair; the lubricant reduces tangles and improves visibility.
Examine the hair close to the scalp, especially behind the ears, at the nape of the neck, and along the crown, where lice prefer to lay eggs.
Look for nits attached at a 45‑degree angle to the hair shaft; a firmly glued nit will not slide easily when pulled.
Identify live lice by their grayish‑brown, elongated bodies, which move quickly when disturbed.
Employ a bright, preferably natural light source; a magnifying glass can reveal minute details.
Conduct the inspection on a clean, flat surface, such as a table covered with a white sheet, to catch falling insects.
Repeat the process on both sides of the head and on all family members, as infestation often spreads quickly.

A systematic visual check, performed with appropriate tools and lighting, provides definitive evidence and guides subsequent treatment steps.

Immediate Actions and Treatment

Notifying Others

School Policies

When a student is identified with head lice, the school must activate a predefined response to protect the health of the community and maintain uninterrupted learning. The policy should be documented, regularly reviewed, and communicated to all stakeholders.

Immediate isolation of the affected student from classroom activities until treatment is confirmed.
Notification of the child’s parents or guardians, including clear instructions for treatment and re‑entry criteria.
Mandatory reporting to the school nurse or health coordinator, who records the case and monitors follow‑up.
Provision of informational material on proper lice detection, treatment options, and preventive measures.
Coordination with local health authorities if multiple cases emerge, triggering a broader screening or intervention.

Implementation requires staff training on identification techniques, confidential handling of records, and consistent enforcement of re‑entry standards (e.g., verification of successful treatment after 24 hours). The school’s attendance policy should accommodate missed days for treatment without penalizing the student.

Communication channels—email bulletins, posted notices, and parent‑teacher meetings—must convey the policy’s requirements and timelines. Compliance is verified through periodic audits of case logs and by confirming that all affected families receive and acknowledge the stipulated guidelines.

Family and Close Contacts

When a child is diagnosed with head lice, immediate attention must extend to everyone who shares close proximity or personal items. Begin by examining each household member, including siblings, parents, and caregivers, for live insects or viable nits. Treat any positive cases with an approved pediculicide, following the product’s instructions for dosage and repeat application if required. Simultaneously, remove all combable nits from hair using a fine-toothed lice comb, working from the scalp outward.

Implement thorough sanitation of shared objects and environments. Recommended actions include:

Washing clothing, bedding, and towels used within the previous 48 hours in hot water (≥130 °F) and drying on high heat.
Sealing non‑washable items in a sealed plastic bag for two weeks to starve remaining lice.
Cleaning hairbrushes, combs, and hats with hot, soapy water.
Disinfecting upholstered furniture and car seats with a suitable insecticidal spray.

Inform schools, daycare centers, or other group settings about the infestation so they can conduct screenings and advise on preventive measures. Encourage all contacts to avoid head-to-head contact and refrain from sharing personal accessories until treatment is complete and re‑inspection confirms eradication.

Choosing a Treatment Method

Over-the-Counter Products

Over‑the‑counter treatments are the first line of defense when a child is diagnosed with head lice. These products are available without a prescription and are formulated to eliminate live insects and their eggs.

Common categories include:

Shampoos and rinses – contain permethrin (1 %) or pyrethrin combined with piperonyl butoxide. Apply to wet hair, lather, leave for the recommended time (usually 10 minutes), then rinse thoroughly.
Lotions or creams – formulated with dimethicone (4 %). Apply to dry hair, massage into the scalp, leave for the specified duration (often 8 hours), then wash out.
Sprays and powders – use pyrethrins or essential‑oil blends. Spray onto dry hair and comb through; powders are dusted onto the scalp and brushed out after a set period.
Nit combs – metal or fine‑tooth plastic combs used after chemical treatment to remove nits. Comb from scalp to ends in sections, cleaning the comb after each pass.

