How to Spot and Treat Head Lice in Kids

Here's our panic-free guide to spotting and treating head lice, plus lice remedies and combs we recommend.
By Holly Pevzner



How to Spot and Treat Head Lice in Kids

Forget sniffles and coughs; never mind pinkeye. The thing parents really fear their kids catching from classmates? Lice. (Cue the head-scratching!) “I was horrified when my daughter had them,” admits Hannah Chow-Johnson, M.D., assistant professor of pediatrics at Loyola University Chicago Stritch School of Medicine, who suspects her first-grader picked them up at school. That’s no surprise to Richard J. Pollack, Ph.D., an instructor at Harvard School of Public Health. “Whenever there’s close contact between kids, lice spread,” he says. Fortunately, they’re not dangerous, but really, who cares? No one wants insects living off her child. Lucky for you, we’ve got a step-by-step plan that will help you keep or (shudder!) get your kid lice-free. 

Meet the Enemy

Lice (Pediculus capitis) are sesame seed–sized six-legged parasitic insects that reside on the scalp of humans. They get their nutrients by feeding off the blood of their host. (Lovely.) While lice can cause itching, skin infection, and aggravation, they are benign creatures that transmit zero diseases. “Of all the infections or infestations that a kid might catch, head lice are the most trivial,” assures Pollack.

If you get the dreaded letter that says someone in the class has bugs — and especially if your kid is itching — it’s time to go on pest patrol. Here’s what to do:

1.  Know what to look for 

Check out the images below of the live bugs, the nits (eggs), and the casings (hatched eggs). You should be most concerned about actual live lice or eggs that are fat, shiny, and tan. Hatched eggs are clear or white and appear shrunken (no need to treat these alone).

Here's what the little buggers look like up close as babies and adults:

This is a "hatched" nit casing:

This is an example of a live, viable nit:

2. Get the right tools

Grab a magnifying glass and buy yourself a lice comb. These bugs are just 2 to 3 mm long, making them hard to spot and even harder to remove. Special lice combs have thin, tightly spaced metal teeth that can collect and crush nits. “It’s a more efficient way to diagnose than simply looking,” says Barbara L. Frankowski, M.D., co-author of the American Academy of Pediatrics 2010 report on head lice. One to try: RIDvantage Lice Comb ($7; drugstores).

3. Wet your kid’s hair

Damp hair slows lice down, making them easier to spot. You’ll want to keep a close eye on the roots: Lice lay eggs close to the scalp to keep them warm. 

Here's how to properly comb through your child's hair to spot lice:

4. Start your search

Separate out a small section, and slowly comb through from the roots outward. Make sure the comb’s teeth come in close contact with the scalp, since most lice are found within a half-inch of the head. Inspect the comb for any lice, nits, or casings. If you find any, rinse the comb and keep going. After finishing a section, pin hair to the side and repeat. This technique can accurately ID the buggers 90 percent of the time, according to a report in the Archives of Dermatology. If no bugs are found, repeat a week later. 

Fast Fact:

Lice are more active at night. If Junior is suddenly having a hard time sleeping, ask him some “Are you itchy?” questions and do a head check.

How to Get Rid of ’Em

So you’ve found live lice and/or fat, shiny, unhatched eggs. It’s time to choose a treatment. We’ve got four options below. (Remember, if you spot only shrunken hatched eggs, which are clear or white, treatment isn’t necessary.)

OTC Insecticides: Look for treatments containing pyrethrins or permethrin. Says Pollack, “These OTC insecticides are inexpensive, effective, and unlikely to cause harm.” Find them at your local pharmacy. Don’t use conditioning products before treatment, since they can prevent meds from adhering. Repeat treatment in 7 to 14 days if more lice are found. Still there after a second treatment? Contact your child’s ediatrician. A prescription-strength medicine may be required.

Cetaphil: Coat your child’s hair with Cetaphil and comb it through. Then blow-dry her hair until the cleanser hardens. Shampoo it out eight hours later (or let it sit overnight). “This makes it hard for adult lice to breathe, so they die of suffocation,” says Dr. Frankowski. A recent study found this method to be 95 percent successful at removing lice when it was repeated once a week for three weeks. Continue to wet-comb hair daily for about two weeks. 

Chem-Free: LiceMD Pesticide Free is an effective nontoxic, natural product, says Lawrence D. Rosen, M.D., co-author of Treatment Alternatives for Children. The active ingredient makes removing nits easier and more effective. Plus, it’s odorless.

Rx Treatment: Try these meds if lice persist after two OTC treatments, says Pollack. There are several available, and all are effective, but they’re not always covered. Check your insurance plan to see what your options are before your doc appointment. 

Should You Call a Pro?

You can hire someone to do just about anything these days — even to remove every egg from your child’s head! But if you’re already treating the infestation, nit picking is a waste of time. “Nits are firmly attached to the hair shaft. They don’t transfer from one head to another,” says Dr. Frankowski. “Even if a louse hatched, it takes 7 to 10 days — and a louse of the opposite sex — to start another infestation.” Some schools do have a no-nit policy, in which case a little patience and a lot of combing will work fine.

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