Effective use requires strict adherence to label directions: correct dosage, precise exposure time, and a second application 7–10 days later to target newly hatched lice. For children under the age specified on the packaging, choose products with dimethicone, which poses minimal risk of skin irritation.

Safety considerations include:

Checking for allergic reactions before full application; test a small area of skin 24 hours in advance.
Avoiding use on broken or inflamed scalp.
Keeping treated hair away from eyes and mouth.
Storing products out of reach of younger children.

After chemical treatment, wash bedding, hats, scarves, and personal items in hot water (≥ 130 °F) or seal them in a plastic bag for two weeks to prevent re‑infestation. Regularly inspect the child’s hair for live lice or remaining nits, using a nit comb at least twice weekly until no evidence remains.

Prescription Medications

When a child is identified as having head lice, prescription‐only treatments become necessary if over‑the‑counter options have failed or are unsuitable. These medications are formulated to eradicate both live insects and their newly hatched nits, reducing the risk of reinfestation.

Prescription options include:

Malathion 0.5 % lotion – applied to dry hair, left for 8–12 hours, then rinsed. Repeat after 7 days. Contraindicated in children under 6 years. Common adverse effects: scalp irritation, itching.
Benzyl alcohol 5 % lotion – applied to dry hair, left for 10 minutes, then washed off. A second application is required 7 days later. Not recommended for infants younger than 2 months. Side effects may include mild burning or redness.
Ivermectin 200 µg/kg oral dose – single dose for children weighing at least 15 kg. A second dose may be administered after 7 days if live lice persist. Contraindicated in patients with a history of severe reactions to ivermectin. Possible adverse events: nausea, dizziness, mild rash.
Spinosad 0.9 % lotion – applied to dry hair, left for 10 minutes, then rinsed. A repeat treatment after 7 days is advised. Not approved for children under 12 months. Reported side effects include scalp irritation and transient hair loss.

Key administration points:

Verify the child’s weight and age to select an appropriate agent.
Follow the exact contact time; insufficient exposure reduces efficacy.
Wash bedding, clothing, and personal items in hot water or seal them in plastic bags for two weeks.
Conduct a thorough combing with a fine‑toothed nit comb after treatment to remove residual nits.
Monitor for adverse reactions; discontinue use and seek medical advice if severe irritation or systemic symptoms develop.

Prescription medications provide a higher likelihood of complete eradication when applied correctly, complementing environmental decontamination measures.

Natural Remedies

When a child is diagnosed with lice, natural treatments can complement or replace conventional options. Effective plant‑based agents target the insect’s nervous system, disrupt its ability to cling to hair, or suffocate it. Use only pure, undiluted products or follow manufacturer dilution guidelines to avoid scalp irritation.

Tea tree oil: Mix 10–15 drops with a carrier oil (e.g., coconut) and apply to the scalp. Leave for 30 minutes, then comb out nits with a fine‑toothed lice comb. Repeat every 48 hours for three sessions.
Neem oil: Combine 2 tablespoons with 2 cups of warm water, soak hair for 20 minutes, then rinse. Neem’s insecticidal compounds reduce hatchability of eggs. Apply twice a week for two weeks.
Apple cider vinegar: Dilute 1:1 with water, saturate hair, and cover with a shower cap for 15 minutes. The acidic environment loosens the glue that secures nits, facilitating removal with a comb. Perform daily until no live lice are detected.
Mayonnaise: Coat hair thoroughly, cover with a plastic cap, and leave for 2 hours. The oily medium suffocates lice and eases combing. Rinse and comb out nits immediately afterward. Use once, then repeat after 7 days.
Sea salt solution: Dissolve 1 cup of sea salt in 2 liters of warm water, rinse hair, and towel‑dry. Salt dehydrates lice, causing rapid mortality. Apply twice weekly for ten days.

Safety considerations include patch‑testing each remedy on a small skin area before full application, avoiding use on broken skin or allergic individuals, and supervising children to prevent ingestion. After treatment, wash all bedding, clothing, and personal items in hot water (≥ 130 °F) and vacuum upholstery to eliminate residual eggs.

Combining any of the above with regular mechanical removal—using a fine lice comb at least twice daily—provides the most reliable eradication. If infestation persists after two weeks of consistent natural therapy, consult a healthcare professional for alternative interventions.

Step-by-Step Treatment Application

Preparing for Treatment

When an infestation is identified, immediate preparation determines the effectiveness of any remedial measure.

Verify the presence of live nits or adult insects using a fine‑tooth comb on damp hair.
Select a treatment product that is approved for the child’s age group; read the label for dosage, application time, and safety warnings.
Gather necessary items: the chosen medication, a wide‑tooth comb, disposable gloves, a timer, and a clean towel.
Separate the affected child’s personal belongings—clothing, bedding, hats, scarves—from other family members.
Wash contaminated fabrics in hot water (minimum 130 °F/54 °C) and dry on high heat; seal items that cannot be laundered in a sealed plastic bag for two weeks.
Trim hair to a manageable length if it is excessively long; this facilitates combing and reduces treatment time.

After treatment, repeat the combing process every 2–3 days for two weeks to remove newly hatched lice. Maintain clean environments by vacuuming carpets and upholstered furniture, and discourage head‑to‑head contact during the monitoring period.

Applying the Product

When lice are detected, immediate treatment with an approved pediculicide is essential. Follow the product’s instructions precisely to achieve maximum efficacy and minimize re‑infestation.

Begin by washing the child’s hair with a mild shampoo, then apply the lice‑killing solution according to the label dosage. Distribute the liquid evenly from scalp to hair tips, ensuring coverage of all strands and the nape of the neck. Allow the product to remain on the hair for the specified duration—typically 10 to 15 minutes—without rinsing prematurely.

After the exposure time, rinse thoroughly with warm water. Use a fine‑toothed comb to remove dead lice and nits; comb in sections, starting at the scalp and moving outward. Repeat the combing process at least twice, each session spaced a few minutes apart, to capture any residual eggs.

A second application is often required 7 to 10 days later to eradicate newly hatched lice that survived the first treatment. Schedule this follow‑up dose exactly as directed, and avoid using additional products unless recommended by a healthcare professional.

Throughout the treatment period, wash all bedding, clothing, and personal items in hot water (minimum 130 °F/54 °C) or seal them in plastic bags for two weeks. Vacuum carpets and upholstered furniture to eliminate stray hairs that may harbor eggs.

Adhering to these steps ensures thorough elimination of lice while reducing the risk of recurrence.

Removing Nits

When a child is diagnosed with head‑lice, the immediate priority is to eliminate the viable eggs (nits) that cling to hair shafts. Nits survive longer than adult insects, so thorough removal prevents reinfestation.

Use a fine‑toothed nit comb, preferably stainless steel, to separate each egg from the strand.
Apply a lice‑approved conditioner or a small amount of mineral oil to the scalp; this loosens the cement that secures nits.
Starting at the scalp, comb a few centimeters of hair at a time, moving the comb from root to tip in a steady motion.
After each pass, wipe the comb on a white tissue to verify captured nits; discard any that remain attached.
Rinse the hair, repeat the combing process at least three times over a 24‑hour interval, then again after seven days to catch any newly hatched lice.

Perform the procedure on dry hair for optimal grip. Conduct the session in a well‑lit area and use a mirror or a second person to ensure no section is overlooked. Clean the comb with hot, soapy water after each use to avoid cross‑contamination.

Maintain the results by washing bedding, hats, and personal items in hot water, and by vacuuming upholstered furniture. Regular checks—once every two to three days for two weeks—confirm that no nits persist.

Post-Treatment and Prevention

Follow-Up Care

Re-treatment Schedule

When a child’s infestation is confirmed, the first application of a pediculicide should be followed by a planned repeat to eliminate newly hatched nits that survived the initial dose. The repeat must occur before the hatching cycle completes, ensuring that any surviving eggs are exposed to the insecticide.

Day 0: Apply the recommended product according to label directions; comb out visible lice and nits immediately after treatment.
Day 7–10: Re‑apply the same product; repeat thorough combing to remove any remaining nits.
Day 14 (optional): If live lice are still detected after the second application, perform a third treatment and continue daily combing for three days.
Day 21: Conduct a final inspection; if no live lice are found, consider the infestation resolved.

During the entire period, wash bedding, hats, and clothing in hot water or seal them in plastic bags for at least 48 hours. Maintain regular head‑checking routines for at least four weeks after the last application.

Continued Monitoring

After the first treatment, observe the child’s hair and scalp regularly to verify that the infestation has been eliminated and to catch any new activity early.

Day 7: Examine the entire scalp, parting hair in sections no wider than one inch. Look for live insects and for eggs attached within a quarter‑inch of the scalp.
Day 14: Repeat the thorough inspection. Confirm that previously detected nits have either hatched and been removed or fallen off.
Day 30: Perform a final check before ending the monitoring period.

During each inspection, note any of the following indicators: live lice, moving nymphs, fresh nits positioned close to the scalp, persistent scratching, or reports of itching that began after treatment.

If any indicator appears, initiate a second round of treatment immediately, inform the child’s school or childcare provider, and resume the monitoring schedule without delay.

Maintain a simple log that records the date of each check, findings, and any actions taken. Share the log with parents and school personnel to ensure coordinated response and to reduce the risk of re‑infestation.

Cleaning the Environment

Laundry Procedures

When a child is diagnosed with lice, all personal textiles must be treated to prevent re‑infestation. Follow a strict laundering protocol:

Separate contaminated items (clothing, pajamas, hats, socks, towels, bedding) from unaffected laundry.
Wash each item in hot water, minimum 130 °F (54 °C). Use a regular detergent; add a cup of white vinegar or a mild disinfectant if desired.
Dry on high heat for at least 20 minutes. Heat kills lice and nits that survive washing.
For items that cannot withstand high temperatures, place them in a sealed plastic bag for two weeks. The life cycle of lice does not exceed 48 hours, and prolonged isolation eliminates viable specimens.
Clean all washing machine components: run an empty cycle with hot water and bleach or a commercial disinfectant to remove any stray nits.
Vacuum floors, carpets, and upholstered furniture after laundering to capture any dislodged insects.

Repeat the washing cycle after seven days to address any eggs that may have hatched after the first treatment. Store cleaned textiles in a clean, sealed container until the child returns to school or daycare. This systematic approach removes live lice, destroys eggs, and reduces the risk of recurrence.

Cleaning Combs and Brushes

When a child is diagnosed with lice, the hair‑care tools used during treatment must be decontaminated to prevent re‑infestation.

Remove hair from combs, brushes, and detachable parts.
Soak items in hot water (minimum 130 °F / 54 °C) for at least 10 minutes.
Add a disinfectant such as a few drops of tea‑tree oil or a diluted bleach solution (1 part bleach to 9 parts water).
Rinse thoroughly and allow to air‑dry on a clean surface.
For plastic or metal tools that cannot tolerate heat, place them in a sealed bag with a lice‑killing spray, leave for the manufacturer‑recommended time, then wash with soap and water.

If any tool shows signs of wear, breakage, or persistent odor after cleaning, discard it and replace with a new, sterilized item.

Store cleaned combs and brushes in a sealed container until the treatment course is complete, then keep them in a dry, dust‑free environment.

Regularly repeat the cleaning process after each use throughout the treatment period to maintain a lice‑free environment.

Managing Stuffed Animals and Furniture

When a lice infestation is identified in children, eliminating the source extends beyond hair treatment. Items that remain in close contact with the scalp, such as plush toys and upholstered furniture, can harbor viable eggs and must be addressed immediately.

Place all stuffed animals in a sealed plastic bag for at least 48 hours; the lack of a suitable environment will cause any lice or nits to die.
For washable toys, run a hot‑water cycle (minimum 130 °F/54 °C) and dry on high heat for 30 minutes.
Non‑washable plush items should be sealed in a freezer for 24 hours, then vacuum thoroughly before returning to use.

Furniture that children sit on or lean against requires systematic cleaning:

Vacuum sofas, chairs, and cushions using a brush attachment; discard the vacuum bag or clean the canister afterward.
Steam‑clean upholstered surfaces with a temperature exceeding 160 °F (71 °C) to destroy eggs embedded in fibers.
Wipe hard‑surface furniture with a solution containing 0.5% permethrin or a comparable pediculicide, following manufacturer instructions for safety.

After treatment, maintain a schedule of weekly inspections of both toys and furniture for at least one month. Replace any items that cannot be adequately sanitized. Prompt, thorough sanitation of these environments reduces the likelihood of re‑infestation and supports effective eradication of head‑lice outbreaks.

Preventing Re-infestation

Regular Checks

Regular visual inspections are the first line of defense against head‑lice outbreaks. By examining children’s hair at consistent intervals, caregivers can detect infestations early, limit spread, and reduce the need for extensive treatment.

Inspections should occur at least once a week during the peak season and after any known exposure. Use a fine‑toothed lice comb on damp hair, starting at the scalp and working toward the ends. Separate sections of hair with clips to ensure full coverage.

Part the hair into 1‑inch sections.
Apply a conditioner or water to reduce tangles.
Run the comb from the scalp outward, wiping the teeth after each pass.
Examine the comb for live insects, viable eggs (nits), or empty shells.
Record the date, findings, and any children who show signs.

If live lice or viable nits are found, isolate the affected child, notify the school or childcare facility, and begin an approved treatment regimen. Continue weekly checks for the next three weeks to confirm eradication. Maintain a simple log to track results and to provide evidence for any required reporting.

Avoiding Head-to-Head Contact

When a child is identified with lice, preventing further spread begins with limiting direct head contact. Lice move only by crawling, so eliminating opportunities for heads to touch each other removes the primary transmission route.

Practical measures include:

Encourage children to keep hair away from other children’s heads during play, especially in close‑contact activities such as wrestling, hugging, or sharing helmets.
Supervise group activities that involve close proximity, and modify games that require head‑to‑head contact.
Provide individual personal items—hats, scarves, hair accessories—to avoid sharing.
Teach children to avoid resting their heads on shared surfaces like couches or pillows without a protective barrier.

Consistent enforcement of these habits, combined with appropriate treatment, reduces the risk of re‑infestation and limits lice propagation within the group.

Hair Care Strategies

When lice are detected in a child, the first priority is to treat the scalp and hair promptly. Use an FDA‑approved pediculicide shampoo according to the label, allowing the recommended contact time before rinsing. Follow with a thorough rinse to remove all residue.

After chemical treatment, remove live insects and nits mechanically. A fine‑toothed nit comb should be drawn through the hair in sections, starting at the scalp and moving toward the ends. Repeat combing at least every 12 hours for a full week to catch newly hatched nits.

Maintain a clean environment to support hair care efforts. Wash the child’s bedding, clothing, and personal items in hot water (≥ 130 °F) and dry on high heat. Seal untouched items in sealed plastic bags for two weeks to starve any remaining lice.

Implement ongoing monitoring to prevent reinfestation. Perform a visual inspection of the scalp twice weekly for three weeks following treatment. Encourage regular hair washing with a mild, non‑medicated shampoo to keep the scalp healthy without compromising the effectiveness of the pediculicide.

Key hair‑care actions

Apply medicated shampoo as directed; do not exceed recommended frequency.
Comb hair with a nit comb after each wash; clean the comb after every pass.
Launder all personal textiles in hot water; dry on high heat.
Store unused items in sealed bags for 14 days.
Conduct systematic scalp checks for three weeks post‑treatment.